胸部正常CT断层解剖图片严选材料

前前 言言 肺、纵隔内部组织结构之间、正常结构与病变之间的密度差异 CT满意显示胸部正常结构和病灶的大体解剖，定位、定量准确，为定性分析提供形态学基础有关胸部有关胸部CTCT检查技术的几个问题检查技术的几个问题1、CT值与窗宽、窗位：肺窗和纵膈窗，双 窗技术2、层厚和层距：吸气末扫描，薄层/重叠扫 描；减小部分容积效应、肺血坠积现象3、平扫和增强扫描：LN，病灶，血管4、高分辨CT（High Resolution,HRCT）层厚 12mm，显示次级肺小叶结构；显示间质性病变、支扩、孤立小病灶 一、主要观察内容主要观察内容 1、纵膈：有无纵膈肿块、多余结构 LN有无肿大或/及增多 “三管”结构形态（气道结合肺窗）2、较大范围的肺、胸膜（腔）病变的内部 结构 3、阅片顺序：辨认每一层纵膈内的“三管”结构 自上而下、由近段向远段 完整完整观察某一结构Can you find the right and left subclavian arteries?(click for answer)The right subclavian artery as itdumps into the brachiocephalic artery.(click to highlight)What are the 3 yellow air-filled(black)structures highlighted here?(click to highlight)These are the Right lung apexTrachea and Esophagus.This is contrast(white)being injected into the left subclavian vein.Can you find the first 3 branches off the aortic arch?(click for answer)Brachiocephalic arteryLeft Common Carotid arteryLeft Subclavian arteryIncidental lipoma(fat tumor)(notice it is the same density as fat in the chest wall)Can you find the left brachiocephalic vein as it dumps into the SVC?(click for answer)We are at the level of the top of the aortic arch(click to highlight)Can you find the right pectoralis major and minor?(click for answer)What is the structure in blue?(click to highlight)This is the SuperiorVena cavaCan you find the azygous arch?(where the azygous vein comes across to dump into the SVC)(click for answer)Notice the bifurcation ofthe trachea(corina)at this level(click to highlight)What is the structure in red?(click to highlight)This is the left pulmonaryartery.Can you find the pulmonary trunk and right pulmonary artery?(click for answer)Where are the ascending(A)and descending(D)limbs of the thoracic aorta?(click to highlight)ADWe are at the level of the top of the left atrium.Notice The pulmonary veins dumping into it as they return from the lungs.(click to highlight)Can you find the left main coronary artery coming off the aorta?(click for answer)You can further seeThe left coronary branch into theCircumflex artery and theLAD artery(click to highlight)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 left atrium dumping Into the left ventricle.Can you find it?(click to highlight)You can clearly see the left ventricular wall and septum with the projecting papillary wall muscles attachingto the mitral valve leaflets.(click to highlight)Contrast filling the right ventricleCan you find the 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 visible纵膈的分区方法纵膈的分区方法：CT较平片 （侧位）直接显示 前纵膈-心脏、大血管前 间隙，胸腺中纵膈-“三管”结构及其 周围间隙、LN后纵膈-脊柱旁（沟）；脊神经、植物神经 心脏和心包心脏和心包 一、主要观察内容主要观察内容 1 1、CTCT肺门（肺野内带）：肺门（肺野内带）：第一、二肺门之间的血第一、二肺门之间的血 管、支气管等管、支气管等 内侧内侧 -与纵膈内支气管、血管相续（结合纵膈窗）与纵膈内支气管、血管相续（结合纵膈窗）外侧外侧 -段支气管开口处，与外周支气管血管束相续段支气管开口处，与外周支气管血管束相续 2 2、支气管血管束（肺野中带）、支气管血管束（肺野中带）由肺门发出的、相伴行的支气管和肺由肺门发出的、相伴行的支气管和肺A A分支；分支；向肺门向肺门/左房回流的、无支气管伴行的肺静脉左房回流的、无支气管伴行的肺静脉 3 3、外周肺（胸膜下区）：、外周肺（胸膜下区）：段以下的血管、支气管断面段以下的血管、支气管断面 影，呈小条、星、叉、点状影，呈小条、星、叉、点状 4 4、阅片要点：、阅片要点：抓住重点层面，抓住重点层面，观察每一层时，注意上下相邻层面，观察每一层时，注意上下相邻层面，完整观察某一结构完整观察某一结构二、主要层面和结构主要层面和结构 标志：与肺门相续的支气管、血管标志：与肺门相续的支气管、血管 1、右上叶支气管以上层面：右上叶支气管以上层面：两侧尖段支气管及其外侧的同名动脉两侧尖段支气管及其外侧的同名动脉 2 2、右上叶支气管层面：、右上叶支气管层面：右主支气管，前、后段支气管，右主支气管，前、后段支气管，右右PAPA上干；右上上干；右上PVPV前干前干 左上前段支气管左上前段支气管 3 3、右中间段支气管层面：、右中间段支气管层面：叶间动脉（右下叶间动脉（右下PA PA 干）干）4 4、左上叶支气管层面：、左上叶支气管层面：左主、左上叶支气管左主、左上叶支气管 5 5、右中叶、左舌叶，两侧下叶背段气管开口层面：、右中叶、左舌叶，两侧下叶背段气管开口层面：中叶脊，左下肺中叶脊，左下肺A A以下层面：以下层面：基底段支气管和基底段支气管和PAPA分支，两侧基本对称；分支，两侧基本对称；近水平走向的双下近水平走向的双下PVPV，由近向远渐小，由近向远渐小几个注意点：几个注意点：肺叶、肺段的判断肺叶、肺段的判断 肺门邻近-叶、段支气管叶、段支气管 外周肺-叶间胸膜（裂）叶间胸膜（裂）细线状细线状 稍高密度带状稍高密度带状 乏血管带（区）乏血管带（区）