胸部外伤影像.ppt

1、同济医院放射科胸部外伤很常见急性外伤 慢性外伤原因：车祸 挤压 刀伤 火器 爆炸部位：胸壁软组织 肋骨 胸骨 胸膜 肺 气管 纵膈常规X线是诊断基础胸壁外伤外伤性气胸 液气胸肺挫伤 撕裂伤气管、支气管损伤A rib fracture is a break in a rib bone. Bruised muscles and ligaments often happen with a rib fracture. More seriously, the lungs and other organs can be injured. More than one rib fracture after a

2、 trauma can indicate serious internal injury.Fractures of the 1st Rib are very rare because the 1st Rib is very well protected by the Shoulder and Clavicle.Fractures to Rib 2 through Rib 4 are relatively rare because these Ribs are generally smaller and stronger than Ribs 5 throught Rib 12 .5thRib-1

3、0thRibFractures Rib 5 through Rib 10 are the most common Ribs Fractured in blunt force trauma.11th-12thRibFractures Rib 11 and Rib 12 are most commonly injured with blunt force trauma to the lower backCT scan shows the herniation of lung tissue (arrowhead) through a fracture of the right third costo

4、chondral junction (arrow).Three-dimensional CT image clearly depicts the lung herniation (arrowhead).一般由直接暴力的冲击所致，如车祸时方向盘向司机胸部撞击。 临床表现 胸骨处肿胀、压痛。 影像学表现 多为横断形，可有两处以上骨折线，并可发生移位。一般于侧位片显示更佳。Sternal body fracture with retrosternal hematomaSternal trauma. Right sagittal volume-rendered image clearly depict

5、s a midbody, depressed sternal fracture (arrow).A traumatic pneumothorax may result from either blunttrauma or penetratinginjuryto the chest wall. The most common mechanism is due to sharp bony points at a new ribfracture penetrating pleura and damaging lung tissue. Traumatic pneumothorax may also b

6、e observed in those exposed to an explosiveblast, even if no visible injury to the chest is apparent.Medical procedures of the chest, such as the insertion of a centralvenouscatheterinto one of the chest veins or the taking of biopsysamplesfrom lung tissue, may lead to pneumothorax.The size of the p

7、neumothorax can be determined with a reasonable degree of accuracy by measuring the distance between the chest wall and the lung. An air rim of 2cmmeans that the pneumothorax occupies about 50%ofthehemithorax.肺野外侧受压1/4时，肺组织大约受压35%；当受压至1/3时，肺组织受压50%；当受压1/2时，肺组织受压65%；当受压至2/3时，肺组织受压80%；而当肺组织全部被压缩至肺门，呈软

8、组织 密 度 时 ， 肺 组 织 受 压 约 为 9 5 % 。计算肺压缩比例的方法：面积法体积法三线法 2.2+3.65*(a+b+c)abc CTscanningcan provide a more accurate determination of the size of the pneumothorax.In secondary pneumothorax it can help to identify most of the causes.A haemothorax, pneumothorax or both can occur if the chest wall is punctur

9、ed.If the chest wall, and thus the pleural space, is punctured, blood, air or both can enter the pleural space. Air/blood rushes into the space in order to equalise the pressure with that of the atmosphere.Air/blood rushes into the space in order to equalise the pressure with that of the atmosphere.

10、A pulmonarycontusion is a contusion (bruise) of the lung, caused by chest trauma. As a result of damage to capillaries, blood and other fluids accumulate in the lung tissue. The excess fluid interferes with gas exchange, potentially leading to inadequate oxygen levels (hypoxia). X线胸片是诊断肺挫伤的重要手段。约70%

11、病例在伤后1小时内出现，30%病例可延迟到伤后46小时，斑点状浸润、弥漫性或局部斑点融合浸润、以致弥漫性单肺或双肺大片浸润或实变阴影。治疗后一般在伤后23天开始吸收，完全吸收需23周以上。A chest X-ray showing right sided pulmonary contusion associated with rib fractures and subcutaneous emphysemaUnlike pulmonary laceration, another type of lung injury, pulmonary contusion does not involve a

12、 cut or tear of the lung tissue.Unlike pulmonary laceration, another type of lung injury, pulmonary contusion does not involve a cut or tear of the lung tissue.A chest CT scan revealing pulmonary contusions, pneumothorax, and pseudocysts. Pulmonary contusion. Axial (a) and coronal reformatted (b) CT

13、 images show the characteristic features of pulmonary contusion: nonsegmental patchy airspace opacities in the lung periphery (*) with thin subpleural sparing (arrows in b). Pulmonary contusion. Axial (a) and coronal reformatted (b) CT images show the characteristic features of pulmonary contusion:

14、nonsegmental patchy airspace opacities in the lung periphery (*) with thin subpleural sparing (arrows in b). 胸部闭合性创伤可引起肺组织的撕裂伤。轻度的撕裂伤表现和肺挫伤相同，不易发现。较大的撕裂伤，肺组织破裂后可形成囊肿，囊肿内有液平和气体，如完全被血液所充满即形成血肿。Pulmonary laceration may not be visible using chest x-rayCT scanning is more sensitive and better at detectin

15、g pulmonary On a CT scan, pulmonary lacerations show up in a contused area of the lung, typically appearing as cavities filled with air or fluid that usually have a round or ovoid shape due to the lungs elasticity.气管裂伤常发生在近隆突处支气管裂伤大多在主支气管离隆突12cm处成年人常并发第13肋骨前段骨折临床呼吸困难，可有明显咯血X线：纵膈气肿、皮下气肿及气胸等间接征象。肺不张。C

16、T：优于X线。可重建支气管树。Axial (a) and coronal reformatted (b) CT images show a tear (long arrow) in the posterior wall of the right intermediate bronchus with an air leak into the mediastinum (*) and a small right pneumothorax. Short arrows indicate multiple pulmonary lacerations in the right lung against a

17、background of extensive bilateral pulmonary contusions. Axial (a) and coronal reformatted (b) CT images show a tear (long arrow) in the posterior wall of the right intermediate bronchus with an air leak into the mediastinum (*) and a small right pneumothorax. Short arrows indicate multiple pulmonary

18、 lacerations in the right lung against a background of extensive bilateral pulmonary contusions. CT scan shows a traumatic hemopericardium (arrowheads).a pericardial laceration with pneumopericardium (arrows in a) resulting from extension of a left pneumothorax (*) into the pericardial space.Traumatic pseudoaneurysm of the proximal descending thoracic aorta.