医学mediastinummodadam的学习资料

医学mediastinummodadam的学习资料第1页/共70页MediastinumBoundedlaterallybyparietalpleuraofeachlungSuperiormarginisthoracicinletDefinedbyplaneof1stribsInferiormarginisdiaphragmTissueplanesextendsuperiorlyintoneckaroundgreatvessels,tracheaandesophagusConnectstoabdominalcavityviaesophageal,cavalandaortichiatusesConnectstolungsalonghilarvesselsandbronchi第2页/共70页MediastinumRadiologicanatomyCXRCTNormalornot?Compartmentsandtheirpathologies:AnteriorMiddlePosterior第3页/共70页RadiologicAnatomyLandmarkstolookforonthechestradiograph:TracheaParatrachealstripeDescendingaorticcontourAzygo-esophagealcontour第4页/共70页Pneumomediastinumwithcervicalemphysema第5页/共70页TrachealaircolumnShouldbestraightSlightbendtorightduetoaorticarchonitsleft.第6页/共70页Tracheadeviatestotheleft第7页/共70页RightAorticArch第8页/共70页RightparatrachealstripeExtendsfromthoracicinlettoazygosveinWidensoutatazygosveinNomorethan3-4mmthick第9页/共70页SarcoidOldfilm第10页/共70页Aorticcontour第11页/共70页Azygo-esophagealrecess第12页/共70页Aorticcontourandazygo-esophagealrecessabnormal第13页/共70页Normalanatomy:

CT/CXRcorrelation第14页/共70页Normalanatomy:

CT/CXRcorrelation第15页/共70页Normalanatomy:

CT/CXRcorrelation第16页/共70页Normalanatomy:

CT/CXRcorrelation第17页/共70页Isthemediastinumwide?Firstask…isittechnical?Positioning:rotated:?AP?Lordotic?Supine?InspirationIfso,repeatthefilmbeforeproceedingtoCT.Thenask…Isitnew?GETOLDFILMS

beforegettingaCTunlesstimeiscritical.第18页/共70页30yearoldmaninmotorvehicleaccident第19页/共70页APsupineAPuprightPAupright第20页/共70页Thinkaboutnormalvariants!VascularstructuresAorticanomaliesTortuousvesselsAzygosveinLipomatosisFatpads第21页/共70页Severeasthmaonlongtermsteroids第22页/共70页Mediastinallipomatosis第23页/共70页第24页/共70页PericardialFatPad第25页/共70页第26页/共70页Tortuousbrachiocephalicvessels第27页/共70页第28页/共70页AzygoscontinuationoftheIVC—congenitalvariant第29页/共70页70yearoldwithdysphagiaTrachealaircolumn第30页/共70页Esophagealcancer第31页/共70页AbnormalrightparatrachealstripeHodgkinsdisease第32页/共70页Abnormalrightparatrachealstripe第33页/共70页Checktheoldfilm!2daysearlierHematomafromlineinsertion第34页/共70页OneyearagoAbnormalrightparatrachealstripeandaorticarchobscured第35页/共70页第36页/共70页第37页/共70页Tumorobscuringthetopoftheaorticarch第38页/共70页AirfluidlevelsThinkbowelorabscess:HiatalherniaZenkerdiverticulumEpiphrenicdiverticulumAchalasiaMediastinalabscess第39页/共70页Achalasia第40页/共70页Zenkerdiverticulum第41页/共70页Hiatalhernia第42页/共70页MediastinalabscessafterCABG第43页/共70页DifferentialdiagnosisofmediastinalmassesTraditionally,wedividethemediastinumintocompartments.LikelydiagnosisofmassdependsonwhatiscontainedineachcompartmentThesearenotanatomicboundaries,andmassescommonlycrossoverintocompartmentswheretheydon’t“belong”.第44页/共70页PosteriormediastinumParaspinalareaMassesusuallyvisibleonlateralfilmoverlyingspineMayobscuredescendingaortacontour第45页/共70页PosteriormediastinumNeurogenictumorsSchwannomaSympatheticnervetumorse.g.ganglioneuromaNeurentericcyst,lateralmeningoceleLymphnodes(unusualasonlyareainvolved)ExtramedullaryhematopoesisVertebraltumors,spurs第46页/共70页Schwannoma第47页/共70页Extramedullaryhematopoesis第48页/共70页LateralmeningoceleinNF-1第49页/共70页AnteriormediastinumSpaceanteriortogreatvesselsandheart,behindthesternum第50页/共70页AnteriormediastinumMostcommon:LymphomaThymiclesionsGermcellorigintumorsThyroidmassesAlso:Foregutcysts,nervetumors,aorticaneurysm,etc.第51页/共70页AnteriormediastinalmassesThymichyperplasiateratocarcinomateratomalymphomathymomahemorrhage第52页/共70页MiddlemediastinumContainsheart,greatvessels,esophagus,trachea,lymphnodes,nerves.CXRabnormalityinparatrachealarea,azygo-esophagealrecess,retrocardiacareaMaybedifficulttoseeonlateralview第53页/共70页MiddleMediastinumLymphnodesForegutcystsVascularlesionse.g.aneurysmBronchogeniccarcinomaHiatalhernia,otheresophagealorGIlesions第54页/共70页Lymphoma第55页/共70页CardiacevaluationRemember:cardiothoracicratioofabout0.5appliesonlytogoodPAchestx-rays.Knowingwhichchambersformwhichcardiaccontourscanhelpidentifywhatisenlarged.Lookforaccompanyingsigns:PulmonaryvenousengorgementandisolatedLAenlargementsuggestsmitralstenosis.DilatedaortaandLVenlargementsuggestsaorticvalveinsufficiency.第56页/共70页NormalheartcontoursLeftatriumLeftventricleRightatrium第57页/共70页Leftatrialenlargement-mitralstenosisMitralvalve第58页/共70页Leftatrialenlargement“Doubledensity”StraightenedleftheartborderLAenlargedLVnormal第59页/共70页EnlargedascendingaortainAS第60页/共70页CalcificAorticStenosisEnlargedascendingaorta,normalarch,normaloverallheartsizeLVH第61页/共70页LVenlargement第62页/共70页Dilatedcardiomyopathymultichanberenlargement第63页/共70页ReviewQuestions第64页/共70页Amassthatwidenstheparatrachealstripeisprobablyinthe1.Anteriormediastinum2.Middlemediastinum3.Posteriormediastinum4.Neck第65页/共70页Posteriormediastinalmassesincludeallexcept:1.Schwannoma2.Extramedullaryhematopoesis3.Thymoma4.Lymphoma第66页/共70页Non-pathologicalcausesofmediastinalwideningonachestradiographinclude:1.