循环系统专业知识讲座

循环系统

Circulatorysystem程克斌KebinCheng内容检验措施旳选择正常心脏三位片及径线测量阅片顺序常见心脏病和肺血管变化旳影像体现检验措施旳选择透视平片MSCTMRI超声心动图英文缩写PA位（Posterior-anteriorview)后前位RAO(rightanteriorobliqueview)右前斜位LAO(leftanteriorobliqueview)左前斜位LA(leftatrium）左房LV（leftventricle）左室RA(rightatrium）右房RV(rightventricle）右室LR胶片球管2米横位心斜位心垂位心小儿球形心AscendingAorta“Doubledensity”ofLAenlargementRightatriumLeftventricleIndentationforLApulmonaryarterialsegementAorticknobTheCardiacContours

SuperiorvenacavaInferiorvenacavaRAOviewLARAAscendingaortaPulmonaryarteriousconeRVLAOAscendingaortaRVLVLMBRALAEnlargementofheartchambersandgreatvesselsLAenlargementMainPulmonaryArteryBIGLVenlargementRVenlargementRAenlargementLeftatriumsitsinmiddleofheartposteriorlyLeftatriumformsnoborderofnormalheartinPAviewLARALVNomalleftatrium“DoubleDensity”

ofleftatrialenlargementWhentheLAenlargesStraightenedleftheartborderLeftatrialenlargementLA,RV,LVenlargement.MPAbig=mitralvalvestenosis+mitralvalveincompetenceRAOLAOPAStraightenedleftheartborderImportantMainPulmonaryArtery

AdjacenttoleftpulmonaryarteryFindingtheMainPulmonaryArtery

Wecanmeasurethemainpulmonaryartery...Ifwedrawatangentlinefromtheapexoftheleftventricletotheaorticknob(redline)andmeasurealongaperpendiculartothattangentline(yellowline)Thedistancebetweenthetangentandthemainpulmonaryartery(betweentwosmallgreenarrows)fallsinarangebetween0mm(touchingthetangentline)toasmuchas15mmawayfromthetangentline0mmMain

Pulmonary

ArteryAo15mmMain

Pulmonary

ArteryAoLVLVMainpulmonary

arteryrangesfrom

0mm–15mm

fromtangentlineTwoMajorClassificationsThemainpulmonaryartery(MPA)projectsbeyondthetangentlineThemainpulmonaryarteryismorethan15mmawayfromthetangentlineIncreasedpressureIncreasedflowMainpulmonaryarteryprojectsbeyondtangent

27SmallpulmonaryarteryTetralogyofFallotMainpulmonaryarteryismorethan15mm

fromtangent靴形心Leftventricleand/oraorticknobpushthetangentawayCommon29Mainpulmonaryarteryismorethan15mm

fromtangent主动脉型心脏??Aorticknobshouldmeasure

<35mmAorticKnob

Thefirstbumpontheleft-sideistheaorticarch.Wecanmeasuretheknobfromthelateralborderofairinthetracheatotheedgeoftheaorticknob.42mmEnlargedwith:IncreasedpressureIncreasedflowChangesinaorticwallAorticKnob

LeftVentricleNormalleftventricle

?Cardio-thoracicRatio<50%Leftventricleenlargement主动脉型心脏LeftatrialenlargementLA,RV,LVenlargement.MPAbig=mitralvalvestenosis+mitralvalveincompetenceRAOLAOPAStraightenedleftheartborderRVenlargement二尖瓣型心RVenlargementPALAORAOLA,RV,LV

enlargement.MPAbig=mitralvalvestenosis+mitralvalveincompetenceWhichVentricleisEnlarged?IfHeartIsEnlarged,

AndMainPulmonaryArteryisBig>50%WhichVentricleisEnlarged?ThenRightVentricleisEnlargedIfHeartIsEnlarged,

AndAortaisBig>50%WhichVentricleisEnlarged?ThenLeftVentricleisEnlargedLowdensity,

almoststraightedge

representssize

ofascendingaortaAscendingAortaSmallProminentAscendingAortaRightatrium–notimportantcontourinadultsRightatriumRightatriumenlargementRA,RVenlargement,pulmonaryarterialhypertensionAtrialseptaldefectThePulmonary

VasculatureFiveStatesofthePulmonaryVasculatureNormalPulmonaryvenoushypertensionPulmonaryarterialhypertensionIncreasedflowDecreasedflowWhatWe’reGoingtoEvaluateRightDescendingPulmonaryArteryDistributionofflowinthelungsUpperversuslowerlobesCentralversusperipheralRightDescendingPulmonaryArteryServesrightmiddleandlowerlobes1.RightDescendingPulmonaryArteryDiametercanbemeasured(beforebifurcation)RDPA

<15mm1.RightDescendingPulmonaryArteryNormally,therightdescendingpulmonaryarteryshouldnotbemorethan15mmindiameter2.NormalDistributionofFlow

UpperVersusLowerLobesInerectposition,bloodflowtobases>thanflowtoapicesSizeofvesselsatbasesisnormally

>thansize

ofvessels

atapexYoucan’tmeasuresizeofvesselsattheleftbasebecausetheheartobscuresthemNormaltaperingofvesselsfromcentraltoperipheralCentralvesselsgiverisetoprogressivelysmallerperipheralbranches3.NormalDistributionofFlow

Centralversusperipheral1322NormalVasculature-reviewRDPA

<15mmindiameterLowerlobevesselslargerthanupperlobevesselsGradualtaperingofvesselsfromcentraltoperipheralRDPAusually

>15mmUpperlobevesselsequaltoorlargerthansizeoflowerlobevesselsVenousHypertensionVenousHypertensionPulmonaryvenousstasisMitralvalvestenosisPulmonaryedemaMitralvalvestenosisRheumaticheartdisease，LA,RA,RVenlargement，hemosiderin肺淤血－含铁血黄素从容二狭－LA,RV轻度增大PARAOLAOPulmonaryArterialHypertensionRDPAusually

>15mmMainPulmonaryArteryprojectsbeyondtangentlineRapidcutoffinsizeofperipheralvesselsrelativetosizeofcentralvesselsIncreasedFlowRDPAusually

>15mmUnrecognizablemostofthetimeSmallhilaFewerthannormalbloodvesselsDecreasedFlowTetralogyofFallot怎样对心脏片进行诊疗

TheABC,SCardiacevaluationRemember:cardiothoracicratioofabout0.5appliesonlytogoodPAchest