1、目 錄概論縱隔窗的CT解剖肺窗的CT解剖目 錄概論 前 言 肺、縱隔內部組織結構之間、正常結構與病變之間的密度差異 CT滿意顯示胸部正常結構和病灶的大體解剖，定位、定量準確，為定性分析提供形態學基礎 前 言有關胸部CT檢查技術的幾個問題1、CT值與窗寬、窗位：肺窗和縱膈窗，雙 窗技術2、層厚和層距：吸氣末掃描，薄層/重疊掃 描；減小部分容積效應、肺血墜積現象3、平掃和增強掃描：LN，病灶，血管4、高分辨CT（High Resolution ,HRCT） 層厚 12mm，顯示次級肺小葉結構； 顯示間質性病變、支擴、孤立小病灶 有關胸部CT檢查技術的幾個問題胸部CT正常解剖課件胸部CT正常解剖課件

2、胸部CT正常解剖課件胸部CT正常解剖課件胸部CT正常解剖課件胸部CT正常解剖課件胸部CT正常解剖課件胸部CT正常解剖課件胸部正常CT解剖縱隔窗胸部正常CT解剖縱隔窗 一、 主要觀察內容 1、縱膈：有無縱膈腫塊、多余結構 LN有無腫大或/及增多 “三管”結構形態（氣道結合肺窗） 2、較大范圍的肺、胸膜（腔）病變的內部 結構 3、閱片順序： 辨認每一層縱膈內的“三管”結構 自上而下、由近段向遠段 完整觀察某一結構 一、 主要觀察內容 主要層面和結構主動脈弓及其以上層面：辨認頭臂血管主-肺動脈窗層面：窗空虛/潛在，氣管分叉，奇V弓右上葉支氣管層面：左PA弓、右上PV前干，右上PA，上腔V左上葉支氣管

3、層面：右中間段支氣管，右PA，右下PA，左上PV，左PA降支其他肺門層面：兩側大小基本對稱（肺窗顯示更佳），相伴隨的支氣管和PA分支，由近向遠漸小主要層面和結構主動脈弓及其以上層面：辨認頭臂血管胸部CT正常解剖課件胸部CT正常解剖課件胸部CT正常解剖課件胸部CT正常解剖課件Can you find the right and left subclavian arteries? (click for answer)Can you find the right and lefThe right subclavian artery as itdumps into the brachiocephali

4、c artery.(click to highlight)The right subclavian artery asWhat are the 3 yellow air-filled (black) structures highlighted here? (click to highlight)These are the Right lung apexTrachea and Esophagus.What are the 3 yellow air-fillThis is contrast (white) being injected into the left subclavian vein.

5、This is contrast (white) beingCan you find the first 3 branches off the aortic arch? (click for answer)Brachiocephalic arteryLeft Common Carotid arteryLeft Subclavian arteryCan you find the first 3 brancIncidental lipoma (fat tumor) (notice it is the same density as fat in the chest wall) Incidental

6、 lipoma (fat tumor胸部CT正常解剖課件胸部CT正常解剖課件Can you find the left brachiocephalic vein as it dumps into the SVC?(click for answer)Can you find the left brachiocWe are at the level of the top of the aortic arch (click to highlight)We are at the level of the topCan you find the right pectoralis major and mi

7、nor? (click for answer)Can you find the right pectoraWhat is the structure in blue? (click to highlight)This is the SuperiorVena cavaWhat is the structure in blue?胸部CT正常解剖課件胸部CT正常解剖課件Can you find the azygous arch ? (where the azygous vein comes across to dump into the SVC) (click for answer)Can you

8、find the azygous arch 胸部CT正常解剖課件Notice the bifurcation ofthe trachea (corina) at this level (click to highlight)Notice the bifurcation of胸部CT正常解剖課件What is the structure in red? (click to highlight)This is the left pulmonaryartery.What is the structure in red? 胸部CT正常解剖課件胸部CT正常解剖課件胸部CT正常解剖課件Can you fi

9、nd the pulmonary trunk and right pulmonary artery? (click for answer)Can you find the pulmonary truWhere are the ascending (A) and descending (D) limbs of the thoracic aorta? (click to highlight)ADWhere are the ascending (A) an胸部CT正常解剖課件We are at the level of the top of the left atrium. Notice The p

10、ulmonary veins dumping into it as they return from the lungs. (click to highlight)We are at the level of the topCan you find the left main coronary artery coming off the aorta? (click for answer)Can you find the left main corYou can further seeThe left coronary branch into theCircumflex artery and t

11、heLAD artery (click to highlight)You can further see胸部CT正常解剖課件Here is a good image of the aortic semi-lunar valve leaflets. Can you find them? (click for answer)Here is a good image of the aoHere is a good image of the left atrium dumping Into the left ventricle. Can you find it? (click to highlight

12、)Here is a good image of the leYou can clearly see the left ventricular wall and septum with the projecting papillary wall muscles attachingto the mitral valve leaflets. (click to highlight)You can clearly see the left vContrast filling the right ventricleContrast filling the right venCan you find t

13、he pericardial sac here? (click for answer)It is relatively easy tosee because there is a fat layer around the heartand around the pericardium making the soft tissue more visibleCan you find the pericardial s縱膈的分區方法：CT較平片 （側位）直接顯示 前縱膈 - 心臟、大血管前 間隙，胸腺中縱膈 - “三管”結構及其 周圍間隙、LN后縱膈 - 脊柱旁（溝）； 脊神經、植物神經 心臟和心包

14、 縱膈的分區方法：CT較平片胸部CT正常解剖課件胸部CT正常解剖課件胸部CT正常解剖課件胸部CT正常解剖課件胸部CT正常解剖課件胸部CT正常解剖課件胸部正常CT解剖肺窗胸部正常CT解剖肺窗一、主要觀察內容 1、CT肺門（肺野內帶）：第一、二肺門之間的血 管、支氣管等 內側 - 與縱膈內支氣管、血管相續（結合縱膈窗） 外側 - 段支氣管開口處，與外周支氣管血管束相續 2、支氣管血管束（肺野中帶） 由肺門發出的、相伴行的支氣管和肺A分支； 向肺門/左房回流的、無支氣管伴行的肺靜脈 3、外周肺（胸膜下區）：段以下的血管、支氣管斷面 影，呈小條、星、叉、點狀 4、閱片要點：抓住重點層面， 觀察每一層時，注意上下相鄰層面， 完整觀察某一結構一、主要觀察內容二、主要層面和結構 標志：與肺門相續的支氣管、血管 1、右上葉支氣管以上層面： 兩側尖段支氣管及其外側的同名動脈 2、右上葉支氣管層面：右主支氣管，前、后段支氣管， 右PA上干；右上PV前干 左上前段支氣管 3、右中間段支氣管層面：葉間動脈（右下PA 干） 4、左上葉支氣管層面：左主、左上葉支氣管 5、右中葉、左舌葉，兩側下葉背段氣管開口層面： 中葉脊，左下肺A以下層面：基底段支氣管和PA分支，兩側基本對稱； 近水平走向的雙下PV，由近向遠漸小幾個注