诊断学教学课件 胸部检查.pptVIP

The Lung Palpation 肺部触诊 Chest expansion 胸廓扩张度 Tracheal position 气管位置 Pleural friction feelings 胸膜摩擦感 Vocal (tactile) fremitus 语音震颤 Chest Expansion胸廓扩张度 Compare bilateral dynamic events of respiration 测定双侧呼吸动度 Abnormal Chest Expansion胸廓扩张度异常 Asymmetrical chest expansion is abnormal The abnormal side expands less and lags behind the normal side Any form of unilateral lung or pleural disease can cause asymmetry of chest expansion Global expansion decrease indicate diffuse lung or pleural disease 胸廓扩张度不对称 胸廓扩张度减小侧 为病变侧 单侧肺或胸膜疾病 均可引起 胸廓扩张度减小 对侧代偿性增强 双侧胸廓扩张度减小 两肺弥散病变 双侧胸腔积液 Tracheal Position: Mediastinum气管位置: 提示纵隔位置 Any deviation of the mediastinum is abnormal Lateral shift: The mediastinum can be either pulled or pushed away from the lesion Pull: Loss of lung volume (Atelectasis, fibrosis, agenesis, surgical resection, pleural fibrosis) Push: Space occupying lesions (pleural effusion, pneumothorax, large mass lesions) Mediastinal masses and thyroid tumors 纵隔位移提示异常 移向患侧 肺容积缩小 肺不张 肺纤维化 肺发育不良 肺切除 胸膜粘连 推向健侧 胸腔容积增大 胸腔积液 气胸 巨大占位 纵隔或甲状腺肿瘤 Tracheal Shift to Right气管右移 Pleural Friction Feelings胸膜摩擦感 Mechanism: pleural surface roughness 机制: 胸膜表面粗糙 Feeling friction like leather rubbing by breathing. 随呼吸感觉到如皮革相互摩擦 Touch in ventro-location of the thorax 胸廓下前侧部位易触及 A sign of acute pleuritis 提示胸膜炎 Tactile Fremitus语音震颤 Principle 机制 wave from tract along the lung and pleural to the chest wall 声波→气道→肺泡→胸膜腔 →胸壁振动→手掌 Influence factor 影响因素 laryngeal bulk, respiratory open, conductive medium and distance 喉音大小 气道通畅 传导介质 传导距离 Technique检查方法 From upper to lower 自上而下 From prothorax to back 由前至后 Contrast alternation 交替对比 Pathological Conditions异常改变 Weaken or disappear: Obstructive atelectasis, emphysema, Pleural effusion, pneumothorax, subcutaneous emphysema Enhanced: Consolidation of lung tissue: lobar pneumonia, pulmonary infarction.