X线读片技能训练

泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGEX线片读片技能训练漆军副教授泸州医学院附属医院放射科泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE读片一般要求理解X片影像的形成及实质正确摆放X光片全面系统地观察影像改变，得出初步结论结合临床症状、体征、相关实验室检查等作出进一步诊断X线诊断有其局限性泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE骨与关节X片的读片技能首选要明确投照部位其次，熟悉正常骨与关节X线表现再其次，仔细观察，与健侧对比，发现病变分析病变的性质–孤立性病变？多发性病变？全身性病变？–密度增高？降低？–骨质破坏的形态–……最后结合临床，得出诊断意见泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE读片实战演练泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE骨质疏松(osteoporosis)定义：–一定单位体积内正常钙化的骨组织含量减少。X线表现：–骨质密度减低，显影清晰，骨小梁变细减少。骨皮质变薄，髓腔增宽。椎体内形成纵行条纹，上下缘“双凹征”、“鱼脊椎”，椎间隙增宽。分类：–广泛疏松：老年人、绝经期妇女–局限疏松：多见于废用、结核。泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE骨质软化(osteomalacia)定义：–一定单位体积内骨组织有机成分正常，矿物质含量不足。因大量类骨质堆积得不到钙化。X线表现：–骨质密度减低，显影模糊，皮质变薄，小梁减少。承重骨骼各种变形，X形腿、O形腿。此外，还可见假骨折线。临床：–发生于儿童为佝偻病，发生于成人为骨软化症。泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE骨质破坏(Destructionofbone)定义：–局部骨质被病理组织取代造成的骨组织消失。X线表现：–局限性骨质密度减低区。临床：炎症、结核、肿瘤等。–急性炎症、恶性肿瘤：浸润性生长，边缘模糊，形态不规则，骨皮质破坏中断,多伴骨膜增生。–慢性炎症、良性肿瘤：膨胀性生长，边界清楚，形态规则或不规则，骨皮质膨大，保持连续性，较少骨膜增生。泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE骨质增生硬化（Hyperostosisosteosclerosis)定义：–一定单位体积内骨量的增多。多数为病变刺激成骨细胞引起的反应性增生，少数为肿瘤自身成骨（肿瘤新生骨）。X线表现：–骨质密度增高，骨小梁增多增粗。皮质增厚，髓腔变窄。骨干可粗大变形。临床：–局限性：慢性炎症、良性肿瘤、骨肉瘤。–全身性：氟骨症、石骨症。泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE骨膜增生（骨膜反应）(periostealproliferation)定义：–骨膜受刺激，其内层成骨细胞增生，引起的骨质增生。而正常骨膜X线下不显影。X线表现：–多种多样，可为平行状、分层状、花边状、骨膜三角。临床：–多见于炎症、肿瘤、外伤等，骨膜增生提示病变存在，但无法确定病变性质，须结合其它征象。泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE骨质坏死（necrosisofbone)定义：–骨组织血供中断，代谢停止。坏死的骨质称为死骨(sequestrum)。X线表现：–死骨，大块状、长条状高密度影，周围有透亮影与正常骨分隔，常见于慢性炎症；泥沙状高密度影，常见于结核。临床：–慢性化脓性骨髓炎、结核、缺血坏死。泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE骨内、软骨内钙化原发于骨的软骨类肿瘤可出现软骨内钙化。X线表现为颗粒状、小环状无结构的致密影。泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE矿物质沉积铅、磷、铋等进入人体内，沉积于生长较快的干骺端，X线表现为多条横行致密带。氟骨症也属矿物质沉积。泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE关节病变关节破坏(destructionofjoint)炎症、结核、肿瘤、类风湿性关节炎。关节脱位(dislocationofjoint)外伤性、先天性、病理性。关节退行性变(degenerationofjoint)关节强直(ankylosisofjoint)骨性强直：见于化脓性关节炎。纤维性强直：见于关节结核。以上两种强直兼有：类风湿性关节炎。泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE胸片的读片技能首选要正确摆放胸片其次，熟悉正常胸片X线表现再其次，仔细观察，双侧对比，发现病变分析病变的性质–肺野透光度增强？降低？–渗出性病变–结节和肿块性病变–弥漫性病变–……最后结合临床，得出诊断意见泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE正常纵隔(mediastinum)X线表现–居胸骨后胸椎前两肺之间；其中组织脏器多；九分区如图，其对判断纵隔肿瘤来源和性质有重要意义。–纵隔居中，压力改变致其移位。–多种疾病致其局限或弥漫增宽。–纵隔气肿、纵隔摆动。泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE正常X线表现横膈(diaphragm)–左右两叶圆顶状；–平10后肋水平，右高左低，内前高外后低；–上下活动1~3cm；与胸廓构成外前后肋膈角；–局限膈膨升，波状膈为变异；–膈本身、胸腹腔病变可致位置动变改变。泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE读片实战演习泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE慢支炎肺气肿泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE肺含气囊肿泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE左侧气胸泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE小结：透光度增强（密度减低）肺气肿(emphysema)–定义：肺组织过度充气膨胀体积增大的一种状态。–机理：支气管不完全阻塞产生活瓣作用的结果。–分型:弥漫性者继发于多种慢性肺部疾病；局限性者见于异物、肿瘤.气胸肺含气囊肿肺大泡泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE大叶性肺炎泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE小叶性肺炎泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE右下叶支气管内金属异物伴右下肺不张泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE右侧胸腔中量、大量积液泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE左侧胸腔包裹性积液泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE血源性肺脓肿泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE浸润性肺结核伴空洞形成泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE慢性纤维性空洞性肺结核泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE右肺上叶中央型肺癌伴右上肺不张泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE右肺下叶中央型肺癌伴右下肺不张泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE左肺上叶中央型肺癌伴左上肺不张泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE左主支气管中央型肺癌伴左肺不张泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE左肺上叶周围型肺癌泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE右下肺周围型肺癌伴空洞形成泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE小结：透光度降低（密度增高）肺不张：肿瘤，异物、痰栓、血凝块阻塞–一侧性不张–肺叶不张–肺段不张胸膜增厚：炎症、结核、间皮瘤–弥漫性–局限性胸腔积液：炎症、结核、外伤、肿瘤。–游离积液：大量、中量、小量–包裹性积液肺内渗出性与实变：–炎症、结核、外伤、肿瘤肺、纵隔、胸壁肿瘤泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE消化道造影读片技能首选要正确摆放造影片其次，熟悉正常消化道X线表现再其次，必须明确造影所见乃消化道内腔情况分析病变的性质–充盈缺损？嵌影？–位置是否正常？–管壁是否僵硬？蠕动是否正常？–……最后结合临床，得出诊断意见泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE消化道正常造影表现泸医附院THEAFFILIATEDHOSPITALOFLUZHOUMEDICALCOLLEGE读片实战演练泸医附院T