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1、Radiology Diagnosis of Respiratory System,刘 辉 Department of Radiology, the second Xiangya hospital,The X-ray examination is applied very commonly,nature contrast is the best in body,Why?,Contains of the chapter： The X-ray examination methods Normal chest view The basic X-ray features X-ray demonstra
2、tions in common diseases,胸部透视（Chest fluoroscopy） 胸部摄影（chest film） CT（computed tomography） MRI（magnetic resonance imaging） DSA(digital substration angiography),The X-ray examination methods,X-ray examination methodsChest fluoroscopy,real-time imaging to free position observation of mediastinum moveme
3、nt inferior resolution,后前位 posteroanterior view,侧位：lateral view Key points：患侧靠胶片; 用于全面观察病变形态与病变定位,Notice: be taken when the PA view has be inspected,体层摄影Tomography高千伏摄影High-Kilovoltage Radiography造影检查contrast examination,X-ray examination methods special examinations,造影检查 contrast examination,Bronch
4、ography Angiography,支气管造影Bronchography,To definite a diagnosis of bronchiectasis (high resolution CT ),Pulmonary Angiography,demonstration of pulmonary emboli demonstration of pulmonary arteriovenous malformations,CT scan methods,Unenhanced CT scan Enhanced CT scan HRCT (high resolution ) Helices CT
5、 or spiral CT scan,CT（computed tomography）,密度分辨率高high Density resolution ，量化measured ，以CT值体现Hounsfield Unit （Hu）空间分辨率Spatial resolution :无前后结构重叠avoiding overlapping structures,可三维重建provided three-dimension evaluation,CT（computed tomography）,CT can find small lesions just 0.3-0.5cm in diameter show t
6、he lesions detail optimal病变的细节,CT（computed tomography）,纵隔肿瘤的定位和定性 determining tumor location and the nature With enhanced scan , CT can display the relationship of tumor and great vessels Distinguish vessels,lymph nodes and mass,MRI（magnetic resonance）,主要对纵隔肿瘤的定位和定性(tumor location and the nature)较好
7、对与心脏大血管的关系显示好(the relationship of the tumor and great vessels),二、正常胸部X线表现Normal Chest View,1 . Normal Chest Viewchest cast软组织soft tissue胸锁乳突肌（sterno-mastoid muscle）锁骨上皮肤皱褶（skin reflection overthe clavicle）胸大肌（pectoral muscle major）女性乳房及乳头（female breast and nipple） 骨 胳bony skeleton肋骨（ribs）肩胛骨（scapula
8、）锁骨（clavicle）胸骨 (sternum)胸椎（thoracic spine）,Normal Chest Viewchest cast soft tissuesterno-mastoid muscle skin reflection over the clavicle,胸壁软组织 正常乳房和乳头影,Normal Chest View,Normal Chest Viewchest cast soft tissue:pectoral muscle majorfemale breast and nipple,2. Normal Chest Viewchest cast bony skelet
9、on 肋骨ribs 肩胛骨scapula 胸骨sternum锁骨clavicle 胸椎thoracic spine,气管、支气管 Trachea and Bronchus,气管trachea,起自环状软骨 长11-13cm宽1.5-2cm 胸5-6平面分叉 分叉下壁形成气管隆突 分叉角60-85度,支气管bronchus,分级grade：main bronchuslobe bronchussegment bronchussub-segment broalveolus(主-叶-段-亚段-多级分支-肺泡) 支气管分支名称,右侧 上叶 1 尖支2后支3前支中间支气管中叶 4 外支5 内支下叶 6背支
10、7内基底支8 前基底支9外基底支10后基底支,左侧上叶 上部支气管12尖后支3前支下部支气管4上舌支（舌部） 5下舌支下叶 6背支78内前基底支9外基底支10后基底支,两侧支气管分支及差异,肺 lung,肺野（lung field）： The area into which the pulmonary organ is projected on the radiography 两肺野透明度相同，吸气时透明度增高,肺 lung,肺野（lung field）： divided into zones which do not correspond to actual lobes三带：内、中、外带三野
11、：上、中、下野,肺门（hilum）,肺门组成：主要为pulmonary arteries and veins 肺门阴影（hilar shadow）： 肺动、静脉、支气管和淋巴组织等的复合投影 X-ray features：radiopaque shadow on each side of mediastinum,Hilum：,右肺门 呈“ ”形 上部：由上肺动脉、静脉、下肺动脉干后回归支组成 下部：由右下肺动脉干（15mm）组成，内侧 为中间段支气管 肺门角：成钝角，突出为异常 左肺门由左肺动脉弓与左下肺动脉及 分支构成 左肺门较右肺门高1-2cm,X-ray manifest,肺门hilum
12、： X线表现X-ray manifest,肺门异常 hilum shadow abnormity,肺门增大 hilum shadow enlarged 肺门缩小 hilum shadow shrinked 肺门移位 hilum shadow shifted 肺门密度增高 hilum shadow density stronger,肺门增大hilum shadow enlarged,肺门缩小 hilum shadow shrinked,肺门移位 hilum shadow shifted,肺纹理 lung markings,X-ray manifest：Radiate outward from t
13、he hilum and continue to spread 下肺野纹理较上肺野粗,肺纹理 lung markings,组成component: these are made up almost entirely of vascular shadow,especially pulmonary arteries,X线特点 From thick to thin branching as tree树枝状分布；Lack lung markings in periphery外带细少,肺叶lobes,肺叶（lobes ）： three lobes in the right lung two in the
14、 leftseparated by interlobular septa,叶间裂走向及X线表现interlobular septa course andX-ray manifests,叶间裂是识别肺叶的标志,肺叶分布示意图,The interlobular septa are not visible or fine linear,叶间裂处表现为无或少血管结构的透明带,肺段（segment）,Lobes are consisted of segments from two to five The name of the segment is corresponded to bronchus 肺段
15、间有肺段静脉和结缔组织隔开,肺段(segment),正常时X线不能显示肺段界限 because of overlapping of segments 单独某肺段病变时可见肺段轮廓 Segment outline may be showed as taper shape and top forward hilum,肺小叶（lobule）,Each segment is consisted of many lobules 小叶支气管 bronchus及小叶动脉lobule artery进入小叶 小叶之间为小叶间隔 lobuls septa The diameter of a lobule is 1
16、-2.5 cm,腺泡acinus,The basic and functional unit The diameter is about 6mm 每支末梢细支气管small terminal bronchiols所支配的范围为腺泡,肺实质与肺间质 parenchyma and Interstitium,肺实质:具气体交换功能的肺泡、肺泡壁肺间质：由结缔组织组成的支架与间隙 frame and interstitial structure,纵隔mediastinum,Mediastinum Extension and constitutes,范围 : Below sternum,in front of the thoracic spine,between two side of lungs.组成 心脏、大血管、气管、支气管、淋巴组织、胸腺、神经、脂肪等Constitutes: the heart, trachea,great vessels, lymph nodes and fat etc.,
