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1、胸片阅读与心影改变,谭洪毅,X-rays-describe radiation which is part of thespectrum which includes visible light,gamma rays and cosmic radiation.Unlike visible light,radiation passes through stuff.When you shine a beam of X-Ray at a person and put a film on the other side of them a shadow is produced of the inside
2、 of their body.,Different tissues in our body absorb X-rays at different extents:Bone-high absorption(white)Tissue-somewhere in the middle absorption(grey)Air-low absorption(black),Be systematic:,1)Check the quality of the film,Film Quality,First determine is the film a PA or AP view.PA-the x-rays p
3、enetrate through the back of the patient on to the filmAP-the x-rays penetrate through the front of the patient on to the film.All x-rays in the PICU are portable and are AP view,Film Quality(cont),Was film taken under full inspiration?-10 posterior ribs should be visible.Why do I say posterior here
4、?,When X-ray beams pass through the anterior chest on to the film Under the patient,the ribs closer to the film(posterior)are most apparent.,A really good film will show anterior ribs too,there shouldBe 6 to qualify as a good inspiratory film.,Quality(cont.),Is the film over or under penetrated if u
5、nder penetrated you will not be able to see the thoracic vertebrae.,Quality(cont),Check for rotationDoes the thoracic spine align in the center of the sternum and between the clavicles?Are the clavicles level?,Verify Right and Left sides,Gastric bubble should be on the left,X线,一、心胸比:心脏横径与胸廓横径之比.正常值:
6、0.5,分为三度,0.510.55 为轻度、0.560.60为中度、大于0.60为高度增大。缺点:受体型,横膈位置影响大,横位心及垂位心较大误差;不能反映心脏前后径的增大。,心胸比测量示意图一,心胸比等于：T1T2/Th；T1：右心缘距中线的最大距离；T2：左心缘距中线的最大距离；Th：胸廓横径，以通过右膈顶上缘测量胸廓横径为准。摘自刘玉清主编,B：心脏横径，两心缘最凸点垂直线之间的距离。A：胸廓最大横径。心胸比：B/A摘自,心胸比测量示意图二,二、心高比：,取右心房与大血管交点至右心膈角水平线垂直距离为右心房高，取主动脉弓项至右心膈角水平线垂直距离为心高，两者之比右心房一心高比率。平均0.4
7、6 0.04,反映右心房增大.。,三、主，肺动脉的测量,1升主动脉宽径(A1)，以升主动脉右缘最凸点至中线的垂直距离计(如果升主动脉外缘不清，可按上腔静脉外缘计)。100例青壮年的测 量(下同)：平均2.580.48cm。2主动脉结宽径(A2)，主动脉结最凸点至大气管左线主动脉结压迹最凹的距离。平均276土0.28厘米。3主动脉长径(A3)，自右心缘大血管与右心房交点至主动脉结最凸点的距离。平均935土161厘米。,1肺动脉段基线(P1)；主动脉结肺动脉交点与肺动脉左心房耳部(或左心室)交点的连线。平均4.880.72cm。2主肺动脉干横径(P2)：自肺动脉段最凸点（或最凹点，如平直则取其中点
8、)至正中线的垂直距离。平均3.86 0.53。3肺动脉段凸出度(P3)：自肺动脉段最凸点(或最凹点)至肺动脉段基线的垂直距离，如果肺动脉段为平直则其凸出废为0，凸出者为正值，凹陷者为负数。平均0.110.28cm。4.右下肺动脉干横径(P4):右下肺动脉干上端外缘至中间段支气管外缘的距离,正常1.5cm。,（摘自临床心脏X线诊断学刘玉清主编）,正位解剖,侧位解剖,动脉导管未闭-肺动脉段突出,房缺-肺动脉段突出,二尖瓣狭窄-左房大,左房大,室间隔缺损-肺动脉段突出,室间隔缺损-直径2.5cm,法乐四联症-肺血少,二尖瓣狭窄-肺间质水肿,冠心病动脉硬化,高血压心脏病心衰-肺泡肺水肿,肺动脉高压,肺动脉瓣狭窄-右心扩大,扩心病-左心大,肥厚性心肌病-肺血正常,缩窄性心包炎,心包积液,心包囊肿,
