X-Quang Tim Phi

Nguyn Vn Long H Y Hi Phng

Dn Bi

K thut thm khm Gii phu X-Quang Cc hi chng Mt s bnh l tim mch

i cng

L mt xt nghim thng quy Mc ch nhm pht hin nhng bnh l v lng ngc Hin ti c nhiu phng php chn on hnh nh nh gi phi Ph bin vn l chp X quang phi

Phng php thm khm

Chiu X quang phi Chp X quang phi: Nhiu t th

Chp phi thng t th sau trc (PA) Chp phi thng t th trc sau (AP) Chp phi nghing (nghing tri) Chp phi nm nghing tia i ngang Chp phi chch trc phi v tri Chp phi nm Chp th th ra Chp nh phi (Lordotic)

Phng php thm khm

Chp ct lp thng quy Chp thc qun cn quang Chp ph qun Chp mch mu phi: ng mch, tnh mch Chp ct lp vi tnh Siu m Chp cng hng t Chp nhp nhy: ng tim v ng ht

Thnh phn cu trc phi

Mt s cu trc ca phi
- Kh qun v ph qun gc - Cc rnh lin thy v s phn chia ca cc thy phi - Cc mch mu phi - Nhu m phi - Thnh ngc - Trung tht

Phn chia cy ph qun v phn thy phi

Bn phi:
- Thy trn
+ Phn thy I (nh trn) + Phn thy II (Sau trn) + Phn thy III (Trc trn)

- Thy gia
+ Phn thy IV (Sau ngoi) + Phn thy V (Trc trong)

Phn chia cy ph qun v phn thy phi

Thy di
- Phn thy VI (nh di, thy Nelson) - Phn thy VII (Cnh tim) - Phn thy VIII (Trc nn) - Phn thy IX (Gia nn or cnh nn, bn nn) - Phn thy X (Sau nn)

Phn chia cy ph qun v phn thy phi

Bn tri:
- Thy trn
+ Phn thy I (nh trn) + Phn thy II (Sau trn) + Phn thy III (Trc trn)

- Thy li (thuc thy trn)

+ Phn thy IV (Li trn) + Phn thy V (Li di)

Phn chia cy ph qun v phn thy phi

Thy di
- Ging nh phi phi nhng khng c phn thy VII.

i chiu tng trong lng ngc

nh gi phim phi chun

Bnh nhn c chp t th sau trc Phi ly c ht trng phi: hai nh phi n ht hai gc sn honh T th bnh nhn cn i :
- Cc t sng ngc gia phim - Gai sau cc t sng ngc thng hng gia phim - Khp c n v khp cng n hai bn i xng qua ng gia

nh gi phim phi chun

Tiu chun k thut

- Phi thy c l m 4 t sng ngc trn cng (nu l phim phi in th thp) v b ct sng ngc (nu l in th cao) - Xng b vai hai bn tch hon ton ra khi trng phi - Thy c cc mch mu phi tn ht cch thnh ngc khong 1 n 1,5cm - Bnh nhn phi chp th ht vo

Cch c phim phi thng chun

nh gi xem phim chp tiu chun cha Nn nh gi h xng, thnh ngc, trung tht, bng tim trc Cui cng nh gi nhu m

Cc hi chng phi

HC ph nang HC ph qun HC k HC mng phi HC mch mu HC trung tht HC thnh ngc HC nhu m

Hi chng ph nang

nh ngha: L s th hin s c mt ca cc cht bt thng trong ph nang nh dch, t bo lnh tnh, c tnh... Bao gm 7 du hiu

Hi chng ph nang

Hnh m c b vin m Hnh m c tnh cht hp lu Hnh m h thng Hnh nh ph qun ph nang cha kh Hnh cnh bm Hnh nt m ph nang (chm ph nang) Tin trin nhanh Chn on khi c >2 du hiu

Hi chng ph nang

Gp trong mt s bnh nh vim phi, ph phi, si ph nang, vim phi do ht, ung th tiu ph qun ph nang...

Ph phi

Pulmonary haemorage

?????

02 ngy sau

Hi chng ph qun

nh ngha: L nhng du hiu th hin s c mt ca nhng cht bt thng trong ph qun hoc s dy ln ca thnh ph qun

Hi chng ph qun

Hnh dy ln ca thnh ph qun

- Hnh ng ray - Hnh trn - Hnh ny tng ng vi s dy ln ca thnh ph qun trong vim hoc tn thng m k quanh ph huyt qun

Hi chng ph qun

Gin ph qun
- Chp ph qun cn quang - Chp CT - Tn thng l nhng hnh m b song song, c th thy phn nhnh - Hnh ngn tay i gng - Hnh tr, hnh chm nho - Tng kch thc so vi mch mu song hnh (trn CT)

Hi chng ph qun

Tc nghn ph qun mt phn

- Hin tng by kh - Chp th th ra - C th gp trong nhng trng hp u ph qun cha gy tc hoc d vt gy tc mt phn

Hi chng ph qun

Tc nghn hon ton lng ph qun

- Do u, d vt, nt nhy - Do teo ph qun (di chng), iatrogen... - Xp phi gy co ko cc thnh phn xung quanh: ko trung tht v bn bnh, ko rn phi ln cao hoc xung thp, ko c honh ln cao, cc khoang lin sn hp... - C th xp mt phn thy, thy, c mt bn phi

Xp thy gia P

Xp thy di P v T

Hi chng k

T chc k l khung ca phi C cc t chc k quanh ph huyt qun, t chc k vch lin tiu thy, t chc k di mng phi T chc k quanh ph nang (nhu m) Cc t chc k ny thng vi nhau Khng thy trn phim X quang trng thi bnh thng Ch thy khi xut hin cc cht dch, t bo trong t chc ny.

Hi chng k

Dy vch lin tiu thy

- ng Kerley B: di khong 1cm, dy khong 1-2mm, y phi. - Kerley A: nh, hnh cong - Kerley C: bt cho - Kerley D: dy 3-4mm, di khong 5-6cm, thy trn phim chp nghing, nm phn trc ca phi.

Hi chng k

Dy v bao ph huyt qun

- Thy hnh nh ph qun nm trong vng phi cha kh

Dy t chc di mng phi

- Dy cc rnh lin thy - ng vin mng phi

Kerley B

Dy t chc di mng phi rnh lin thy nh

Dy t chc k vch lin tiu thy (X phi)

Hi chng k

M k nhu m
- Hnh knh m (Ground-glass or Verre depoli) l giai on u, gim sng ca trng phi - Nt m nh: k (1-3mm) - Nt m ln: 3mm n 3cm - Hnh li - Hnh li nt : Nt+Li - Hnh t ong

Hi chng k

M k nhu m
- R nt - Khng hp lu - Khng h thng - Khng c hnh nh ph qun cha kh (Air bronchogram) - Phn b khng theo cu trc mch mu v ph qun - Tin trin chm (so vi lm sng)

Knh m

Vim phi k do Influenza

Knh m

Nt nh

Nt nh

Nt ln

Li

T ong

Hi chng k

Gp trong rt nhiu loi bnh:

- Bnh l ca bch mch: lympho ht, bi phi, nm, vim ph nang d ng ngoi lai... - Bnh l c tnh: di cn - Ph phi k: suy tim, vim phi k... - X k lan ta

Hi chng thnh ngc

Hoi chng thanh ngc bao gom tat ca nhng dau hieu X quang dien ta nhng bat thng hoac ton thng mo mem hoac khung xng long ngc. Hoi chng nay rat thng bi bo sot neu ta khong chu y va ngh en.

Hi chng thnh ngc

Tng hoc gim dy ca thnh ngc

- Khu tr: bng m c th b r nt, m, bn nt bn m - Lan ta: Hnh tng sng gi hoc hnh m gi bn tn thng

Cc hnh vi ha thnh ngc

- Chp tip tuyn nh gi - CT gip nh gi tt

Tn thng h thng xng thnh ngc

Hi chng thnh ngc

Mt yu t quan trng nh gi tn thng thnh ngc l li mch phi hai bn cn xng.

U m thnh ngc

Nang phnh mch xng sn

Hi chng mng phi

nh ngha: Gm nhng du hiu biu hin cho s c mt ca dch, kh v cc cht bt thng trong khoang mng phi Bao gm:
- Hnh m mng phi - Hnh sng mng phi - Vi ho mng phi

Trn dch mng phi

Trn dch mng phi t do

- Mc t: M gc sn honh - Mc trung bnh: ng cong Damoiseaux: cong lm xung di, t trung tht cao dn v pha thnh ngc - Nhiu: M ton b mt bn phi - Du hiu gin tip: xo vm honh, y lch trung tht sang bn i din - Th c bit: th di phi (th honh)

Chp ng thng Chp nm nghing tia i ngang TDMP di phi

Trn dch mng phi

Trn dch mng phi khu tr

- Trn dch rnh lin thu
+ Hnh m hnh thoi rnh lin thu nh, ln + Hnh m vi mt b r mt b c th khng r trn phim thng + Nn chp c phim thng v nghing

- Trn dch mng phi thnh ngc (hoc u mng phi

+ Chp tip tuyn s c hnh nh bng m dn vo thnh ngc vi mt gc dc nh, khng thay i khi thay i t th (Ging hnh nh ca thnh ngc)

Trn dch mng phi thnh ngc

Trn dch mng phi

Trn dch trn kh phi hp:

- C hnh nh mc ngang

Trn dch mng phi

Trong nhng trng hp cn thit: kt hp vi siu m

Trn kh mng phi

Trn kh t do
- Hnh qu sng ca mng phi, mt cc vn phi - Nhu m phi co v trung tm - Thy c ng vin l tng mng phi - Trung tht y lch sang bn i din - Vm honh xung thp - Rng cc khoang lin sn - Nu t chp th th ra

Ht vo

Th ra

Trn kh mng phi

Khu tr
- To thnh mt gc dc nh so vi thnh ngc, trong cha kh (khi chp tip tuyn)

Vi ho mng phi v dy mng phi

L nhng hnh m m mng phi Khng lin quan n cu trc nhu m phi Chp tip tuyn: nm ngoi vi dc theo mng phi Nhiu: c hnh nh mai mc Chp CT nh gi Dy mng phi: hnh m ging trn dch nhng co ko xung quanh

Hi chng trung tht

Bao gm cc du hiu biu hin cho s c mt ca dch, kh, t chc bt thng trong trung tht Phn chia trung tht theo Felson

TT trn
TT gia Cung MC Carina

TT di

Trung tht sau

Trung tht trc

Quan nim mi v trung tht

Hi chng trung tht

Hnh m trung tht

- Hnh m c b ngoi nt, u - B trong khng thy do chm vo trung tht - Lm vi trung tht mt gc t - Cong v pha phi

Hi chng trung tht

Hnh m trung tht

- Hch - U tuyn c - Tuyn gip...

nh gi tt nht bng chp CT

Tng trn

Trung tht trc Bu gip Nang ph qun

Nang ph qun Nang mng tim mng phi Ti tha mng tim Bu tim Bu tuyn hung Bu qui, bu mm Phnh mch Bu bch mch Hch trung tht.

Trung tht gia Hch trung tht Bu gip Bu kh qun Hch trung tht Bu kh qun

Trung tht sau

Tng gia Tng di

C ba tng

Nang rut Bu thn kinh Bu thc qun

Bu thn kinh Meningocele Kyste neuromesenterique Hch trung tht Nang ong ngc Nang ph qun Hemangiome Tng sinh ngoi tu Bu gip Thymus ectopique

Hi chng trung tht

Hnh sng trung tht

- Trn kh mng phi:
+ Qu sng dc theo trung tht + Phim nghing: ng sng thng ng pha trc + Km theo trn kh di da

- Bt thng thc qun

+ Hnh kh trong thc qun + y lch ng thc qun

- Thot v honh

Hi chng trung tht

Vi ho trung tht
- Vi ho mng tim - Vi ho valve tim - Vi ho mch mu - Vi ho hch - Vi ho trong khi u

Thot v honh

Vi ho MC/ Bc tch MC

Trn kh trung tht

Trn kh trung tht

Hi chng mch mu

L du hiu lin quan n s thay i khu knh, s lng v trng thi ca cc mch mu phi Tng khu knh mch mu khu tr
- Phnh ng mch - R ng tnh mch: Nt m c nhn mt nhnh ng mch v tnh mch dn lu

Tng lan to
- Tng cung lng mu ln phi

Hi chng mch mu

Phn b li ti mu
- Tng cung lng mu ln phi: tng p lc tnh mch phi - Gim ti mu: gin ph nang

Gim khu knh mch mu lan to hoc khu tr

- Hp, tc ng mch phi - Thiu sn ng mch phi - Tng p lc ph nang hoc TKMP

Tng p ng mch phi

Tng p ng mch phi

Thng ng tnh mch phi

Hi chng nhu m

Tp hp ton b nhng tn thng c ngun gc nhu m. Nhng tn thng ny hoc qu khu tr hoc qu lan to, khng nm trong cc hi chng trn. Khng nh n nm trong nhu m v:
- c bao quanh bi nhu m phi - Khi ngoi vi n to vi thnh ngc mt gc nhn - Nu lan to n c s thay i v mch mu

Hi chng nhu m

Bao gm
- Nt n c:
+ Kch thc + B vin + Cht cha bn trong + Nhng tn thng phi hp

- Hnh nhiu nt m trn

+ Hnh th bng hoc hnh bng bay (M) + Thm nhim mau bay... (t gp hn

Hi chng nhu m
- Hang:
+ Cha kh + Mc dch kh + Tnh cht thnh hang + Tn thng phi hp

- Hnh qu sng thnh vng

+ B mnh + Ranh gii r + V mch

Hi chng nhu m
- Qu sng lan to
+ Tng sng lan to + Gim khu knh mch mu phi + Thng kh b

- Qu sng khu tr
+ By kh (Air trapping)

- Hnh sng c bit

+ Nm trong hang + Sng hnh lim

Hnh nhc nga (Aspergilloma)

Emphysema

U phi hang ho

i vi bnh l ca phi: c th kt hp nhiu hi chng Cn phn tch k lng v nh gi mt cch ton din Hin nay, chp CT c p dng nhiu i vi lng ngc, gip cho vic nh gi c chnh xc Tuy vy, cn phi nm c vng chc triu chng v hi chng ln phi

Mt s bnh l phi-lng ngc

Vim phi thu Lao phi cc th U phi Bnh hp van hai l Thng lin nh

Vim phi thy

L mt bnh l thng gp Do nhiu loi vi khun: Gr(+), (-), Mycobarterium... Biu hin chnh l hi chng ph nang Trn phim X quang: Hnh m hnh tam gic, y ngoi, nh trong, mt b ta ln rnh lin thy C hnh nh ph qun cha kh

Lao phi

L bnh thng gp T l gia tng do bi nhim trn bnh nhn AIDS C nhiu th lao phi

Lao phi

Gm:
- Lao s nhim - Lao sau s nhim
+ Lao k + Lao phi thm nhim sm

- Lao mn tnh
+ Lao nt + Lao x hang

- Mt s th c bit khc: vim phi, mng phi...

Lao phi

Lao s nhim
- C hnh nh phc hp nguyn thy - Hnh qu chy (qu t): Sng so nhim-Hch rn phi ni vi nhau bi ng bch mch vim - C khi ch thy hch rn phi - C th xp phi do hch chn p

Lao k

L lao cp tnh Lan theo ng mu L nhng hnh nt m nh nh ht k Tp trung nhiu hn pha trn C th kt hp vi trn dch mng phi Chn on phn bit vi bi phi, M th k, huyt phi...

Lao phi thm nhim sm

Hnh m m nht (ca m k) V tr h n Nt m trn kch thc <2cm h n C th tin trin thnh hang hoc thnh so

Lao phi mn tnh

Lao nt: Nt m khong 3-15mm, tp trung thnh m, km theo c di x Tuberculoma Lao x hang: Hnh nh hang: thnh mng, trong cha kh hoc c th bi nhim nm>>Nhc nga Lao x: tn thng x, co ko cc thnh phn xung quanh>>Gim th tch phi Tn thng thng gp nh v h n hai bn

Lao nt
???? ?

U phi (c tnh)

L bnh l hay gp C tn thng u nguyn pht v tha pht Ch yu xut pht t ph qun C lin quan vi ht thuc lo, thuc l Quan nim hin nay: chia u nguyn phat thnh hai loi : t bo nh v khng t bo nh Lm sng ch yu l ho ra mu, au ngc, HC cn ung th... Hin nay s dng CT trong chn on

U phi nguyn pht

Th trung tm
- Khi gy hp ph qun gy ra xp phi - Nu cha bt tc hong ton >> By kh - Thng pht hin khi ph qun tc hon ton

U phi ngoi vi

L nhng hnh khi m trn, kch thc >3cm B ca khi c th u, tua gai Hoi t trung tm dn n hang ha C th c vi ha trong khi Tng th tch nhanh Hch trung tht Chp CT nh gi

U phi th pht

Di cn n phi Hay gp do di cn v, sinh dc, tin lit tuyn, h thng tiu ha... C cc loi
- Th k: Nt <3mm, tp trung nhiu vng y - Th nt nh: Nt 3mm< Nt<10mm - Th nt ln: th bng (nt >10mm) - Th li: Hnh vim bch mch to thnh mng li - Nm trong hi chng k v nhu m

Mt s bnh l tim

Bnh l tim bm sinh v mc phi Trc kia s dng X quang nh gi Hin nay: dng X quang nh gi phi l ch yu nh gi: dng siu m v Doppler Hin ti: dng CT v MRI

Thng lin nh

Bnh tim bm sinh tm mun Cn tn ti l thng gia nh phi v nh tri Cung ng mch phi ni Gin on gn ca ng mch phi Tim to, cung nh phi li v mm tim tin st n thnh ngc, ht ln trn Chiu thy ng mch phi ny

Hp hai l

L bnh tim mc phi (do thp tim) Hp n thun hoc hp phi hp vi h Gy nhiu bin chng Gy tng p lc tiu tun hon

Hp hai l

Hnh tim: b phi 4 cung B tri: Nh tri to theo 3 Phim chp thc qun: thc qun b y ra sau on 1/3 di Vi ha valve Chc ba kh ph qun b y ln cao, rng Phi:
- Hnh nh ti phn b tun hon phi - Hnh nh huyt phi: ng Kerley (B) - Hnh nh m ph nang - Dch mng phi

Siu m o din tch valve, dy...

T chng Fallot

L bnh tim bm sinh tm sm Hp ng mch phi ng mch ch ci nga Thng lin tht Ph i tht phi X quang: Hnh nh cung ng mch phi lm/ Mm tim ht ln trn

Trn dch mng ngoi tim

Do nhiu nguyn nhn Gy hi chng p tim trn lm sng X quang: Tim to, hnh qu bu Cc cung tim ngn li Chiu: thy tim hnh hai b

Xin cm n s theo di ca cc bn !