X QUANG PHOI QUY C

Hnh anh bnh thng Trieu chng hoc

KY THUAT

Kiem tra cac yeu to ky thuat:

T the, tia, ten tuoi, date.

Figure 4 Osteophyte of the left first rib in a 60-year-old woman. (a) PA chest radiograph shows a poorly defined nodular area of increased opacity overlying the anterior aspect of the left first rib (arrow). (b) PA chest radiograph obtained 2 years earlier shows that interval growth has occurred (cf a). This interval growth raised suspicion for malignancy. (c) Contiguous chest CT scans (image on right obtained at a lower level) reveal that the area of increased opacity is a large osteophyte of the first rib.

Hnh anh bnh thng

Dau silhoutte
Neu hai bong m co cung
mat o nam ke nhau va co mot phan chong len nhau ma xoa b cua nhau th chung nam tren cung mat phang (co dau silouette), neu khong xoa b nhau th chung nam hai mat phang khac nhau.

DAU CO - NGC
Mot bong m nam vung
nh phoi, neu b ngoai cua no ch thay c di b tren xng on th bong m o nam pha trc, con neu b ngoai cua no vt qua b tren xng on th bong m o nam pha sau.

DAU NGC - BUNG

Neu b ngoai cua mot bong
m nam vung ay ngc c thay lien tuc qua c hoanh th bong m o nam trong ngc, con neu b ngoai cua no khong thay c di c hoanh th bong m o nam bung.

DAU HOI TU, DAU AM XUYEN VA DAU BAO PHU.

Dau hoi tu: mot bong m

nam vung ron phoi, neu cac mach mau phoi dng lai ngang b cua bong m, o la ong mach phoi. Dau am xuyen:neu cac mach mau phoi am xuyen qua b bong m, o la ton thng u. Dau bao phu:trong cas nay, neu bong m xoa mat b tim, th bong m o pha trc va neu khong xoa b tim, th no nam pha sau.

Dau mc ngang
Nham xac nh mot hnh anh
mc nc hi nam trong mang phoi hay trong nhu mo phoi: Ta o chieu ngang cua mc nc hi tren ca phim thang va phim nghieng, neu ca hai bang nhau th ton thng nam trong nhu mo phoi, con neu ca hai khac nhau th ton thng nam trong xoang mang phoi

Dau sinh oi: gan vung ron phoi, chung ta co the gap cac cap mat: mot m (dch) la hnh mot tieu M phoi
va mot sang (kh) la hnh mot tieu phe quan, trong trng hp bnh thng chung co kch thc bang nhau, neu vong sang ln hn tc gian phe quan (dau vong nhan cm), neu vong m ln hn tc cao ap M phoi.

AIR BRONCHOGRAM

Dau c hoanh lien tuc

Bnh thng, c hoanh trai,

1/3 trc trong, co bong tim ta len nen tren phim X quang ta khong thay c, trong trng hp ta thay tron ven ca c hoanh trai: dau c hoanh lien tuc, tc la gia tim va hoanh trai a co lp kh phan cach: tran kh mang tim, tran kh trung that.

Normal: IC=0.5

 Ch so WOOD: ng knh

ngang cua M thuy di phoi, o nh di cua ron phoi phai, khong ln hn 16mm.

Dau Danelius
Giam kch thc hoac khong co
mot ron phoi: giam san M phoi (HC Mac Leo: giam san mot nhanh M phoi kem phoi tang sang cung ben), bat san M phoi, thuyen tac hoan toan mot nhanh M phoi.

Cac ng trung that

1. 2. 3. 4. 5. 6. 7. 8.
ng trung that sau ng trung that trc. ng canh trai ong mach chu. ng canh CS. ng canh CS. ng canh phai kh quan. ng canh TM n. ng canh thc quan.

Sai lam do ky thuat

Cac hoi chng ln

1. Hoi chng phe nang. 2. Hoi chng phe quan. 3. Hoi chng xep phoi. 4. Hoi chng hang. 5. Hoi chng mo ke. 6. Mat knh m. 7. Hoi chng mang phoi. 8. Hoi chng trung that.

Hoi chng ong ac

Hoi chng ong ac c nh ngha nh la mot tap hp cac hnh anh X
quang phan anh tnh trang thay the kh trong phe nang bang: dch xuat tiet (viem phoi), dch tham (phu phoi) hoac cac te bao benh ly (alveolobronchiolar carcinoma). Tren X quang o la mot am m tng oi ong nhat, phan bo co he thong, ben trong co air bronchogram, khu tru hoac lan toa, mot hoac hai ben. Nguyen nhan: viem phoi cap hoac man, phu phoi, BOOP ,alveolobronchiolar carcinoma, lymphoma, nhoi mau phoi, proteinose.

Cas 1 Cac trng hp viem phoi

Cas 2

Cas 3

Lymphom phoi nguyen phat

BOOP: bronchiolitis obliterant organising pneumonia

BOOP: bronchiolitis obliterant organising pneumonia

Alveolobronchiolar carcinoma

HOI CHNG PHE QUAN

La tap hp cac dau hieu X quang phan anh benh ly cua phe
quan. Cac dau hieu trc tiep: day vach PQ, dan long PQ va ong dch trong long PQ. Dan long PQ co 3 mc o: hnh tru (dau ng ray xe la, dau vong nhan cm) hnh choi ngoc (dau chuoi ngoc) va hnh tui (cac ken dch hi tu quanh truc PQ). Cac dau hieu gian tiep: xep phoi, se noi phan sau.

XEP PHOI
La tnh trang tac nghen long phe quan do nguyen nhan noi
sinh hoac ngoai sinh (d vat, u noi PQ, viem phu ne, hep do seo niem mac, hep do chen ep t ngoai). Tnh trang nay lam mat dan kh trong phe nang do o lam co giam the tch cua phan thuy, thuy hoac phan phoi benh. Hnh anh X quang giong nh ong ac nhng ong nhat hn, co hnh anh co keo cac cau truc lan can, khong co air bronchogram. Xep phoi con co the do nguyen nhan x xep cua nhu mo phoi (cas dan PQ, x xep sau lao).

HOI CHNG HANG

o la cac bong kh sang, vach co the day hay mong,
ben trong co the co cha mc dch hi. Nguyen nhan: abces phoi, hang lao, aspergiloma neu trong long hang co hnh anh cai luc lac, u phoi hoai t trung tam, ken kh bam sinh, bong kh phe thung.

Abces phoi trong thuy tren phai, can phan biet vi lao

Hoai th phoi: nhiem trung + thuyen tac phoi: hang ben trong co dang ban o. Can phan biet vi lao.

Abces phoi a o do vi trung yem kh, can phan biet lao

Lao phoi BK (+)

Lao phoi BK (+)

Pneumatocele nhiem trung

Cac ken kh phe thung

U phoi hoai t trung tam

Hoi chng mang phoi

Dung e ch cac tnh trang: 1. 2. 3. 4. 5.
Tran dch mang phoi. Tran kh mang phoi. Tran dch tran kh mang phoi. U mang phoi. Day mang phoi, voi hoa mang phoi.

Xep phoi tron

HOI CHNG TRUNG THAT

La tap hp cac dau hieu minh chng s co mat cua
mot khoi u phat trien hoac mot tham nhiem bat thng ben trong trung that. Thng, o la mot bong m ong nhat, b ngoai ro va lien tuc, loi ra mat phoi, b tao goc tu vi b trung that, b trong thng khong thay c do b che trong trung that.

TT tren
TT gia Cung MC

TT di

Carina

Trung that sau

Trung that trc

Benh nguyen cua cac u trung that

Trung that trc Trung that gia Hach trung that Bu giap. Bu kh quan. Hach trung that. Bu kh quan. Trung that sau

Tang tren

Bu giap Bu giap Nang phe quan Nang phe quan

Tang gia Tang di

Nang mang tim mang phoi Tui tha mang tim Bu tim Bu tuyen hung. Bu quai, bu mam Bu m. Bu bach mach Hach trung that. Nang ruot Bu than kinh Bu thc quan Bu than kinh Meningocele Kyste neuromesenterique Hach trung that Nang ong ngc Nang phe quan Hemangiome O tao mau ngoai tuy Bu giap Thymus ectopique

Ca 3 tang.

TOM TAT

TT trc Thyroid Teratoma Thymoma Adenopathy Anevrism

TT gia Bronchogenic cyst Oesophagus tumor

TT sau Neurogenic tumor

Bu giap

Bu giap

Bu tuyen c

Tang san tuyen c

Teratoma

Lymphoma

Kyste bronchogenique

Kyste pleuropericardique

Neurinome

Neurinome

Lipome

O tao mau ngoai tuy