胸部X光判讀注意事项.PDFVIP

壢新醫院畢業後一般醫學內科訓練課程教案 胸部 X 光判讀注意事項 洪敦玫醫師 1.由內往外看, 或由外往內看, 建立順序及評估 thorax symmetry 如 soft tissue (含 chest wall, diaphragm, abdomen) ? bony skeletons ( neck-shoulder-ribs-spines) ? lung (apex-CP angle-lung-hilum) ? trachea ? heart 2.Soft tissues: breast shadow (S/P mastectomy?) Local soft tissue mass (ex: axillary LNs, neck mass…) 有無 subcutaneous emphysema? 3.Bony Skeletons: Sternum: stitches: S/P CABG lateral film: pigeon chest or funnel chest deformity Clavicles: clavicle end resorption (RA, 2nd hyperparathyroidism) Shoulder: dislocation or subacromial spur Rib/spine: metastasis or fractures, bone tumors Rib-end: 1st 要特別小心 superimposed nodules 4.Lungs: **請注意 small nodular lesions 尤其 rib, heart 及血管重疊處 Apex: 兩側對稱性 (R/O pancoast tumor, scar cancer) CP angles: blunting – effusion. thickening – fibrothorax. Lung parenchyma: alveolar infiltration: 會 confluent 在一起 Interstitial infiltration: 較少會 confluent 在一起 5.Hilum: 兩側對稱性及高度: 正常(97%) left 高於 right side. 大小: descending branch of pulmonary artery. Male: 10-16 mm, Female: 9-15 mm, 若有 displacement 及 opacity 變化考量 S/P lobectomy or collapse 6.Heart: (C/T) ratio: (spine 中線至 heart 兩邊距離)/ (thorax 橫徑) 應 0.5 **heart chamber enlargement criteria 如下: RA: PA film: (心臟右側 border 至中線距離 ) 5.5 cm RV: PA film: 心尖往上翹, lateral film: 心臟高度 1/3 (前 CP sulcus-louis angle) LA: PA film: carinal angle 75 degrees LV: PA film: 心尖往下垂, lateral film: (IVC 至心臟後緣距離) 1.8cm 7.注意 mediastinal density 及 line 8.橫膈高低位置(右側通常較左側高半個 intercostal space) 9.比較老片, 参考臨床資料如症狀,病史,檢驗報告以俾綜合診斷.