醫(yī)學影像診斷學-胸膜病變

1、胸 膜 病 變湖北醫(yī)藥學院醫(yī)學影像系醫(yī)學影像診斷學教研室徐霖 化膿性胸膜炎pyothorax化膿性細菌或結核桿菌感染導致的胸膜腔積膿Pyothorax-病理細菌直接侵犯或經(jīng)過淋巴管蔓延到胸膜胸膜水腫炎變壞死、積膿胸膜肥厚粘連Pyothorax-臨床發(fā)熱、氣急、胸痛中毒癥狀和消耗癥狀Pyothorax-影像胸腔積液：粘稠、容易形成分隔或包裹胸膜增厚：增強可見胸膜強化膿氣胸氣胸與液氣胸pneumonthorax hydropneumothoraxDL = average diameter of lungDH = average diameter of hemithorax % PTX = (1 -

2、 DL 3/DH3) X 100 少許氣胸肺壓縮約20%右肺壓縮約50%肺壓縮約80%右肺完全壓縮，肺組織萎縮于肺門部呈軟組織密度張力性氣胸CASE胸膜間皮瘤mesothelioma of pleuro起源于胸膜間皮細胞、纖維細胞分為上皮型、纖維型、混合型局限型（良性為主）、彌漫性（惡性為主）彌漫型與接觸石棉有關mesothelioma of pleuro-臨床良性可無癥狀胸痛：持續(xù)性、劇烈、逐漸加重呼吸困難、咳嗽、體重下降肺性肺大性關節(jié)炎mesothelioma of pleuro-影像胸膜結節(jié)狀影，與胸壁呈鈍角相交胸膜廣泛結節(jié)狀或不規(guī)則增厚增強掃描均勻強化T1略高信號、T2高信號胸腔積液縱

3、隔淋巴結增大胸膜腫塊的鑒別胸膜下腫瘤或結核瘤：銳角胸膜間皮瘤：多發(fā)腫塊胸膜轉移瘤：原發(fā)病灶、胸腔積液多Which of the following clinical situations require chest tube placement? A : 20 year old college student presenting with acute chest pain which has now resolved and a 30% pneumothorax on CXRB : 35 year old woman with pneumococcal pneumonia on mechan

4、ical ventilation who has developed subcutaneous emphysema without evidence for pneumothorax on her CXRC : 68 year old man with COPD who has acute worsening of his dyspnea and has a 30% pneumothorax on his CXRD : 28 year old asthmatic with worsening wheezing and dyspnea and a pneumomediastinum on CXR

5、A 56 year old man with COPD presents with worsening dyspnea. On CXR he has a pneumothorax on the right. The distance from the hilum to his chest wall is 11 cm and the distance from his hilum to the visceral pleura on the right is 8 cm. What % pneumothorax has he developed? A : 10%B : 25%C : 35%D : 6

6、0%All of the following are true about tension pneumothorax except: A : Can occur with a pneumothorax as small as 20%B : Is associated with contralateral displacement of mediastinal structuresC : Is potentially life threateningD : Requires radiologic confirmation before treatingAll of the following i

7、nvasive procedures can be complicated by iatrogenic pneumothorax except: A : Bone marrow biopsyB : Placing a right heart catheter through a subclavian approachC : Transbronchial lung biopsyD : ThoracentesisWhich of the following clinical situations is most likely to represent pneumothorax? A : Patie

8、nt with COPD who has decreased breath sounds on the leftB : Young man with a 12-hour history of pleuritic left chest pain and dyspneaC : 45 year old patient with emphysema, recently worsened dyspnea, and decreased lung marking in the right upper lung fieldD : 18 year old high school football player with mi