1、2023/6/9,1,呼 吸 系 统 影 像 诊 断,河南大学淮河临床学院 医学影像教研室 李长波,2023/6/9,2,呼 吸 系 统,一、检查方法,二、正常胸部影像表现,三、基本病变表现,四、常见病的影像诊断,2023/6/9,3,一、检查方法(一)常规X线检查,透视胸片体层摄影(肺门、病灶)高千伏摄影支气管造影,(二)C T检查(平扫、增强)(三)M R检查(平扫、增强),2023/6/9,4,透 视,方法简单多体位、动态观察,不易发现细小病变没有永久记录,2023/6/9,5,RADIOGRAPHY,摄 影,正位(P-A位 A-P位)侧位(左右侧)前弓位卧位点片,2023/6/9,6,
2、Frontal view,暗 盒CASSETTE,正位胸片,优点:射线较透视少;有永久记录,便 于复查。,2023/6/9,7,Lateral view,暗 盒CASSETTE,X-ray,侧位胸片,缺点:不能动态观察,2023/6/9,8,高千伏摄影,120kv、5-7mAs减少胸壁、软组织 及肋骨对肺部病变 的干扰。,2023/6/9,9,支气管造影,2023/6/9,10,2023/6/9,11,2023/6/9,12,二、正常胸片表现及变异,2023/6/9,13,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.1
3、13.53.133/national/yxx/doc/4-1.files/slide0695.htmTitle:幻灯片 1 Size:8291 Last Modified:Thu,15 Jun 2006 03:23:18 GMT,一、正常X线表现(1),胸廓(正位)1.骨骼肋骨:肋软骨钙化呈条带状或斑点状 常见变异:颈肋、叉状肋、肋骨联合锁骨:内端下缘半圆形凹陷为菱形窝肩胛骨:肩胛骨下角可出现二次骨化中心,勿误为 骨折胸骨:大部与纵隔影重叠胸椎:14胸椎清楚可见,其余隐约可见,2023/6/9,14,2023/6/9,15,WebZIP 7.0.2.1028 on 02/13/09 下午 02
4、:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0659.htmTitle:幻灯片 1 Size:4177 Last Modified:Thu,15 Jun 2006 03:23:08 GMT,胸廓骨骼(线图),2023/6/9,16,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0660.htmTitle:幻灯片 1 Size:4403 Last
5、Modified:Thu,15 Jun 2006 03:23:10 GMT,颈肋(图),2023/6/9,17,肋骨联合,2023/6/9,18,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0384.htmTitle:幻灯片 1 Size:6942 Last Modified:Thu,15 Jun 2006 03:22:38 GMT,一、正常X线表现(2),胸廓(正位)2.软组织:胸锁乳突肌和锁骨上皮肤皱褶 胸大肌女性乳房和乳头伴随阴
6、影,2023/6/9,19,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0662.htmTitle:幻灯片 1 Size:3640 Last Modified:Thu,15 Jun 2006 03:23:10 GMT,软组织(线图),2023/6/9,20,2023/6/9,21,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/nationa
7、l/yxx/doc/4-1.files/slide0663.htmTitle:幻灯片 1 Size:3661 Last Modified:Thu,15 Jun 2006 03:23:12 GMT,软组织(图),2023/6/9,22,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0386.htmTitle:幻灯片 1 Size:8587 Last Modified:Thu,15 Jun 2006 03:22:38 GMT,一、正常X线表
8、现(3),气管、支气管(正位)1.气管:起于环状软骨下缘,5/6胸椎水平分左右主支气管,分叉角度65850(900)2.支气管及其分支:右主支气管与体轴成200300,左主支气管成400550,2023/6/9,23,2023/6/9,24,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0652.htmTitle:幻灯片 1 Size:7751 Last Modified:Thu,15 Jun 2006 03:23:06 GMT,一、正
9、常X线表现(4),肺1.肺野分区(正位):上、中、下三野,内、中、外带,肺尖区,锁骨下区2.肺叶:以叶间胸膜分隔肺叶 副叶:为先天变异,常见的有奇叶、下副叶3.肺段:圆锥形,尖端指向肺门,每侧肺含10段 4.肺纹理:由肺动脉(主要)、肺静脉构成,支气管、淋巴管、少量间质组织也参与,2023/6/9,25,肺门血管,2023/6/9,26,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0470.htmTitle:幻灯片 1 Size:39
10、18 Last Modified:Thu,15 Jun 2006 03:22:48 GMT,肺野分区(线图),2023/6/9,27,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0471.htmTitle:幻灯片 1 Size:5693 Last Modified:Thu,15 Jun 2006 03:22:48 GMT,肺段的X线解剖(线图),a.右肺 b.左肺(图中数字1-10表示肺段的序号),2023/6/9,28,WebZIP
11、 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0746.htmTitle:幻灯片 1 Size:5161 Last Modified:Thu,15 Jun 2006 03:23:18 GMT,A.箭示奇裂,B.箭示奇静脉,奇叶(图),2023/6/9,29,2023/6/9,30,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/d
12、oc/4-1.files/slide0647.htmTitle:幻灯片 1 Size:10858 Last Modified:Thu,15 Jun 2006 03:23:06 GMT,一、正常X线表现(5),肺(正位)5.肺门:肺动、静脉和支气管、淋巴组织的总投影正位右肺门上部:上肺静脉下后静脉干右肺门下部:下肺动脉干,宽度15mm肺门角:上下部夹角,呈钝角左肺门上部:左肺动脉弓左肺门下部:下肺动脉侧位两肺门结构重叠右肺动脉干偏前呈逗号 状左肺动脉弓居后上缘,2023/6/9,31,2023/6/9,32,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Ad
13、dress:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0645.htmTitle:幻灯片 1 Size:4090 Last Modified:Thu,15 Jun 2006 03:23:04 GMT,正常胸片(线图),2023/6/9,33,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0469.htmTitle:幻灯片 1 Size:5107 Last Modified:
14、Thu,15 Jun 2006 03:22:46 GMT,正常正侧位胸片(图),2023/6/9,34,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0389.htmTitle:幻灯片 1 Size:7080 Last Modified:Thu,15 Jun 2006 03:22:38 GMT,一、正常X线表现(6),纵隔(侧位)前纵隔:胸骨后、心脏和升主动脉及气管前 中纵隔:心脏、主动脉弓、气管、肺门占据区域 后纵隔:食管为中、后纵隔
15、分界以胸骨角至第4胸椎体下缘连线、肺门下缘水平线及横膈为界分为上、中、下纵隔,2023/6/9,35,四条线:1 胸骨柄体交界处 与T4下缘连线2 肺门下缘与T8连线3 心、升主动脉及气管前缘连线4 食管前壁,2023/6/9,36,2023/6/9,37,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0392.htmTitle:幻灯片 1 Size:8465 Last Modified:Thu,15 Jun 2006 03:22:38
16、 GMT,一、正常X线表现(7),胸膜(正、侧位)胸膜反摺处或叶间胸膜与X线平行可显影横膈(正位)右膈顶多位于第5肋前端或第6前肋间、第9或10后肋水平,比左膈高12cm 正常变异:局限性膈膨升、波浪膈,2023/6/9,38,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0665.htmTitle:幻灯片 1 Size:3621 Last Modified:Thu,15 Jun 2006 03:23:12 GMT,叶间胸膜(示意图),
17、2023/6/9,39,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0666.htmTitle:幻灯片 1 Size:3964 Last Modified:Thu,15 Jun 2006 03:23:14 GMT,叶间胸膜(图),2023/6/9,40,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.
18、files/slide0667.htmTitle:幻灯片 1 Size:3657 Last Modified:Thu,15 Jun 2006 03:23:14 GMT,局限性膈膨升(图),2023/6/9,41,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0669.htmTitle:幻灯片 1 Size:3628 Last Modified:Thu,15 Jun 2006 03:23:16 GMT,波浪膈(图),2023/6/9,42
19、,正常胸部后前位片,2023/6/9,43,正常胸部侧位片,2023/6/9,44,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0396.htmTitle:幻灯片 1 Size:6807 Last Modified:Thu,15 Jun 2006 03:22:40 GMT,二、正常CT表现(1),胸壁 1.软组织:包括胸壁肌、女性乳房、肌间脂肪层;腋窝内充满脂肪,内含血管、小淋巴结 2.骨骼:可见锁骨、胸骨柄、胸骨体、胸椎、多根肋骨的
20、断面影;第1肋软骨钙化可向下突入肺内螺旋CT容积扫描3D重建可立体显示胸部骨骼,2023/6/9,45,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0397.htmTitle:幻灯片 1 Size:6693 Last Modified:Thu,15 Jun 2006 03:22:40 GMT,二、正常CT表现(2),气管与支气管 气管:圆、椭圆、马蹄、倒梨形,儿童呈圆形;气管右后壁厚度不应 4mm主支气管:右侧较左侧短粗,椭圆形,中间
21、为隆突支气管:与层面平行者呈轨道状,垂直走行者呈管状,倾斜走行者呈卵圆形,2023/6/9,46,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0648.htmTitle:幻灯片 1 Size:7093 Last Modified:Thu,15 Jun 2006 03:23:06 GMT,正常胸部CT所见(肺窗),1.右上叶尖后段支气管 2.左上叶尖后段支气管 3.右上叶前段支气管.右上叶后段支气管 5.左上叶尖后段支气管 6.中间段支
22、气管 7.左舌叶支气管 8.右中叶支气管 9.右下叶支气管 10.左下叶支气管 11.左下叶背段支气管,2023/6/9,47,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0476.htmTitle:幻灯片 1 Size:7889 Last Modified:Thu,15 Jun 2006 03:22:50 GMT,1.胸腺 2.上腔静脉 3.主动脉弓 4.升主动脉 5.上腔静脉 6.右肺动脉 7.主肺动脉 8.左肺动脉 9.降主动脉
23、 10.升主动脉 11.左心房 12.降主动脉 13.右心房 14.左心房 15.右心室 16.左心室 17.肺静脉,2023/6/9,48,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0398.htmTitle:幻灯片 1 Size:6808 Last Modified:Thu,15 Jun 2006 03:22:40 GMT,二、正常CT表现(3),肺段和肺小叶肺段:肺段动脉、支气管位于肺段中心,肺段静 脉位于肺段间支气管血管束:
24、支气管、肺动脉及周围结缔组织肺血坠积效应:肺下垂部位纹理增粗、边缘模糊,2023/6/9,49,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0612.htmTitle:幻灯片 1 Size:4285 Last Modified:Thu,15 Jun 2006 03:23:00 GMT,正常肺段(图),2023/6/9,50,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/
25、202.113.53.133/national/yxx/doc/4-1.files/slide0613.htmTitle:幻灯片 1 Size:4382 Last Modified:Thu,15 Jun 2006 03:23:00 GMT,正常肺段(图),2023/6/9,51,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0654.htmTitle:幻灯片 1 Size:6921 Last Modified:Thu,15 Jun 20
26、06 03:23:08 GMT,二、正常CT表现(4),肺段和肺小叶 肺小叶(pulmonary lobule),又称次级肺小叶 小叶核心:小叶肺动脉、细支气管(1mm)小叶间隔:结缔组织间隔,内含小静脉、淋巴管 小叶实质:呼吸性细支气管、肺泡等含气间隙,2023/6/9,52,2023/6/9,53,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0614.htmTitle:幻灯片 1 Size:3632 Last Modified:T
27、hu,15 Jun 2006 03:23:02 GMT,次级肺小叶(示意图),2023/6/9,54,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0633.htmTitle:幻灯片 1 Size:3627 Last Modified:Thu,15 Jun 2006 03:23:04 GMT,次级肺小叶(示意图),2023/6/9,55,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:
28、http:/202.113.53.133/national/yxx/doc/4-1.files/slide0399.htmTitle:幻灯片 1 Size:6731 Last Modified:Thu,15 Jun 2006 03:22:42 GMT,二、正常CT表现(5),肺门右肺门上部:右上肺动脉居右上叶支气管前方,下肺动脉居中间支气管前、外侧右肺门下部:下肺动脉居中、下叶支气管外侧,上、下肺静脉干分别居中叶支气 管、基底段支气管内侧,2023/6/9,56,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53
29、.133/national/yxx/doc/4-1.files/slide0655.htmTitle:幻灯片 1 Size:6035 Last Modified:Thu,15 Jun 2006 03:23:08 GMT,二、正常CT表现(6),肺门左肺门:左肺动脉弓、下肺动脉分别居上叶支气管外、后;上肺静脉干居左上叶支气管前方下肺静脉干居基底段支气管内侧正常时两侧肺门区可有小淋巴结,2023/6/9,57,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.fil
30、es/slide0605.htmTitle:幻灯片 1 Size:3649 Last Modified:Thu,15 Jun 2006 03:22:56 GMT,段支气管(示意图),2023/6/9,58,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0607.htmTitle:幻灯片 1 Size:4420 Last Modified:Thu,15 Jun 2006 03:22:56 GMT,上肺门(图),2023/6/9,59,We
31、bZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0608.htmTitle:幻灯片 1 Size:3629 Last Modified:Thu,15 Jun 2006 03:22:56 GMT,上肺门(图),2023/6/9,60,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0609
32、.htmTitle:幻灯片 1 Size:3632 Last Modified:Thu,15 Jun 2006 03:22:58 GMT,下肺门(图),2023/6/9,61,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0610.htmTitle:幻灯片 1 Size:3612 Last Modified:Thu,15 Jun 2006 03:22:58 GMT,下肺门(图),2023/6/9,62,WebZIP 7.0.2.1028
33、 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0400.htmTitle:幻灯片 1 Size:7216 Last Modified:Thu,15 Jun 2006 03:22:42 GMT,二、正常CT表现(7),纵隔 心脏:心腔密度同心肌,心膈角区常见心包外脂肪垫,心包呈线状致密影胸腺:位于上纵隔血管前间隙,略呈三角形,分左右两叶,随年龄增长胸腺萎缩、密度减 低,60岁以后几乎被脂肪组织替代纵隔淋巴结:正常时短径 10mm,2023/6/9,63,WebZIP 7.0.2.1028 on 02/13/09 下午 02:52:54.Address:http:/202.113.53.133/national/yxx/doc/4-1.files/slide0476.h