超声chestecho超音波用於胸腔急症.pptxVIP

第1页/共25页超声chestecho超音波用於胸腔急症第2页/共25页胸腔急症的超音波診斷第3页/共25页Chest Radiograph in Critically Ill PatientsToo weak to sit up and air-fluid level will be visibleunable to inspirate fully because of sedation, consciousness change, pain or fatigueunrecognized rotation of bodymobile radiographic equipment has low powertechniques and target-film distances varyMirvis SE. Thoracic CT in detecting occult diseasein critically ill patients. AJR 1987;148:685-9第4页/共25页Diagnostic Ultrasonography in the Emergency Department RadiologyMore timely medical imaging of unstable patientshypotension of unknown etiologycardiac tamponadepulmonary embolismaortic aneurysm…Critically time-sensitive proceduresPortable, fast, noninvasive, safe, inexpensive and provides anatomic and functional informationAnn Emerg Med March 1993;592-3第5页/共25页Ultrasound in EM The J of EM Med 2007TraumaIdentification of pregnancyCardiacRUQ abdomenRenalAortaProcedureCVPSubcutaneous FB detectionThoracentesis and paracentesis第6页/共25页Diagnostic and Therapeutic Use of Chest Sonography: value in Critically ill patientsPleural diseasesperipheral parenchymal lesionsmediastinal lesionsconsolidationatelectasistransthoracic aspiration biopsyassisting the diagnosis and management of critically ill patients whose chest radiographs were difficult to interpretCJ Yu. AJR 159:695-701, Oct. 1992 第7页/共25页肺部急症的超音波診斷一、前言二、探測方法三、肋膜腔、縱膈、肺臟的正常超音波 表現四、肋膜腔疾病的超音波表現五、縱膈疾病的超音波表現六、肺部疾病超音波表現第8页/共25页前言急性胸腔部疾病: CXR CT and MRI超音波便捷、安全、快速之輔助佐以胸腔放液、腫瘤抽吸等技術更加提高快速治療及診斷率肋膜疾病、周邊肺實質病變、縱膈腔疾患、心胞膜病變和橫膈病變等第9页/共25页探 測 方 法儀器選擇(with color doppler is better)2.5 - 5 MHz for pleura and lung5 - 7.5 MHz for chest wall masses and adenopathy檢查前準備CXR, CT scan, MRI if available 體位檢查方法第10页/共25页Transducer Positions A: suprasternalB: transosseousC: intercostalD: subxyphoidE: subcostalAJR 134:1019-27, May 1980第11页/共25页肋膜腔、縱膈、肺臟的正常超音波圖縱膈大血管及心臟。aortic arch。兒童或嬰兒期，偶可見胸腺一葉或兩葉增大，外有包膜，內為均質低回聲區。肺臟充滿氣體，強回聲反射，後方衰減，不能顯示其內部構造及回聲狀態。肋膜很薄，超音波難以顯示。往往在胸壁後顯示肺的強反射。Comet-tail sign.第12页/共25页急性肋膜腔疾病的超