Transcript
April 17, 2015 1
CAÙC DAÁU HIEÄU X QUANG LOÀNG NGÖÏC
BS.NGUYEÃN QUYÙ KHOAÙNG
BS.NGUYEÃN QUANG TROÏNG
KHOA CHAÅN ÑOAÙN HÌNH AÛNH
BEÄNH VIEÄN AN BÌNH -TP.HCM
2 April 17, 2015
DAØN BAØI Ñaïi cöông. 1.Daáu hieäu boùng bôø (Silhouette sign). 2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign). 3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng (Thoraco-abdominal sign or Iceberg sign). 4.Daáu hieäu caùnh buoàm (Sail sign). 5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi (Hilum overlay sign & Hilum convergence sign). 7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign). 8.Daáu hieäu S-Golden (S-Golden’s sign). 9.Daáu hieäu lieàm khí (Air crescent sign). 10.Daáu hieäu luftsichel (Luftsichel sign). 11.Daáu hieäu phaúng eo (Flat waist sign).
3 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
4 April 17, 2015
DAØN BAØI Ñaïi cöông. 1.Daáu hieäu boùng bôø (Silhouette sign). 2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign). 3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng (Thoraco-abdominal sign or Iceberg sign). 4.Daáu hieäu caùnh buoàm (Sail sign). 5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi (Hilum overlay sign & Hilum convergence sign). 7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign). 8.Daáu hieäu S-Golden (S-Golden’s sign). 9.Daáu hieäu lieàm khí (Air crescent sign). 10.Daáu hieäu luftsichel (Luftsichel sign). 11.Daáu hieäu phaúng eo (Flat waist sign).
5 April 17, 2015
ÑAÏI CÖÔNG
Caùc daáu hieäu X quang chính laø trieäu chöùng hoïc X quang giuùp ta ñöa ra nhöõng chaån ñoaùn chính xaùc. Coù daáu hieäu chung cho moät soá beänh lyù,nhöng cuõng coù nhöõng daáu hieäu ñaëc hieäu cho moät beänh lyù. Rieâng veà loàng ngöïc,cho ñeán nay ñaõ coù nhieàu daáu hieäu ñöôïc ñöa ra vaø seõ ñöôïc tieáp tuïc boå sung theo thôøi gian.
6 April 17, 2015
DAØN BAØI Ñaïi cöông. 1.Daáu hieäu boùng bôø (Silhouette sign). 2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign). 3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng (Thoraco-abdominal sign or Iceberg sign). 4.Daáu hieäu caùnh buoàm (Sail sign). 5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi (Hilum overlay sign & Hilum convergence sign). 7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign). 8.Daáu hieäu S-Golden (S-Golden’s sign). 9.Daáu hieäu lieàm khí (Air crescent sign). 10.Daáu hieäu luftsichel (Luftsichel sign). 11.Daáu hieäu phaúng eo (Flat waist sign).
7 April 17, 2015
DAÁU HIEÄU BOÙNG BÔØ SILHOUETTE SIGN
Daáu hieäu naøy ñöôïc ñöa ra vaøo naêm 1935 bôûi Dr.H.Kennon Dunham,sau ñoù ñöôïc phaùt trieån bôûi Benjamin Felson. Ñònh nghóa: Moät boùng môø trong loàng ngöïc coù ñaäm ñoä dòch, tieáp xuùc veà maët giaûi phaãu vôùi bôø cuûa caùc caáu truùc coù ñaäm ñoä dòch trong loàng ngöïc (tim,ñoäng maïch chuû,voøm hoaønh) seõ xoùa bôø tieáp xuùc vôùi nhau.Ngöôïc laïi,neáu khoâng tieáp xuùc veà maët giaûi phaãu thì bôø cuûa caùc caáu truùc ñoù vaãn hieän roõ treân phim cho duø coù choàng laáp leân nhau. Khi coù hieän töôïng xoùa bôø ta goïi laø Silhouette sign (+). Khi khoâng xoùa bôø ta goïi laø Silhouette sign (-).
8 April 17, 2015
DAÁU HIEÄU BOÙNG BÔØ SILHOUETTE SIGN
Ñaây laø daáu hieäu cô baûn vaø quan troïng nhaát trong X quang loàng ngöïc qui öôùc. Trong moät soá tröôøng hôïp,noù giuùp chuùng ta ñònh vò ñöôïc caùc boùng môø trong loàng ngöïc maø khoâng caàn ñeán phim ngöïc nghieâng.
9 April 17, 2015
DAÁU HIEÄU BOÙNG BÔØ SILHOUETTE SIGN
BOÙNG (SILHOUETTE) THUØY HOAËC PHAÂN THUØY TIEÁP XUÙC
Voøm hoaønh (P). Caùc phaân thuøy ñaùy - thuøy döôùi phoåi (P).
Bôø tim (P). Phaân thuøy trong (medial) - thuøy giöõa phoåi (P)
ÑMC leân. Phaân thuøy tröôùc - thuøy treân phoåi (P).
Quai ÑMC. Phaân thuøy sau - thuøy treân phoåi (T).
Bôø (T) tim. Phaân thuøy döôùi (inferior) - thuøy löôõi (lingula).
ÑMC xuoáng. Phaân thuøy ñænh & trong – thuøy döôùi phoåi (T).
Voøm hoaønh (T). Caùc phaân thuøy ñaùy - thuøy döôùi phoåi (T).
10 April 17, 2015
DAÁU HIEÄU BOÙNG BÔØ SILHOUETTE SIGN
SILHOUETTE SIGN (+) SILHOUETTE SIGN (-)
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
11 April 17, 2015
SILHOUETTE SIGN (+) SILHOUETTE SIGN (-)
12 April 17, 2015
DAÁU HIEÄU BOÙNG BÔØ SILHOUETTE SIGN
PHIM NGÖÏC NGHIEÂNG:
1.Voøm hoaønh (T) khoâng coøn thaáy ôû phaàn tieáp xuùc boùng tim.
2.Voøm hoaønh (P) ñöôïc thaáy toaøn boä töø sau ra tröôùc.
13 April 17, 2015
DAÁU HIEÄU BOÙNG BÔØ SILHOUETTE SIGN
SILHOUETTE SIGN (+): THYMUS
14 April 17, 2015
DAÁU HIEÄU BOÙNG BÔØ SILHOUETTE SIGN
SILHOUETTE SIGN (+): TRAØN DÒCH MAØNG PHOÅI (P)
15 April 17, 2015
DAÁU HIEÄU BOÙNG BÔØ SILHOUETTE SIGN
SILHOUETTE SIGN (+): XEÏP THUØY GIÖÕA (P)
16 April 17, 2015
DAÁU HIEÄU BOÙNG BÔØ SILHOUETTE SIGN
SILHOUETTE SIGN (+): XEÏP THUØY LÖÔÕI A.J.Chandrasekhar,M.D.Chest X-ray Atlas.
17 April 17, 2015
DAÁU HIEÄU BOÙNG BÔØ SILHOUETTE SIGN
SILHOUETTE SIGN (+)
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
18 April 17, 2015
DAÁU HIEÄU BOÙNG BÔØ SILHOUETTE SIGN
SILHOUETTE SIGN (-)
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
19 April 17, 2015
DAÁU HIEÄU BOÙNG BÔØ SILHOUETTE SIGN
SILHOUETTE SIGN (-)
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
20 April 17, 2015
DAÁU HIEÄU BOÙNG BÔØ SILHOUETTE SIGN
SILHOUETTE SIGN (-): TRAØN DÒCH MAØNG PHOÅI KHU TRUÙ PHÍA SAU
21 April 17, 2015
DAØN BAØI Ñaïi cöông. 1.Daáu hieäu boùng bôø (Silhouette sign). 2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign). 3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng (Thoraco-abdominal sign or Iceberg sign). 4.Daáu hieäu caùnh buoàm (Sail sign). 5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi (Hilum overlay sign & Hilum convergence sign). 7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign). 8.Daáu hieäu S-Golden (S-Golden’s sign). 9.Daáu hieäu lieàm khí (Air crescent sign). 10.Daáu hieäu luftsichel (Luftsichel sign). 11.Daáu hieäu phaúng eo (Flat waist sign).
22 April 17, 2015
DAÁU HIEÄU COÅ NGÖÏC CERVICO-THORACIC SIGN
Bình thöôøng ñænh phoåi cao leân töø tröôùc ra sau.Bôø treân cuûa trung thaát tröôùc keát thuùc ngang möùc xöông ñoøn. Do vaäy,bôø treân moät boùng môø trung thaát bieán maát khi gaëp xöông ñoøn thì coù nghóa laø boùng môø naèm moät phaàn ôû coå,moät phaàn ôû trung thaát tröôùc.Luùc naøy ta goïi laø Cervico-thoracic sign (+):beänh lyù thöôøng gaëp laø Böôùu giaùp thoøng. Ngöôïc laïi,moät boùng môø trung thaát thaáy roõ ôû phía treân xöông ñoøn thì noù phaûi naèm ôû trung thaát sau.Luùc naøy ta goïi laø Cervico-thoracic sign (-):beänh lyù thöôøng gaëp laø Neurinoma.
23 April 17, 2015
DAÁU HIEÄU COÅ NGÖÏC CERVICO-THORACIC SIGN
B:CERVICO-THORACIC SIGN (+) A:CERVICO-THORACIC SIGN (-)
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
24 April 17, 2015
DAÁU HIEÄU COÅ NGÖÏC CERVICO-THORACIC SIGN
CERVICO-THORACIC SIGN (+): BÖÔÙU GIAÙP THOØNG
25 April 17, 2015
DAÁU HIEÄU COÅ NGÖÏC CERVICO-THORACIC SIGN
CERVICO-THORACIC SIGN (+): BÖÔÙU GIAÙP THOØNG
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
26 April 17, 2015
DAÁU HIEÄU COÅ NGÖÏC CERVICO-THORACIC SIGN
CERVICO-THORACIC SIGN (-): NEUROBLASTOMA
27 April 17, 2015
DAÁU HIEÄU COÅ NGÖÏC CERVICO-THORACIC SIGN
CERVICO-THORACIC SIGN (-): NEURINOMA
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
28 April 17, 2015
DAÁU HIEÄU COÅ NGÖÏC CERVICO-THORACIC SIGN
CERVICO-THORACIC SIGN (-) àPOSTERIOR MEDIASTINUM + CALCIFICATION à NEUROBLASTOMA
29 April 17, 2015
DAØN BAØI Ñaïi cöông. 1.Daáu hieäu boùng bôø (Silhouette sign). 2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign). 3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng (Thoraco-abdominal sign or Iceberg sign). 4.Daáu hieäu caùnh buoàm (Sail sign). 5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi (Hilum overlay sign & Hilum convergence sign). 7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign). 8.Daáu hieäu S-Golden (S-Golden’s sign). 9.Daáu hieäu lieàm khí (Air crescent sign). 10.Daáu hieäu luftsichel (Luftsichel sign). 11.Daáu hieäu phaúng eo (Flat waist sign).
30 April 17, 2015
DAÁU HIEÄU NGÖÏC-BUÏNG THORACO-ABDOMINAL SIGN (ICEBERG SIGN)
Döïa treân daáu hieäu boùng bôø ngöôøi ta ñöa ra daáu hieäu naøy ñeå ñònh vò moät boùng môø trung thaát sau. Neáu bôø döôùi cuûa moät boùng môø trung thaát ñi xa daàn coät soáng roài bieán maát trong ñaäm ñoä dòch cuûa oå buïng,thì boùng môø naøy naèm trong oå buïng (phaàn chìm cuûa taûng baêng) vôùi phaàn noåi cuûa taûng baêng naèm trong loàng ngöïc.Ta goïi laø Iceberg sign (+). Neáu bôø döôùi cuûa boùng môø vaãn thaáy roõ vaø hoäi tuï veà phía coät soáng thì boùng môø naøy naèm hoaøn toaøn trong loàng ngöïc.Ta goïi laø Iceberg sign (-).
31 April 17, 2015
DAÁU HIEÄU NGÖÏC-BUÏNG THORACO-ABDOMINAL SIGN (ICEBERG SIGN)
ICEBERG SIGN (+) ICEBERG SIGN (-)
32 April 17, 2015
DAÁU HIEÄU NGÖÏC-BUÏNG THORACO-ABDOMINAL SIGN (ICEBERG SIGN)
ICEBERG SIGN (+)
NEUROBLASTOMA
33 April 17, 2015
DAÁU HIEÄU NGÖÏC-BUÏNG THORACO-ABDOMINAL SIGN (ICEBERG SIGN)
ICEBERG SIGN (+) :NEUROBLASTOMA
34 April 17, 2015
DAÁU HIEÄU NGÖÏC-BUÏNG CHAÅN ÑOAÙN PHAÂN BIEÄT
ICEBERG SIGN (+) : NEUROBLASTOMA
BOÙNG MÔØ TAM GIAÙC SAU TIM: XEÏP THUØY DÖÔÙI PHOÅI (T)
35 April 17, 2015
DAÁU HIEÄU NGÖÏC-BUÏNG THORACO-ABDOMINAL SIGN (ICEBERG SIGN)
ICEBERG SIGN (-) : NEUROBLASTOMA
36 April 17, 2015
DAÁU HIEÄU NGÖÏC-BUÏNG THORACO-ABDOMINAL SIGN (ICEBERG SIGN)
ICEBERG SIGN (-): NEURINOMA
37 April 17, 2015
DAØN BAØI Ñaïi cöông. 1.Daáu hieäu boùng bôø (Silhouette sign). 2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign). 3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng (Thoraco-abdominal sign or Iceberg sign). 4.Daáu hieäu caùnh buoàm (Sail sign). 5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi (Hilum overlay sign & Hilum convergence sign). 7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign). 8.Daáu hieäu S-Golden (S-Golden’s sign). 9.Daáu hieäu lieàm khí (Air crescent sign). 10.Daáu hieäu luftsichel (Luftsichel sign). 11.Daáu hieäu phaúng eo (Flat waist sign).
38 April 17, 2015
DAÁU HIEÄU CAÙNH BUOÀM SAIL SIGN
n Boùng tuyeán öùc bình thöôøng (normal thymus) ôû treû döôùi 3 tuoåi ñoâi khi bò chaån ñoaùn laàm laø khoái u trung thaát.
n Hình aûnh thaáy ñöôïc treân X quang raát ña daïng,trong ñoù daáu hieäu caùnh buoàm laø ñieån hình.
39 April 17, 2015
DAÁU HIEÄU CAÙNH BUOÀM SAIL SIGN
THYMIC SAIL SIGN
40 April 17, 2015
41 April 17, 2015
THYMIC SAIL SIGN
Caáu truùc hoài aâm luoân luoân ñaëc, ñoàng daïng
42 April 17, 2015
DAØN BAØI Ñaïi cöông. 1.Daáu hieäu boùng bôø (Silhouette sign). 2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign). 3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng (Thoraco-abdominal sign or Iceberg sign). 4.Daáu hieäu caùnh buoàm (Sail sign). 5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi (Hilum overlay sign & Hilum convergence sign). 7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign). 8.Daáu hieäu S-Golden (S-Golden’s sign). 9.Daáu hieäu lieàm khí (Air crescent sign). 10.Daáu hieäu luftsichel (Luftsichel sign). 11.Daáu hieäu phaúng eo (Flat waist sign).
43 April 17, 2015
DAÁU HIEÄU CHE LAÁP ROÁN PHOÅI & DAÁU HIEÄU HOÄI TUÏ ROÁN PHOÅI HILUM OVERLAY SIGN & HILUM CONVERGENCE SIGN
Daáu hieäu naøy ñöôïc ñöa ra bôûi Benjamine Felson. Khi ñoïc phim oâng ta nhaän thaáy raèng roán phoåi hai beân naèm caïnh boùng tim hoaëc ngay trong bôø cuûa boùng tim ôû 98% tröôøng hôïp,chæ coù 2% tröôøng hôïp roán phoåi naèm chìm trong bôø boùng tim # 1cm.Moái quan heä naøy vaãn giöõ nguyeân khi coù Traøn dòch maøng tim,Tim to hoaëc Phình ÑMP. Moät boùng môø trung thaát tröôùc coù theå laàm vôùi Traøn dòch maøng tim,Tim to hoaëc Phình ÑMP. n Ta noùi Hilum convergence sign (+): Khi boùng roán phoåi
naèm ngay bôø boùng tim à Traøn dòch maøng tim,Tim to hoaëc Phình ÑMP.
n Ta noùi Hilum overlay sign (+): Khi boùng roán phoåi ôû saâu >1cm trong bôø boùng tim à Boùng môø trung thaát tröôùc.
44 April 17, 2015
DAÁU HIEÄU CHE LAÁP ROÁN PHOÅI & DAÁU HIEÄU HOÄI TUÏ ROÁN PHOÅI HILUM OVERLAY SIGN & HILUM CONVERGENCE SIGN
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
45 April 17, 2015
DAÁU HIEÄU CHE LAÁP ROÁN PHOÅI & DAÁU HIEÄU HOÄI TUÏ ROÁN PHOÅI HILUM OVERLAY SIGN & HILUM CONVERGENCE SIGN
HILUM CONVERGENCE SIGN: PHÌNH ÑOÄNG MAÏCH PHOÅI (T)
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
46 April 17, 2015
HILUM CONVERGENCE SIGN: TAÊNG AÙP ÑOÄNG MAÏCH PHOÅI / ÑAÛO NGÖÔÏC
PHUÛ TAÏNG
47 April 17, 2015
DAÁU HIEÄU CHE LAÁP ROÁN PHOÅI & DAÁU HIEÄU HOÄI TUÏ ROÁN PHOÅI HILUM OVERLAY SIGN & HILUM CONVERGENCE SIGN
HILUM OVERLAY SIGN: TERATOMA
48 April 17, 2015
DAÁU HIEÄU CHE LAÁP ROÁN PHOÅI & DAÁU HIEÄU HOÄI TUÏ ROÁN PHOÅI HILUM OVERLAY SIGN & HILUM CONVERGENCE SIGN
HILUM OVERLAY SIGN: THYMOMA
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
49 April 17, 2015
DAÁU HIEÄU CHE LAÁP ROÁN PHOÅI & DAÁU HIEÄU HOÄI TUÏ ROÁN PHOÅI HILUM OVERLAY SIGN & HILUM CONVERGENCE SIGN
HILUM OVERLAY SIGN: TERATOMA
A.J.Chandrasekhar,M.D.Chest X-ray Atlas.
50 April 17, 2015
DAØN BAØI Ñaïi cöông. 1.Daáu hieäu boùng bôø (Silhouette sign). 2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign). 3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng (Thoraco-abdominal sign or Iceberg sign). 4.Daáu hieäu caùnh buoàm (Sail sign). 5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi (Hilum overlay sign & Hilum convergence sign). 7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign). 8.Daáu hieäu S-Golden (S-Golden’s sign). 9.Daáu hieäu lieàm khí (Air crescent sign). 10.Daáu hieäu luftsichel (Luftsichel sign). 11.Daáu hieäu phaúng eo (Flat waist sign).
51 April 17, 2015
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN AIR BRONCHOGRAM SIGN
Bình thöôøng caùc pheá quaûn trong phoåi khoâng thaáy ñöôïc bôûi chuùng chöùa khí vaø bao quanh bôûi caùc pheá nang cuõng chöùa khí. Khi nhu moâ phoåi bò ñoâng ñaëc,caùc pheá nang laáp ñaày dòch,trong khi loøng pheá quaûn coøn thoâng thoaùng,luùc naøy ta seõ thaáy roõ loøng caùc pheá quaûn treân phim: Air bronchogram sign (+).
52 April 17, 2015
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN AIR BRONCHOGRAM SIGN
RUL Consolidation Strep Pneumonia
A.J.Chandrasekhar,M.D.Chest X-ray Atlas.
53 April 17, 2015
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN AIR BRONCHOGRAM SIGN
Khi moät boùng môø coù Air bronchogram sign (+) thì ta coù theå khaúng ñònh toån thöông ôû trong phoåi. Air bronchogram sign (+) giuùp loaïi tröø moät toån thöông thaønh ngöïc,maøng phoåi vaø trung thaát. Air bronchogram sign (+) thöôøng gaëp trong Vieâm phoåi,Phuø phoåi vaø ñoâi khi trong Nhoài maùu phoåi. Caùc khoái u phoåi thöôøng coù Air bronchogram sign (-), ngoaïi tröø alveolar cell carcinoma.
54 April 17, 2015
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN AIR BRONCHOGRAM SIGN
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
55 April 17, 2015
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN AIR BRONCHOGRAM SIGN
-AIR BRONCHOGRAM SIGN (+) -SILHOUETTE SIGN (+) vôùi voøm hoaønh (T). -SILHOUETTE SIGN (-) vôùi bôø tim (T). àVIEÂM THUØY DÖÔÙI PHOÅI (T)
Dalia Megiddo,M.D et al. Chest X-ray interpretation. Academia Medica,Jerusalem,ISRAEL.
56 April 17, 2015
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN AIR BRONCHOGRAM SIGN
AIR BRONCHOGRAM SIGN (+): PHUØ PHOÅI DO NGUYEÂN NHAÂN
THAÀN KINH (CHAÁN THÖÔNG SOÏ NAÕO)
57 April 17, 2015
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN AIR BRONCHOGRAM SIGN
Joseph K.T.Lee. Lee computed body tomography with MRI correlation. 1998
AIR BRONCHOGRAM SIGN (+): VIEÂM PHOÅI
58 April 17, 2015
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN AIR BRONCHOGRAM SIGN
AIR BRONCHOGRAM SIGN (+): PHUØ PHOÅI TOÅN THÖÔNG
59 April 17, 2015
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN AIR BRONCHOGRAM SIGN
U PHEÁ QUAÛN PHAÂN THUØY 2 PHOÅI (P) (BRONCHIOLOALVEOLAR CARCINOMA)
Alain Blum.Scanographie volumique multicoupe.MASSON.
60 April 17, 2015
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN AIR BRONCHOGRAM SIGN
K TIEÅU PHEÁ QUAÛN-PHEÁ NANG LAN TOÛA
61 April 17, 2015
DAØN BAØI Ñaïi cöông. 1.Daáu hieäu boùng bôø (Silhouette sign). 2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign). 3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng (Thoraco-abdominal sign or Iceberg sign). 4.Daáu hieäu caùnh buoàm (Sail sign). 5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi (Hilum overlay sign & Hilum convergence sign). 7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign). 8.Daáu hieäu S-Golden (S-Golden’s sign). 9.Daáu hieäu lieàm khí (Air crescent sign). 10.Daáu hieäu luftsichel (Luftsichel sign). 11.Daáu hieäu phaúng eo (Flat waist sign).
62 April 17, 2015
DAÁU HIEÄU S-GOLDEN S-GOLDEN’S SIGN
Moät khoái u naèm caïnh pheá quaûn,khi phaùt trieån seõ cheøn eùp pheá quaûn gaây xeïp phoåi.Bôø cuûa vuøng phoåi xeïp cuøng vôùi khoái u taïo thaønh hình chöõ S. Daáu hieäu naøy ñieån hình thaáy ôû khoái u pheá quaûn thuøy treân phoåi (P).
63 April 17, 2015
DAÁU HIEÄU S-GOLDEN S-GOLDEN’S SIGN
Non–small cell carcinoma of the bronchus (S-Golden’s sign)
Weissleder et al.Diagnostic Imaging Expert.1998
64 April 17, 2015
DAÁU HIEÄU S-GOLDEN S-GOLDEN’S SIGN
Dalia Megiddo,M.D et al. Chest X-ray interpretation. Academia Medica,Jerusalem,ISRAEL.
65 April 17, 2015
DAÁU HIEÄU S-GOLDEN S-GOLDEN’S SIGN
Joseph K.T.Lee. Lee computed body tomography with MRI correlation. 1998
XEÏP THUØY TREÂN PHOÅI (T) (caùc ñaàu muõi teân) DO U PHEÁ QUAÛN (muõi teân)àS-GOLDEN’S SIGN
66 April 17, 2015
DAØN BAØI Ñaïi cöông. 1.Daáu hieäu boùng bôø (Silhouette sign). 2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign). 3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng (Thoraco-abdominal sign or Iceberg sign). 4.Daáu hieäu caùnh buoàm (Sail sign). 5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi (Hilum overlay sign & Hilum convergence sign). 7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign). 8.Daáu hieäu S-Golden (S-Golden’s sign). 9.Daáu hieäu lieàm khí (Air crescent sign). 10.Daáu hieäu luftsichel (Luftsichel sign). 11.Daáu hieäu phaúng eo (Flat waist sign).
67 April 17, 2015
DAÁU HIEÄU LIEÀM KHÍ AIR CRESCENT SIGN
Khi banh naám (fungus ball) phaùt trieån trong moät caáu truùc hang thì do banh naám laên troøn trong hang,cho neân ta seõ thaáy 1 lieàm khí ôû vò trí cao à Pulmonary Aspergillosis
68 April 17, 2015
DAÁU HIEÄU LIEÀM KHÍ AIR CRESCENT SIGN
69 April 17, 2015
DAØN BAØI Ñaïi cöông. 1.Daáu hieäu boùng bôø (Silhouette sign). 2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign). 3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng (Thoraco-abdominal sign or Iceberg sign). 4.Daáu hieäu caùnh buoàm (Sail sign). 5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi (Hilum overlay sign & Hilum convergence sign). 7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign). 8.Daáu hieäu S-Golden (S-Golden’s sign). 9.Daáu hieäu lieàm khí (Air crescent sign). 10.Daáu hieäu luftsichel (Luftsichel sign). 11.Daáu hieäu phaúng eo (Flat waist sign).
70 April 17, 2015
DAÁU HIEÄU LUFTSICHEL LUFTSICHEL SIGN
Daáu hieäu naøy ñöôïc caùc taùc giaû ngöôøi Ñöùc ñöa ra (luft:air. sichel:crescent). Khi thuøy treân phoåi (T) bò xeïp,noù seõ bò keùo vaøo trong vaø leân treân.Bôø treân trong cuûa thuøy treân seõ taïo vôùi trung thaát moät lieàm khí vôùi quai ÑMC.
71 April 17, 2015
DAÁU HIEÄU LUFTSICHEL LUFTSICHEL SIGN
72 April 17, 2015
DAØN BAØI Ñaïi cöông. 1.Daáu hieäu boùng bôø (Silhouette sign). 2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign). 3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng (Thoraco-abdominal sign or Iceberg sign). 4.Daáu hieäu caùnh buoàm (Sail sign). 5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi (Hilum overlay sign & Hilum convergence sign). 7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign). 8.Daáu hieäu S-Golden (S-Golden’s sign). 9.Daáu hieäu lieàm khí (Air crescent sign). 10.Daáu hieäu luftsichel (Luftsichel sign). 11.Daáu hieäu phaúng eo (Flat waist sign).
73 April 17, 2015
DAÁU HIEÄU PHAÚNG EO FLAT WAIST SIGN
Khi thuøy döôùi (T) xeïp hoaøn toaøn,noù seõ keùo roán phoåi (T) xuoáng döôùi, boùng tim bò xoay, laøm cho maát bôø ngoaøi cuûa roán phoåi (T) vaø quai ÑMC.
74 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
75 April 17, 2015
DAÁU HIEÄU WESTEMARK WESTEMARK’S SIGN
Daáu hieäu naøy coù ñöôïc khi thuyeân taéc ñoäng maïch phoåi laøm giaûm töôùi maùu (oligemia) phaàn phoåi sau taéc ngheõn.
76 April 17, 2015
DAÁU HIEÄU WESTEMARK WESTEMARK’S SIGN
77 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
78 April 17, 2015
BÖÔÙU HAMPTON HAMPTON’S HUMP
Khi xaûy ra Nhoài maùu phoåi (pulmonary infarction),thì treân phim ngöïc xuaát hieän böôùu Hampton. Ñieån hình böôùu Hampton laø boùng môø ñoàng nhaát hình cheâm ôû ngoaïi vi phoåi coù ñaùy naèm treân laù taïng maøng phoåi,ñænh troøn höôùng veà roán phoåi.
79 April 17, 2015
BÖÔÙU HAMPTON HAMPTON’S HUMP
80 April 17, 2015
BÖÔÙU HAMPTON HAMPTON’S HUMP
81 April 17, 2015
BÖÔÙU HAMPTON HAMPTON’S HUMP
WESTEMARK’S SIGN (+) HAMPTON’S HUMP (+) àPULMONARY EMBOLI
82 April 17, 2015
BÖÔÙU HAMPTON HAMPTON’S HUMP
WESTEMARK’S SIGN (+) HAMPTON’S HUMP (+) àPULMONARY EMBOLI
83 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
84 April 17, 2015
DAÁU HIEÄU FLEISCHNER FLEISCHNER’S SIGN
Thöôøng ñi keøm theo daáu hieäu Westemark laø daáu hieäu Fleischner (Fleischner's sign): Phình ÑMP goác (muõi teân) do taéc ngheõn ôû haï löu.
85 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
86 April 17, 2015
DAÁU HIEÄU THANH MAÕ TAÁU SCIMITAR SIGN
Daáu hieäu naøy thaáy trong beänh lyù Söï trôû veà baát thöôøng vaø khoâng hoaøn toaøn cuûa tónh maïch phoåi (Partial anomalous pulmonary venous return-PAPVR).Caùc TM phoåi (P) thay vì ñoå veà nhó (T),thì hôïp laïi thaønh moät thaân chung ñoå veà TMCD taïo neân hình aûnh thanh göôm Thoå Nhó Kyø.
87 April 17, 2015
DAÁU HIEÄU THANH MAÕ TAÁU SCIMITAR SIGN
88 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
89 April 17, 2015
DAÁU HIEÄU HÌNH SOÁ 3 FIGURE 3 SIGN (MOGUL SIGN)
Vò trí cuûa thaét eo ÑMC thöôøng ôû sau nôi xuaát phaùt ÑgM döôùi ñoøn (T).Qua choã thaét eo ÑMC seõ phình ra sau heïp à Taïo thaønh hình soá 3 ngay döôùi quai ÑMC (Figure 3 sign).
90 April 17, 2015
DAÁU HIEÄU HÌNH SOÁ 3 FIGURE 3 SIGN (MOGUL SIGN)
AORTIC COARCTATION
91 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
92 April 17, 2015
DAÁU HIEÄU KHUYEÁT SÖÔØN RIB NOTCHING SIGN
Trong beänh lyù thaét eo ÑMC maùu seõ thieáu huït sau choã thaét eo,do vaäy tuaàn hoaøn baøng heä phaùt trieån: n A:Maùu seõ töø ÑMDÑ qua ÑgM vai
xuoáng (descending scapular artery), tieáp noái vôùi ÑgM lieân söôøn ñeå trôû veà ÑMC sau choã heïp.
n B:Maùu seõ töø ÑMDÑ qua ÑgM vuù trong (internal mammary artery),tieáp noái vôùi ÑgM lieân söôøn ñeå trôû veà ÑMC sau choã heïp.
n Löu yù raèng doøng maùu trong ÑgM lieân söôøn ôû beänh lyù naøy-khaùc vôùi bình thöôøng-seõ chaûy ngöôïc veà ÑMC,vaø khaåu kính seõ taêng leân nhieàu so vôùi bình thöôøng. ÑgM lieân söôøn ñaäp maïnh laøm khuyeát bôø döôùi cung söôøn. Aortic Stenosis: Spectrum of Diseases Depicted at Multisection CT. Carmen Sebastià, MD. (Radiographics. 2003;23:S79-S91.)
93 April 17, 2015
DAÁU HIEÄU KHUYEÁT SÖÔØN RIB NOTCHING SIGN
Aortic Stenosis: Spectrum of Diseases Depicted at Multisection CT. Carmen Sebastià, MD. (Radiographics. 2003;23:S79-S91.)
94 April 17, 2015
DAÁU HIEÄU KHUYEÁT SÖÔØN RIB NOTCHING SIGN
AORTIC COARCTATION WITH THE RIB NOTCHING
95 April 17, 2015
DAÁU HIEÄU KHUYEÁT SÖÔØN RIB NOTCHING SIGN
AORTIC COARCTATION / TURNER’S SYNDROME (XO)
96 April 17, 2015
DAÁU HIEÄU KHUYEÁT SÖÔØN RIB NOTCHING SIGN
Pediatric Ribs: A Spectrum of Abnormalities. Ronald B. J. Glass, MD (Radiographics. 2002;22:87-104.)
NEUROFIBROMATOSIS: Treû gaùi 15 tuoåi,khuyeát xöông bôø döôùi moät soá
cung söôøn do u ôû caùc daây thaàn kinh lieân söôøn.Löu yù coù neurofibromas ôû vuøng
ñænh phoåi hai beân.
Nhö vaäy,ngoaøi nguyeân nhaân Thaét eo ÑMC,thì
Neurofibromatosis cuõng laø moät nguyeân nhaân gaây
khuyeát xöông ôû bôø döôùi cung söôøn.
97 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
98 April 17, 2015
DAÁU HIEÄU CON MEØO DÖÔÙI TAÁM MEÀN CAT UNDER THE RUG SIGN
PLASMACYTOMA RIB
Daáu hieäu naøy giuùp chaån ñoaùn moät boùng môø ngoaøi phoåi (extrapulmonary).
99 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
100 April 17, 2015
DAÁU HIEÄU MÖÏC THUÛY-KHÍ SIGNE DES NIVEAUX
Daáu hieäu naøy ñöôïc phoå bieán ôû Phaùp bôûi Joseù REMY.Noù giuùp phaân bieät hình aûnh möïc thuûy-khí ôû trong nhu moâ phoåi hay ôû maøng phoåi. Neáu A = A’ à ÔÛ trong nhu moâ phoåi. Neáu P # P’ à ÔÛ maøng phoåi.
101 April 17, 2015
DAÁU HIEÄU MÖÏC THUÛY-KHÍ SIGNE DES NIVEAUX
A = A’ = 6cm
102 April 17, 2015
P # P’ A = A’
103 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
104 April 17, 2015
DAÁU HIEÄU GOÙC SÖÔØN HOAØNH SAÂU DEEP SULCUS SIGN
Daáu hieäu naøy thaáy ñöôïc treân caùc phim chuïp beänh nhaân ôû tö theá naèm trong caùc phoøng chaêm soùc ñaëc bieät (ICU). Khi coù traøn khí maøng phoåi,khí seõ tuï taäp ôû goùc söôøn hoaønh tröôùc,taïo ra daáu hieäu goùc söôøn hoaønh saâu.Vieäc nhaän bieát daáu hieäu naøy raát quan troïng vì ta raát deã boû soùt hình aûnh traøn khí maøng phoåi treân phim ngöïc naèm.
105 April 17, 2015
DAÁU HIEÄU GOÙC SÖÔØN HOAØNH SAÂU DEEP SULCUS SIGN
106 April 17, 2015
DAÁU HIEÄU GOÙC SÖÔØN HOAØNH SAÂU DEEP SULCUS SIGN
Coù caàn thieát chuïp laïi phim loàng ngöïc hay khoâng ?
107 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
108 April 17, 2015
DAÁU HIEÄU VIEÀN KHÍ QUANH ÑOÄNG MAÏCH RING AROUND THE ARTERY SIGN
Daáu hieäu naøy thaáy ñöôïc chuû yeáu treân phim ngöïc nghieâng giuùp chaån ñoaùn Traøn khí trung thaát.
109 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
110 April 17, 2015
DAÁU HIEÄU VOØM HOAØNH LIEÂN TUÏC CONTINUOUS DIAPHRAGM SIGN
Bình thöôøng ta khoâng theå thaáy lieân tuïc voøm hoaønh töø (P) sang (T) do boùng tim taïo neân daáu hieäu Silhouette sign (+) vôùi voøm hoaønh. Khi ta thaáy voøm hoaønh (P) ñöôïc noái lieân tuïc qua voøm hoaønh (T) thì coù nghóa laø coù Traøn khí maøng tim do khí len vaøo döôùi boùng tim.
111 April 17, 2015
DAÁU HIEÄU VOØM HOAØNH LIEÂN TUÏC CONTINUOUS DIAPHRAGM SIGN
112 April 17, 2015
DAÁU HIEÄU VOØM HOAØNH LIEÂN TUÏC CONTINUOUS DIAPHRAGM SIGN
113 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
114 April 17, 2015
DAÁU HIEÄU VOØM HOAØNH ÑOÂI DOUBLE-DIAPHRAGM SIGN
Ñoâi khi Traøn khí maøng phoåi khoâng tuï taäp ôû nôi cao maø laïi khu truù döôùi ñaùy phoåi taïo neân daáu hieäu voøm hoaønh ñoâi.
SUBPULMONIC PNEUMOTHORAX
115 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
116 April 17, 2015
DAÁU HIEÄU ÑÖÔØNG VAØO-ÑÖÔØNG RA INLET TO OUTLET SIGN
Thöïc quaûn,ÑMC vaø oáng ngöïc laø 3 caáu truùc chaïy xuyeân qua trung thaát töø ñöôøng vaøo (inlet) tôùi ñöôøng ra (outlet). Giaõn cuûa 1 trong 3 caáu truùc naøy coù theå seõ cho boùng môø ñi töø ñöôøng vaøo tôùi ñöôøng ra. OÁng ngöïc duø coù giaõn cuõng khoâng bao giôø ñuû lôùn ñeå coù theå thaáy.Do ñoù: n Boùng môø töø ñöôøng vaøo ñeán ñöôøng ra ôû beân (P)
trung thaát laø do giaõn thöïc quaûn. n Boùng môø töø ñöôøng vaøo ñeán ñöôøng ra ôû beân (T)
trung thaát laø do phình ÑMC.
117 April 17, 2015
DAÁU HIEÄU ÑÖÔØNG VAØO-ÑÖÔØNG RA INLET TO OUTLET SIGN
ACHALASIA
118 April 17, 2015
DAÁU HIEÄU ÑÖÔØNG VAØO-ÑÖÔØNG RA INLET TO OUTLET SIGN
ACHALASIA
119 April 17, 2015
DAÁU HIEÄU ÑÖÔØNG VAØO-ÑÖÔØNG RA INLET TO OUTLET SIGN
PHÌNH ÑOÄNG MAÏCH CHUÛ NGÖÏC
120 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
121 April 17, 2015
DAÁU HIEÄU BAÊNG QUA ÑÖÔØNG GIÖÕA CROSSING MIDLINE SIGN
Moät boùng môø ôû trung thaát sau döôùi,neáu baêng qua ñöôøng giöõa thì nhieàu khaû naêng boùng môø ñoù coù nguoàn goác töø oáng tieâu hoùa (hiatal hernia). Ñeå xaùc ñònh ta caàn chuïp phim loàng ngöïc coù uoáng caûn quang Baryte.
122 April 17, 2015
DAÁU HIEÄU BAÊNG QUA ÑÖÔØNG GIÖÕA CROSSING MIDLINE SIGN
123 April 17, 2015
DAÁU HIEÄU BAÊNG QUA ÑÖÔØNG GIÖÕA CROSSING MIDLINE SIGN
124 April 17, 2015
DAÁU HIEÄU BAÊNG QUA ÑÖÔØNG GIÖÕA CROSSING MIDLINE SIGN
125 April 17, 2015
DAÁU HIEÄU BAÊNG QUA ÑÖÔØNG GIÖÕA CROSSING MIDLINE SIGN
126 April 17, 2015
DAÁU HIEÄU BAÊNG QUA ÑÖÔØNG GIÖÕA CROSSING MIDLINE SIGN
127 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
128 April 17, 2015
DAÁU HIEÄU BAÊNG QUA THAØNH NGÖÏC CROSSING CHEST WALL SIGN
CROSSING CHEST WALL SIGN: BUÙI TOÙC
129 April 17, 2015
DAÁU HIEÄU BAÊNG QUA THAØNH NGÖÏC CROSSING CHEST WALL SIGN
CROSSING CHEST WALL SIGN: BUÙI TOÙC
130 April 17, 2015
DAÁU HIEÄU BAÊNG QUA THAØNH NGÖÏC CROSSING CHEST WALL SIGN
A.J.Chandrasekhar,M.D.Chest X-ray Atlas.
CROSSING CHEST WALL SIGN: BUÙI TOÙC
131 April 17, 2015
DAÁU HIEÄU BAÊNG QUA THAØNH NGÖÏC CROSSING CHEST WALL SIGN
CROSSING CHEST WALL SIGN: BUÙI TOÙC
132 April 17, 2015
DAØN BAØI (tieáp theo) 12.Daáu hieäu Westemark (Westemark’s sign). 13.Böôùu Hampton (Hampton’s hump). 14.Daáu hieäu Fleichner (Fleichner’s sign). 15.Daáu hieäu thanh maõ taáu (Scimitar sign). 16.Daáu hieäu hình soá 3 (Figure 3 sign). 17.Daáu hieäu khuyeát söôøn (Rib notching sign). 18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign). 19.Daáu hieäu möïc thuûy-khí (Signe des niveaux). 20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign). 21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign). 22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign). 23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign). 24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign). 25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign). 26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign). Keát luaän.
133 April 17, 2015
KEÁT LUAÄN
Vieäc hieåu roõ vaø nhaän bieát ñöôïc caùc daáu hieäu X quang laø nhöõng ñieàu cô baûn vaø thieát yeáu ñoái vôùi moãi BS X quang. Tuy vaäy coù nhöõng daáu hieäu raát tinh vi vaø khoâng deã nhaän bieát.Chæ coù ñoïc phim nhieàu môùi giuùp chuùng ta khoâng boû soùt caùc daáu hieäu naøy.
134 April 17, 2015 CAÛM ÔN SÖÏ CHUÙ YÙ THEO DOÕI CUÛA QUYÙ BAÙC SÓ
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