胸片的及胸部CT的閱讀-定位.ppt

1、胸片及胸部CT的閱讀（定位診斷）,長(zhǎng)征醫(yī)院呼吸內(nèi)科 臧遠(yuǎn)勝 2009.8,Lobes,oblique fissure （major fissure）,horizontal fissure （minor fissure）,Segments and Bronchi,Each lobe is comprised of several smaller units referred to as pulmonary segments .It is important to remember that segmental anatomy is predicated on bronchial anatomy.

2、 Similar to bronchial nomenclature, each segment can be named numerically, using a S, and the same number of the corresponding bronchus that supplies it .,Segment,Bronchus,Right Lung,Left Lung,Right Lung Segments,The apical segment (or S1 segment ) is shaped like a truncated cone with its broadest b

3、ase located superiorly filling the cupula of the lung. This segment thus extends over the pulmonary apex but does not extend inferiorly to the interlobar (minor fissure) surface.,The posterior segment (S2) extends from the right hilum, posteriorly and inferiorly and forms the posterior half of the i

4、nterlobar surface relating to the right major fissure. The anterior segment (S3) of the right upper lobe, which like S2 extends from the right hilar area, is oriented anteriorly and somewhat superiorly. The anterior surface of S3 extends to the chest wall, while the broadest inferior surface borders

5、 the minor fissure which separating S3 from the right middle lobe.,The right middle lobe has two pulmonary segments which are situated side by side; the more lateral segment (S4), approximates the size of its adjacent neighbor , S5 ( medial segment). S5 near the right heart border medially, while S4

6、 extends to and comprises a portion of the lateral border of the right lung. Superiorly, both segments border the right minor fissure, and likewise, both abut the major fissure along their inferior margins. Both S4 and S5 touch the diaphragmatic surface at their anteroinferior edges. Anteriorly, bot

7、h segments are adjacent to the anterior ribs ends of the 5th, 6th, and 7th ribs.,The right lower lobe is comprised of five pulmonary segments : the superior segment (S6) is situated immediately inferior to the posterior segment of the right upper lobe (S2) from which it is separated by the right maj

8、or fissure. S6 is bordered by the major fissure anteriorly and comprises a sizeable portion of the posterior margin of the right lower lobe superiorly. It is this segment that surprisingly occupies a sizeable area behind the anterior segment (S3) of the RUL.,The posterior basal segment (S10) as its

9、name implies occupies the posterior most and inferior most portion of the right lower lobe. As such, it can be best remembered as the pulmonary segment which occupies most of the posterior costophrenic gutter. S10 also comprises a large portion of the posteromedial border of the right lower lobe and

10、 is the segment which is located immediately inferior to S6. S10 characteristically tends to be the largest segment of the right lower lobe.,Immediately anterior to S10 is the medial basal segment (S7) which typically is the smallest pulmonary segment of the lower lobe. Along its superior margin, S7

11、 forms a portion of the major fissure medially, and its location can be best thought of as being immediately inferior to the right hilum, abutting the major fissure ventrally.,Lateral to S7 is the anterior basal segment S8, which tends to be rather large in size. This segment along with S6 comprise

12、a large portion of the major fissure surface, laterally. S8 resides in a predominantly lateral location having a large peripheral surface.,The lateral basal segment (S9), located between S8 and S10 is shaped like a triangle with its base directed laterally and as such forms a portion of the lateral

13、surface of the right lower lobe. The pulmonary segments which border or touch the right hemidiaphragm are S4, S5, S7, S8, S9, and S10. S8 and S10 have the largest surface areas abutting the diaphragm.,Left Lung Segments,(S1+2) represents a combination of the two separate (apical and posterior) segme

14、nts seen on the right upper lobe. It is referred to as the apical posterior segment. Combined, S1+2 anatomically is similar in shape to the two segments on the right.,The S3 or anterior segment also is similar to the right S3 segment, having a large area directed anteriorly.,On the left there is no

15、middle lobe; the anatomical equivalent region corresponding to the right middle lobe is known as the lingula, and like the RML, is also composed of two segments. Unlike their counterparts on the right however, the segments are stacked one on top of another, rather than side by side.,The superior lin

16、gular segment (S4) is positioned immediately inferior to S3 and is directly above the inferior lingular segment (S5). Both lingular segments have their greatest area directed anteriorly and inferiorly. Additionally, S4 tends to have more area directed laterally while S5 has more area directed medial

17、ly, abutting the mediastinum. Both segments extend anteroinferiorly to reach the ventral surface of the left hemidiaphragm, and hence border a large portion of the anteroinferior surface of the major fissure.,The left lower lobe segmental architecture is similar to that of the right lower lobe, howe

18、ver because the anterior and medial basal segments share a common bronchial supply, these two segments are characteristically combined, forming an anterior medial basal segment (S8). Therefore, the anterior segment is combined with the medial segment but may be denoted by SX7. The anterior medial basal segment is bordered anteriorly by the interlobar (major fissure), and abuts the visceral pleural surfaces of the two lingular segments located anterosuperiorly.,Forming the remainder of the interlobar surface is the superior segment (S6). S6 is iden