超声chest echo(超音波用於胸腔急症).ppt

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1、胸腔急症的超音波診斷Te-ChunHsia(夏德椿)Director,RespiratoryIntensiveCareUnitsandHyperbaricOxygenTherapyCenterChinaMedicalUniversityHospitalChestRadiographinCriticallyIllPatientsTooweaktositupandair-fluidlevelwillbevisibleunabletoinspiratefullybecauseofsedation,consciousnesschange

2、,painorfatigueunrecognizedrotationofbodymobileradiographicequipmenthaslowpowertechniquesandtarget-filmdistancesvaryMirvisSE.ThoracicCTindetectingoccultdiseaseincriticallyillpatients.AJR1987;148:685-9DiagnosticUltrasonographyintheEmergencyDepartmentRadiologyMoretimelym

3、edicalimagingofunstablepatientshypotensionofunknownetiologycardiactamponadepulmonaryembolismaorticaneurysm…Criticallytime-sensitiveproceduresPortable,fast,noninvasive,safe,inexpensiveandprovidesanatomicandfunctionalinformationAnnEmergMedMarch1993;592-3UltrasoundinEMTh

4、eJofEMMed2007TraumaIdentificationofpregnancyCardiacRUQabdomenRenalAortaProcedureCVPSubcutaneousFBdetectionThoracentesisandparacentesisDiagnosticandTherapeuticUseofChestSonography:valueinCriticallyillpatientsPleuraldiseasesperipheralparenchymallesionsmediastinallesions

5、consolidationatelectasistransthoracicaspirationbiopsyassistingthediagnosisandmanagementofcriticallyillpatientswhosechestradiographsweredifficulttointerpretCJYu.AJR159:695-701,Oct.1992肺部急症的超音波診斷一、前言二、探測方法三、肋膜腔、縱膈、肺臟的正常超音波表現四、肋膜腔疾病的超音波表現五、縱膈疾病的超音波表現六、肺部疾病超音波表現前言急性胸腔部疾病:

6、CXRCTandMRI超音波便捷、安全、快速之輔助佐以胸腔放液、腫瘤抽吸等技術更加提高快速治療及診斷率肋膜疾病、周邊肺實質病變、縱膈腔疾患、心胞膜病變和橫膈病變等探測方法儀器選擇(withcolordopplerisbetter)2.5-5MHzforpleuraandlung5-7.5MHzforchestwallmassesandadenopathy檢查前準備CXR,CTscan,MRIifavailable體位檢查方法TransducerPositionsA:suprasternalB:transosseousC:inter

7、costalD:subxyphoidE:subcostalAJR134:1019-27,May1980肋膜腔、縱膈、肺臟的正常超音波圖縱膈大血管及心臟。aorticarch。兒童或嬰兒期，偶可見胸腺一葉或兩葉增大，外有包膜，內為均質低回聲區。肺臟充滿氣體，強回聲反射，後方衰減，不能顯示其內部構造及回聲狀態。肋膜很薄，超音波難以顯示。往往在胸壁後顯示肺的強反射。Comet-tailsign.急性肋膜腔疾病的超音波表現游離性肋膜腔積液包裹性積液(loculated)膿胸氣胸血胸肋膜腫瘤肋膜間皮瘤[mesothelioma]肋膜轉移瘤[

8、metastatictumor]縱膈疾病的超音波惡性腫瘤淋巴結結核神經原性腫瘤大血管疾病心包膜疾病縱膈腔炎急性肺部疾病超音波表現肺不張肺膿腫肺炎肺癌肺含氣體、病變或腫瘤被大量氣體所掩蓋，常不易顯示。但肋膜腔積液或肺實變時，肋膜積水及實變consol