醫學的學習資料第1頁/共60頁Howdoyoulookatachestx-ray?Avoidtunnelvision!or第2頁/共60頁Haveasystem第3頁/共60頁Chestwall,bonesandabdomen第4頁/共60頁Mediastinum,heartandhila第5頁/共60頁Lungs第6頁/共60頁TheLateralChestFilm

FindabnormalitieshiddenonthefrontalfilmConfirmabnormalitiessuspectedfromfrontalfilmDon’tbeafraidtolookatit!Ourbestfriend!第7頁/共60頁LookingatthelateralCXR第8頁/共60頁Hilarstructuresonthelateralfilm第9頁/共60頁第10頁/共60頁“Ringaroundthebronchus”第11頁/共60頁TechnicalFactorsPositioningstraightvsoblique(Howwe’lltrytofoolyou)第12頁/共60頁Effectofobliquityonheartsize第13頁/共60頁TechnicalFactorsPositioningstraightvsobliquePAvsAP第14頁/共60頁TechnicalFactorsPositioningstraightvsobliquePAvsAPerectvssupineerectsupine第15頁/共60頁TechnicalFactorsPositioningstraightvsobliquePAvsAPerectvssupinelordoticvskyphoticlordotickyphotic第16頁/共60頁TechnicalFactorsPositioningstraightvsobliquePAvsAPerectvssupinelordoticvskyphoticEffectonmediastinalcontour第17頁/共60頁TechnicalFactorsDepthofinspirationVisualizationofpathologydependsoncontrastprovidedbyairinthelungsCountribs!10第18頁/共60頁8ShortofbreathOneminutelater8第19頁/共60頁TechnicalFactorsBodyhabitusRadiographictechnique:Isitreallydifferent?Changingtechniquecanmakediseaselookbetterorworse.第20頁/共60頁Istheheartlarge?Isthemediastinumwide?Samepatient,4filmswithinonemonth第21頁/共60頁RecognizingairspacediseaseAlveolarspacesfilledwith…something.Radiologist'sreport:“consolidation”“airspaceopacity”“fluffydensity”“infiltrate”Nonspecific:Atelectasis,pneumonia,bleeding,edema,tumor第22頁/共60頁TheSilhouetteSignIndicatesairspacedisease.Obscurationofanormallyseenborder,e.g.diaphragmorheart.Opacitywithsharpedgealongafissure.第23頁/共60頁LocalizingdiseasefromthesilhouettesignRLLRMLLLLLingulaLLL第24頁/共60頁LocalizingdiseasefromthesilhouettesignRULRMLULLLRMLorlingula第25頁/共60頁16hourslaterWhathappenedhere?第26頁/共60頁LobarAtelectasisBestsign–shiftofafissureRapiddevelopmentandclearanceAirbronchogramsifnon-obstructiveSecondarysigns:MediastinalshiftElevateddiaphragmRibsclosertogetherVagueincreaseddensity第27頁/共60頁LLLAtxNextday第28頁/共60頁RULAtx第29頁/共60頁RMLAtx第30頁/共60頁LULAtx第31頁/共60頁PneumoniaSigns:AirbronchogramSilhouette-“positive”or“negative”Densehilum“Spine”signAllaresignsofanyairspaceprocessDxofpneumoniadependsonappropriateclinicalscenario.第32頁/共60頁AirbronchogramsignPseudomonaspneumoniaLungcancer第33頁/共60頁Airbronchograms—CT

PneumoniaLungcancer第34頁/共60頁Rightmiddlelobe第35頁/共60頁Rightupperlobe第36頁/共60頁RightlowerlobePosteriordiaphragmsilhouetted第37頁/共60頁Densehilum,spinesign第38頁/共60頁Densehilum,spinesignagain第39頁/共60頁Fourdayslater第40頁/共60頁FinalExam第41頁/共60頁21y.o.withfeverandcough第42頁/共60頁第43頁/共60頁Hyperlucenthemithorax:why?第44頁/共60頁Didyounoticethemass?第45頁/共60頁Lymphoma

第46頁/共60頁Takehomemessage#1It’sachestx-ray,notalungx-ray.第47頁/共60頁6cmlungmassmissed.How?2yearsago第48頁/共60頁Takehomemessage#2Oldfilmsareyourfriend!第49頁/共60頁Elderlymanwithhypotension第50頁/共60頁Suddenlyseptic第51頁/共60頁Pneumatosisofsmallbowel第52頁/共60頁Takehomemessage#3Thepatientpaysfor

thewholefilm!第53頁/共60頁ReviewQuestions第54頁/共60頁Allarekindsofairspacediseaseexcept:HemorrhagePneumoniaTumorSarcoidosisAtelectasis第55頁/共60頁Themostspecificsignofatelectasisis:ObscurationofadiaphragmShiftofafissureAirbronchogramsDensityoverthespineMediastinalshift第56頁/共60頁Thiscanmaketheheartlooklargerthanitis:LordoticpositioningAPpositioningExpiratoryfilmSupinepositioningAlloftheabove第57頁/共60頁AdditionalReadingChestRoentgenologyFelson,BW.B.SaundersCo,Philadelphia1973Chapter2:LocalizationofIntrathoracicDisease.pp22-70.PareJAPandFraserRGSynopsisofDiseasesoftheChest