纵隔异常诊断方法.pptVIP

后纵膈 范围 前：气管、心包后侧后缘 前下：膈面 后：脊柱 上：胸廓入口 内容物 食道，降主动脉，奇静脉，半奇静脉胸导管，迷走神经，膈神经，淋巴结，脂肪 奇静脉食管隐窝 纵膈与右肺的分界及反折 前方食管后方奇静脉 线状界限源，稍向右侧偏，凹向右侧，儿童年轻人科凸向右侧，中1/3最明显，食道内有气体是可以是带状 椎体前侧病变会“破坏”这个反折，中纵膈病变也可累计 后联合线 在奇静脉和主动脉弓上 食道后椎体前 T3-5水平，可稍下延 纵向，高于前联合线 椎体前病变可“破坏’此线 脊柱旁线 由胸膜在脊柱旁反折形成，左侧易见，由于降主动脉使得其更易显示 上纵膈脊柱旁线容易对称显示 脊柱旁线容易被椎体病变”破坏“。降主动脉病变也可改变旁线 进一步评价 发现纵膈异常，需要断层图像评价 常规运用CT MR可备用，看肿瘤囊性改变，脊柱旁，不能用CT造影剂等 总结 很多纵膈反折会出现在胸片上，识别这些反折可提高对病变的发现能力及鉴别能力 当后纵膈联合线及肺门重叠征出现时，可判断为前纵膈病变 右侧气管旁带增宽，AP窗反折凸出，提示中纵膈病变 奇静脉食管隐窝的”破坏“可以是中后纵膈病变， 椎体旁线的改变多由椎体病变及神经系统病变引起 纵膈锁骨上肿块右侧源是否清楚可判断病变是后纵隔还是前纵膈 但需要注意的是，纵膈划分是人为的，病变常可跨越纵膈”分区“，或多个区域内都有病变 * * Anterior junction line. (a) Posteroanterior chest radiograph demonstrates the anterior junction line(arrow). (b) Computed tomographic (CT) scan shows the four layers of pleura that constitute the anteriorjunction line (arrow). The interface between aerated lung and pleura allows the line to be appreciated at conventionalradiography (cf a). * Figure 3. Hilum overlay sign in a patient with lymphoma. (a) Posteroanterior chest radiograph clearly depicts the hila (white arrow), which indicates that the mass is either anterior or posterior to the hila. In addition, the descending aorta is clearly seen (black arrow), indicating that the mass is not within the posterior mediastinum. (b) Chest CT scan demonstrates an anterior mediastinal mass. The anterior junction line is obliterated, whereas the lung interfaces with the hilar vessels (arrow) and aorta (arrowhead) are preserved. * Figure 4. Epicardial fat pad. (a) Posteroanterior chest radiograph shows loss of the cardiac silhouette at the border of the right side of the heart and an epicardial fat pad with relatively low density (arrow). (b) CT scan shows the fat pad (arrow) as an area of homogeneous fat attenuation adjacent to the right border of the heart. * Figure 7. Right paratracheal stripe. (a) Posteroanterior chest radiograph shows the right paratracheal stripe (arrow). The azygos vein is seen at the inferior margin of the stripe at th