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1、10:40,38,1,Radiodiagnosis in the Circulatory System,广医二院放射科 侯仲军,Department of Radiology The Second Hospital of Guangzhou Medical University,10:40,38,2,Questions,1.How to take the radiographies of PA and LA? 2.What are the normal findings of the lung ? 3.How to demarcate the lung fields and pulmonary
2、 zones? 4.To describe the lung anatomy. 5.To describe lesions in mass and exudation in the lung.,10:40,38,3,Techniques,PA,LL,10:40,38,4,Normal Chest Films,10:40,38,5,Description of Normal Chest Films,The thoracic cage remains symmetrical. All the seen bones are nothing remarkable. The soft tissues a
3、re completely intact in the root of the neck and thoracic wall. The trachea locates centrally without deviation. The lungs are clear, while the lung markings are natural and regular. Both pulmonary hila show neither enlargement nor decrease. The heart and great vessels appear normal in their positio
4、n, size and shape. The diaphragm has a smooth surface with sharp costophrenic angles.,10:40,38,6,Description of pulmonary tumors,There are two soft tissue masses in the right lung. One locates in the inferior margin of the right upper lobe, and other is in the inferior part of right pulmonary hilum.
5、 The margin of the mass in the right upper lung reveals evident spiculation, however, the margin of the right hilar mass is smooth. The densities of the masses are uniform in the right upper lung and the right hilum seperately.,10:40,38,7,Aim and Requirements,1.To make familiar with normal X-ray fin
6、dings in the heart. 2. To make familiar with X-ray finding in enlargement of the ventricles and atria of the heart. 3.To know well the changes of pulmonary blood volume.,10:40,38,8,Heart,A hollow muscular cone-shaped organ, lying between the lungs with pointed end (apex) directed downwards, forwards
7、, and to the left. The heart is about the size of a closed fist. Its wall consists largely of cardiac muscle (myocardium, there are two types of cardic myocytes, autorhythmic and contractile kntrktail ), lined and surrounded by membranes (endocardium .enduk:dim and pericardium .perik:dim ).,10:40,38
8、,9,It is divided by septum into separate right and left halves, each of which is divided into an upper atrium eitrim and a lower ventricle ventrikl . Deoxygenated blood from the vena cava passes through the right atrium to the right ventricle. This contracts and pumps blood to the lungs via the pulm
9、onary artery. The newly oxygenated blood returns to the left atrium via the pulmonary veins and passes through to the left ventricle. This forcefully contracts, pumping blood out to the body via the aorta. The direction of blood flow within the heart is controlled by valves vlvs .,10:40,38,10,10:40,
10、38,11,10:40,38,12,10:40,38,13,Cardiac Teleradiograph,10:40,38,14,CT,High density resolution High spatial resolution High temporal resolution Spiral CT EBCT,10:40,38,15,10:40,38,16,Aortic Dissecting Aneurysm tunica intima, tunica media,tunica adventitia,10:40,38,17,10:40,38,18,10:40,38,19,MRI,High ti
11、ssue resolution One-stop shop Morphology Function Viability,10:40,38,20,10:40,38,21,MR,FUNCTION,ANATOMY,FLOW,VIABILITY,PERFUSION,METABOLISM,MR ANGIOGRAPHY,10:40,38,22,CE-MRPA,10:40,38,23,Cardioangiography,DSA， digital subtraction angiography Gold standard for CAD Intenvention Diagnosis and treatment
12、,10:40,38,24,Ventriculography,Systole,Diastole,sist.li: daistli,10:40,38,25,10:40,38,26,Cardiothoracic Ratio,10:40,38,27,The cardiothoracic ratio=(T1T2) / T,Calculation of the cardiothoracic ratio has been the simplest and most frequently used method for measurement of the heart. The ratio is define
13、d as the value of the transverse dimension of the heart divided by the inner dimension of the thoracic cavity at the level of crossing the dome of the right hemidiaphragm.,10:40,38,28,Value of the Ratio,On PA, relation between size of the heart and the cardiothoracic ratio Normal heart less than 0.5
14、2 Slight enlargement 0.520.55 Moderate enlargement 0.560.60 Severe enlargement more than 0.60,10:40,38,29,PA LL,10:40,38,30,RAO LAO,10:40,38,31,Enlargement of the left ventricle,PA LL LAO LAO,10:40,38,32,Enlargement of the left ventricle,On PA and LL, the extension of the left ventricle develops lef
15、tward along the posteroinferior direction. The LAO is suitable for observation of the enlargement in the left ventricle, the efferent tract of the left heart and distortion and elevation of the aorta.,10:40,38,33,Enlargement of the left atrium,PA LL LL LL,10:40,38,34,Enlargement of the left atrium,O
16、n PA, there is the double contour sign on the right border and a shadow with 4 arches on the left margin of the heart. The enlarged left atrium compresses the esophagus in distortion and displacement on LL.,10:40,38,35,Enlargement of the right ventricle,PA LL RAO LAO,10:40,38,36,Enlargement of the r
17、ight ventricle,On PA, the enlarged right ventricle extends to both sides with elevation of the cardiac apex. The segment of the pulmonary artery protrudes obviously. On LL view, the precardiac space decreases or disappears. The interface between the right ventricle and the sternum occupies more than
18、 1/3 of the height of the sternum. On RAO view, the film can show bulging of the segment of the pulmonary artery and enlargement of the right ventricle. On LAO view, the precardiac and postcardiac spaces become narrow.,10:40,38,37,Enlargement of the right atrium,PA RAO LAO LL,10:40,38,38,Enlargement
19、 of the right atrium,On PA view, there is a bulging in the second arch of the right heart border. The value of a/b can be more than 1/2. On RAO view, the postcardiac space decreases in the inferior one second of the retrocardiac clearance without compression and displacement of the esophagus. On LAO
20、, the space is occupied by a bulging of the anterosuperior border of the heart. On LL view, the enlarged right atrium is not easily found due to overlapping.,10:40,38,39,Changes of pulmonary blood volume,a. Diameter of the right inferior pulmonary artery: The diameter is no more than 1.5 cm in the r
21、ight lower pulmonary artery in the normal state, which is measured at the inferior margin in the intersection between the right inferior pulmonary artery and the right superior pulmonary vein (Fig. 3-32).,10:40,38,40,10:40,38,41,b. Pulmonary arterial congestion,Pulmonary arteries have been broadened
22、 in all its trunks and branches. Pulmonary venous pleonaemia refers to the situation that excessive blood stagnates in the pulmonary veins. So, the lung fields have an attenuated radiolucency and seem like ground glass. Redistribution of the pulmonary blood may happen between the upper and the lower
23、 lung fields. Doctors should be watchful for the signs of pulmonary arterial hypertension and the sign of pulmonary hilar dance under fluoroscopy.,10:40,38,42,Ventricalar Septa Defect,10:40,38,43,Pulmonary Oligaemia lidi:mi,The cause is based on the suffocation of the right cardiac output, or accomp
24、anied by the right to left shunt, and pulmonary hypertension, or obstruction of the pulmonary artery and its branches.,10:40,38,44,X-ray Findings,1) Pruning, sparseness of lung markings,. 2) Decrease of the hilum. The pulmonary segment may dominant. 3) Increased translucency of the lung field. 4) Re
25、ticular net in the lung field because of the collateral circulation.,10:40,38,45,Questions,1) Please list the main examination methods of the heart and great vessels. 2) Please list the examination positions of X-ray in the heart. 3) What the cardiothoracic ratio and its significance? 4) Please describe the X-ray findings of pulmonary blood congestion.,10:40,38,46,Any advices and suggestions are warmly welcome! Cell-phone:13694208683 ,Thank You Very Much,