胸部急症CT诊断ppt课件

1、胸部急症CT胜利油田中心医院CT检查科 宋殿行2021-10-09大致分类胸外伤自发性气胸支气管异物心包填塞自动脉瘤(非急症)自动脉夹层2021-10-09胸外伤缘由：车祸、摔伤、火器伤、刀刺伤阳性征象：胸廓骨折肺挫裂伤，肺挫伤肺裂伤肺内血肿肺气囊胸腔积液、气胸、纵隔气肿，颈胸部皮下及肌间气肿心脏、大血管损伤膈肌损伤2021-10-09男，30岁，肺挫裂伤外伤性肺大泡2021-10-09女，55岁，外伤后就诊，左肺挫裂伤，左侧气胸2021-10-09同一病例，左侧多发肋骨骨折2021-10-09同一病例，VR图像直观显示骨折部位、移位情况2021-10-09男，43岁，外伤就诊，矢状位图像示胸

2、骨骨折、纵隔气肿，脊柱多发骨折2021-10-09膈破裂男，55岁，颅脑、胸腹外伤就诊2021-10-092021-10-09左侧多发肋骨骨折2021-10-09心脏破裂男，43岁，剪刀刺伤左胸部3小时就诊，神志不清2021-10-092021-10-092021-10-09自发性气胸男，27岁，突发胸痛就诊，肺尖见有多发肺大泡2021-10-09纵隔气肿男，24岁，胸部不适就诊，无外伤2021-10-09支气管异物男，33岁，颅脑术后智障，误吸花生米呛咳2021-10-092021-10-09动脉瘤定义：自动脉扩张1.5倍正常管径 升自动脉5cm，自动脉弓、胸自动脉4cm，远侧腹自动脉3cm

3、缘由：变性外伤感染分类：真性假性2021-10-09丈量血管真正断面2021-10-09真性动脉瘤Wall of artery forms the aneurysmAt least one vessel layer still intactFusiformCircumferential, relatively uniform in shapeSaccularPouchlike with narrow neck connecting bulge to one side of arterial wall梭形囊状2021-10-09假性动脉瘤Also called pseudoaneurysmNot

4、 an aneurysmDisruption of all layers of arterial wall Results in bleeding contained by surrounding structuresPseudoaneurysm: an outpouching of a blood vessel, involving a defect in the two innermost layers (the tunica intima and media) with continuity of the outermost layer, the adventitia. Alternat

5、ively, all three layers are damaged and bleeding outside of the vessel is contained by a clot or by surrounding tissue2021-10-09病理真性：动脉壁各层完好，但被延伸假性：动脉壁各层被穿透，瘤壁为纤维组织2021-10-09影像诊断要点：局限性或弥漫型扩张外形与病因关系：梭形动脉瘤多继发于变性与年龄要素相关局限并偏心性，多提示感染后、外伤后来源常规需丈量自动脉瘤的外径2021-10-09提供信息瘤体直径及累及范围与自动脉主要分支的关系血管腔内血栓的情况能否存在泄露、破裂出

6、现的周围渗出性改动能否存在周围脂肪的炎性改动2021-10-09动脉瘤泄露、破裂征象细微：动脉瘤附近的模糊区域或对比剂局限性聚集动脉瘤与脊柱之间明显：血肿临近或围绕动脉瘤纵隔或腹膜后腔的血肿胸腹腔积血2021-10-09Imaging of the acute abdomen,2003,11562021-10-09Imaging of the acute abdomen,2003,11572021-10-092021-10-092021-10-09男，57岁发作性心慌、胸闷2月余术前CT上组图示升自动脉瘤样扩张，自动脉瓣增厚术后CT下组图示升自动脉部分人工血管置换，自动脉瓣置换。2021-10

7、-09男，43岁。突发胸背痛7天。自动脉弓降部真性动脉瘤构成。2021-10-09男，34岁。活动后胸背部疼痛7天。CT示自动脉弓降部假性动脉瘤构成。2021-10-09胸自动脉瘤男，76岁，以纵隔占位就诊2021-10-092021-10-092021-10-09胸自动脉瘤男，69岁2021-10-092021-10-092021-10-09男，40岁，自动脉瓣置换病史2021-10-092021-10-09男，22岁2021-10-092021-10-092021-10-09自动脉夹层自动脉夹层指自动脉腔内的血液经过内膜的破口进入自动脉壁中层而构成的壁内血肿，并非自动脉壁的扩张2021-1

8、0-09危险要素Common predisposing factors in the International Registry of Aortic Dissection (IRAD) were hypertension in 72% of cases, followed by atherosclerosis in 31% and previous cardiac surgery in 18% 国际自动脉夹层官方记录IRAD显示，最常见的危险要素为高血压，占病例的72；其次为动脉粥样硬化，占31；心脏手术史，占18 Analysis of the young patients with di

9、ssection (,40 years of age) revealed that younger patients were less likely to have a history of hypertension (34%) or atherosclerosis (1%), but were more likely to have Marfan syndrome, bicuspid aortic valve, and/or prior aortic surgery 针对年轻患者的分析显示年轻患者40岁较少有高血压病史占34及动脉粥样硬化史1，而马凡氏综合征史、自动脉瓣双瓣畸形和或自动脉手

10、术史能够性更大2021-10-09分型DeBakeyStanford2021-10-09胸自动脉解剖Anatomy of the thoracic aorta and significant landmarks. The ascending aorta extends from the aortic valve to the origin of the innominate artery. Its proximal portion, in relation to the aortic valve and sinuses of Valsalva, is termed the aortic roo

11、t. The aortic arch begins at the innominate artery and ends at the ligamentum arteriosum. Its most distal part, which is often slightly narrowed, is termed the aortic isthmus. The descending aorta begins at the ligamentum. Its proximal portion may appear slightly dilated and has been termed the aortic spindle.2021-10-09男，30岁，突发猛烈胸痛就诊自动脉边缘粗糙2021-10-09DeBakey 型，伴左肾梗死2021-10-092021-10-09男，28岁，突发猛烈胸痛就诊2021-10-09心电门控扫描，DeBakey 型，累及右侧冠状动脉起始部2021-10-09斜矢状图像2021-10-09VR图明晰显示假腔范围，并发峡部囊状动脉瘤2021-10-09女，49岁，降自动脉支架置入病史2021-10-09Debakey 型2021-10-09Debakey 型，左肾动脉来源于假腔2021-10-09鉴别升自动脉搏动