1
CHAÅN ÑOAÙN HÌNH AÛNH
BEÄNH VAN TIM MAÉC PHAÛI
BS.NGUYEÃN QUYÙ KHOAÙNG
BS.NGUYEÃN QUANG TROÏNG
6/19/2013
2
DAØN BAØI
Heïp van 2 laù.
Ñaïi cöông.
X quang Heïp van 2 laù nheï.
X quang Heïp van 2 laù trung bình-naëng.
Thay ñoåi ve...
3
DAØN BAØI
Hôû van 2 laù.
Ñaïi cöông.
X quang Hôû van 2 laù nheï.
X quang Hôû van 2 laù trung bình.
X quang Heïp van 2 la...
4
DAØN BAØI
Heïp van Ñoäng maïch chuû.
Ñaïi cöông.
X quang.
Coäng höôûng töø.
6/19/2013
5
DAØN BAØI
Hôû van Ñoäng maïch chuû.
Ñaïi cöông.
X quang.
Chuïp coù caûn quang.
Coäng höôûng töø.
6/19/2013
6
DAØN BAØI
Beänh lyù van Ñoäng maïch phoåi.
Beänh lyù van 3 laù.
ÖÙng duïng laâm saøng.
Keát luaän.
6/19/2013
7
ÑAÏI CÖÔNG
HEÏP VAN HAI LAÙ
(MITRAL STENOSIS)
Beänh thöôøng gaëp ôû Vieät Nam.
50% laø do Thaáp tim (RAA).Nöõ/Nam=8/1.
C...
8
ÑAÏI CÖÔNG
HEÏP VAN HAI LAÙ
6/19/2013
9
X QUANG
HEÏP VAN HAI LAÙ NHEÏ
Bình thöôøng S loã van=4-6cm2.
Heïp nheï khi 2cm2 ≤ S < 4cm2.
AÙp löïc mao maïch phoåi =10...
10
X QUANG
HEÏP VAN HAI LAÙ NHEÏ
NORMAL MITRAL VALVE MITRAL STENOSIS
6/19/2013
11
X QUANG
HEÏP VAN HAI LAÙ NHEÏ
X quang:
Boùng tim chöa thaáy thay ñoåi gì.
Phaân boá maïch maùu phoåi cuõng chöa
thaáy t...
12
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
Heïp trung bình khi 1cm2 ≤ S < 2cm2.
AÙp löïc mao maïch phoåi =10-17mmHg.
Heï...
13
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
Sinh lyù beänh:
Taéc ngheõn doøng chaûy töø Nhó (T)
xuoáng Thaát (T) Taêng aù...
14
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
Daõn buoàng Nhó (T) khi ñöôøng kính Nhó
(T)>7cm (ño töø bôø...
15
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
ÑgMC xuoáng bò ñaåy qua (T).
Phim thaúng coù uoáng Baryte:T...
16
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
6/19/2013
17
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
6/19/2013
18
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
6/19/2013
19
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
6/19/2013
20
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
LEFT ATRIAL ENLARGEMENT is best
confirmed by measuring the ...
21
PULMONARY EDEMA /
MITRAL STENOSIS
AFTER TREATMENT
6/19/2013
22
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
MITRAL STENOSIS
Enlarged LAA
6/19/2013
23
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
Enlargement of the left atrial
appendage.
6/19/2013
24
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
-Elevation of left main bronchus.
-Double shadow of the lar...
25
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
-Elevation of left main bronchus.
-Splaying of the carina.
...
26
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
RAO-MITRAL STENOSIS
Enlarged LA
6/19/2013
27
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
Caøng ngaøy Nhó (T) caøng to ra,nhaát laø khi
coù Rung nhó....
28
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
Tieåu nhó (T) daõn lôùn bieåu hieän baèng cung
thöù 4 beân ...
29
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
Hieän töôïng Mitralisation roõ laø nhôø Quai
ÑMC nhoû do gi...
30
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
Thaát (T) coù kích thöôùc bình thöôøng,chæ soá
T/N ≤ 0,5.
V...
6/19/2013 31
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
Hình aûnh ít gaëp laø voâi hoùa van hai laù(40%),...
6/19/2013 32
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
MITRAL STENOSIS
6/19/2013 33
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
-Enlarged veins.
-Bulging of the
pulmonary artery...
6/19/2013 34
X QUANG
CHAÅN ÑOAÙN PHAÂN BIEÄT
Pectus excavatum-Cardiac silhouette is rotated and
displaced to the patient’s...
6/19/2013 35
X QUANG
CHAÅN ÑOAÙN PHAÂN BIEÄT
10-year-old asymptomatic boy
with an unusual contour of the
left upper heart ...
6/19/2013 36
X QUANG
CHAÅN ÑOAÙN PHAÂN BIEÄT
Coronal T1-weighted:Bulging of the left atrial appendage
related to partial a...
6/19/2013 37
X QUANG
CHAÅN ÑOAÙN PHAÂN BIEÄT
PARTIAL ABSENCE OF THE PERICARDIUM
6/19/2013 38
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
WALKING MAN SIGN
-The right main bronchus is
outlined.
-The lower l...
6/19/2013 39
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
6/19/2013 40
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
6/19/2013 41
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
-RAO:enlargement of the left
atrium(large black a...
6/19/2013 42
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
C-shaped calcification in the mitral
valve ring-L...
6/19/2013 43
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
Calcification within
the left atrium.
6/19/2013 44
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
Left atrial calcification
(Lateral view).
6/19/2013 45
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
-Left atrial calcification
(white arrows).
-Calci...
6/19/2013 46
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
-Calcified mitral valve.
-Esophagus is pushed
pos...
6/19/2013 47
X QUANG
THAY ÑOÅI VEÀ TIM
Mitral annular calcification in asymptomatic patients.
6/19/2013 48
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
Taêng tuaàn hoaøn phoåi thuï ñoäng ...
6/19/2013 49
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
ÑMP to daàn Khoù chaån ñoaùn phaân ...
50
Tuần hoàn phổi bình thường Tái phân phối mạch máu phổi
6/19/2013
516/19/2013
52
Dày vách liên tiểu thùy
6/19/2013
53
CARDIAC FAILURE
-Enlarged heart size.
-No clear heart border (interstitiel
edema), Kerley’s line, pleural effusion.
-Re...
6/19/2013 54
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
-Left ventricle has normal size.
-D...
6/19/2013 55
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
-Small aortic knob.
-Bulging of the...
6/19/2013 56
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
-Dilated upper lobe vessels.
-Bulgi...
6/19/2013 57
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
-Left main bronchus is
displaced po...
6/19/2013 58
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
PULMONARY ARTERIAL ANEURYSM /
SEVER...
6/19/2013 59
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
6/19/2013 60
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
6/19/2013 61
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-CAÁP
TÍNH
Phuø phoåi moâ keõ.
Phuø pho...
6/19/2013 62
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-CAÁP
TÍNH
PULMONARY INTERSTITIAL EDEMA
6/19/2013 63
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-CAÁP
TÍNH
PULMONARY EDEMA
6/19/2013 64
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH
ÔÛ ngöôøi Heïp van 2 laù laâ...
6/19/2013 65
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH
Xô phoåi:nhöõng daûi môø saé...
6/19/2013 66
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH
Nhoài maùu phoåi (Pulmonary ...
6/19/2013 67
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH
-The cardiac silhouette is
t...
6/19/2013 68
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH
HEMOSIDEROSIS IN MITRAL STEN...
6/19/2013 69
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH
KERLEY’S B LINES & HEMOSIDER...
6/19/2013 70
ÑAÏI CÖÔNG
HÔÛ VAN HAI LAÙ
(MITRAL REGURGITATION)
Hôû van 2 laù coù theå caáp tính:Ñöùt daây
chaèng-coät cô (...
6/19/2013 71
X QUANG
HÔÛ VAN HAI LAÙ NHEÏ
Thaát (T) vaø Nhó (T) giaõn lôùn do “overload”.
Nhó (T) coøn buø X quang tim-pho...
6/19/2013 72
X QUANG
HÔÛ VAN HAI LAÙ TRUNG BÌNH
Nhó (T) coøn buø.
Nhó (T) to ra,nhöng aùp suaát chöa taêng
nhieàu.
Thaát (...
6/19/2013 73
X QUANG
HÔÛ VAN HAI LAÙ NAËNG
Nhó (T) maát buø.
Nhó (T) to ra,aùp suaát taêng cao.Neáu so
saùnh vôùi Heïp 2 l...
6/19/2013 74
X QUANG
HÔÛ VAN HAI LAÙ NAËNG
Quai ÑMC nhoû do cung löôïng tim giaûm.
Phình cung ÑMP ”Mitralisation du bord
g...
6/19/2013 75
X QUANG
HÔÛ VAN HAI LAÙ NAËNG
MITRAL REGURGITATION
6/19/2013 76
X QUANG
HÔÛ VAN HAI LAÙ NAËNG
-Small aortic knob.
-Peribronchial cuffing due
to edema.
-Bulging of the pulmon...
6/19/2013 77
X QUANG
HÔÛ VAN HAI LAÙ NAËNG
MITRAL REGURGITATION
6/19/2013 78
X QUANG
HÔÛ VAN HAI LAÙ NAËNG
-Straightening of the left heart border.
-Small aortic knob.
-Elevation of the ...
6/19/2013 79
X QUANG
HÔÛ VAN HAI LAÙ NAËNG
Enlarged left atrium.
MITRAL REGURGITATION
6/19/2013 80
X QUANG
HÔÛ VAN HAI LAÙ NAËNG
LATERAL VIEW:RETROGRADE
BRACHIAL ARTERY
CATHETERIZATION.
-Left ventricle (small...
6/19/2013 81
X QUANG
HÔÛ VAN HAI LAÙ NAËNG
-Small aortic knob.
-Elevation of the left main
bronchus.
-Enlargement of the l...
6/19/2013 82
X QUANG
HÔÛ VAN HAI LAÙ NAËNG
Calcification of the left atrial wall
MITRAL REGURGITATION
6/19/2013 83
X QUANG
HÔÛ VAN HAI LAÙ NAËNG
-Small aortic knob.
-Bulging of the main pulmonary
artery.
-Bulging of the left...
6/19/2013 84
X QUANG
HÔÛ VAN HAI LAÙ NAËNG
Calcification of the posterior wall of
the huge left atrium.
MITRAL REGURGITATI...
6/19/2013 85
X QUANG
HÔÛ VAN HAI LAÙ NAËNG
MITRAL REGURGITATION
-Small aortic knob.
-Elevation of the left main
bronchus.
...
6/19/2013 86
SIEÂU AÂM
HÔÛ VAN HAI LAÙ
87
PA view:Dilated left atrial
appendage (arrows).
Displacement of the left
ventricular contour
toward the left chest wall...
6/19/2013 88
X QUANG
CAÙC THEÅ KEÁT HÔÏP
Heïp+Hôû van 2 laù:Nhó (T) raát lôùn,coù ñoùng
voâi ôû van 2 laù vaø thaønh Nhó (...
6/19/2013 89
X QUANG
CAÙC THEÅ KEÁT HÔÏP
6/19/2013 90
X QUANG
CAÙC THEÅ KEÁT HÔÏP
Mitral valve stenosis
and regurgitation-
prosthetic mitral valve
6/19/2013 91
X QUANG
CAÙC THEÅ KEÁT HÔÏP
MITRAL STENOSIS AND
MITRAL REGURGITATION
-Small aortic knob.
-Enlarged pulmonary ...
6/19/2013 92
X QUANG
CAÙC THEÅ KEÁT HÔÏP
-Typical cardiac configuration of
mitral valvular disease.
-Calcification of the ...
6/19/2013 93
X QUANG
CAÙC THEÅ KEÁT HÔÏP
RAO
-Calcification of the mitral valve (black
arrows).
-Calcific density in the l...
6/19/2013 94
X QUANG
CAÙC THEÅ KEÁT HÔÏP
-Small aortic knob.
-Bulging of the main pulmonary
artery (white arrow).
-Enlarge...
6/19/2013 95
X QUANG
CAÙC THEÅ KEÁT HÔÏP
MITRAL STENOSIS AND MITRAL REGURGITATION
6/19/2013 96
X QUANG
CAÙC THEÅ KEÁT HÔÏP
-Elevation of the left main
bronchus (black arrow).
-Enlargement of the left
vent...
6/19/2013 97
X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
SEVERE MITRAL VALVE DISEASE
6/19/2013 98
ÑAÏI CÖÔNG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
(AORTIC STENOSIS)
Bình thöôøng SAO=2,5-3,5 cm2.
Khi SAO < 0,7cm2 Coù tri...
6/19/2013 99
X QUANG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
Bôø tim beân (T) baàu do daøy ñoàng taâm
Thaát (T),chæ soá T/N # 0,55.
ÑMC ...
6/19/2013 100
X QUANG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
Phoái hôïp:Heïp van ÑMC+Heïp van 2 laù.
ÔÛ ngöôøi treû,Heïp van ÑMC baåm s...
6/19/2013 101
X QUANG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
6/19/2013 102
X QUANG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
AORTIC STENOSIS
6/19/2013 103
X QUANG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
AORTIC STENOSIS
6/19/2013 104
X QUANG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
Calcifications in the heart lie
on a line drawn between the
sterno-diaphra...
6/19/2013 105
X QUANG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
Ascending aorta shows
slight post-stenotic
dilatation.
6/19/2013 106
X QUANG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
-Aortic valve calcification (arrow).
-Posterior displacement of the left
v...
6/19/2013 107
X QUANG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
-Normal heart size.
-Dilated ascending aorta.
6/19/2013 108
X QUANG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
Calcified aortic valve.
AORTIC STENOSIS
6/19/2013 109
X QUANG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
-Rounded left heart border
(arrowheads).
-Dilated ascending aorta
(small a...
6/19/2013 110
X QUANG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
LAO
-Bulging of the ascending aorta
because of post-stenotic
dilatation (a...
6/19/2013 111
X QUANG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
6/19/2013 112
X QUANG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
AORTIC AND MITRAL STENOSIS
6/19/2013 113
COÄNG HÖÔÛNG TÖØ
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
GRADIENT-ECHO MR
-Aortic valve (arrow).
-The signal void in the
e...
6/19/2013 114
X QUANG
HÔÛ VAN ÑOÄNG MAÏCH CHUÛ
Nguyeân nhaân thöôøng gaëp nhaát laø sau
RAA.
Caùc nguyeân nhaân khaùc bao ...
6/19/2013 115
X QUANG
HÔÛ VAN ÑOÄNG MAÏCH CHUÛ
Sinh lyù beänh:Maùu phuït ngöôïc vaøo Thaát
(T) trong kyø taâm tröông Giaõn...
6/19/2013 116
X QUANG
HÔÛ VAN ÑOÄNG MAÏCH CHUÛ
ÑMP khoâng to,coù khi nhö loõm vaøo.
ÑMC leân thöôøng khoâng giaõn,neáu ÑMC...
6/19/2013 117
X QUANG
HÔÛ VAN ÑOÄNG MAÏCH CHUÛ
6/19/2013 118
X QUANG
HÔÛ VAN ÑOÄNG MAÏCH CHUÛ
-Enlarged left ventricle.The apex
is displaced downward (large
arrow).
-The...
6/19/2013 119
X QUANG
HÔÛ VAN ÑOÄNG MAÏCH CHUÛ
-Enlarged left ventricle.
-The aorta is slightly prominent
but there is no ...
6/19/2013 120
X QUANG
HÔÛ VAN ÑOÄNG MAÏCH CHUÛ
-Enlarged left ventricle.
-The aorta is slightly prominent
but there is no ...
6/19/2013 121
X QUANG
HÔÛ VAN ÑOÄNG MAÏCH CHUÛ
-Dilated left ventricle.
-Post-stenotic dilatation of
the ascending aorta (...
6/19/2013 122
X QUANG
HÔÛ VAN ÑOÄNG MAÏCH CHUÛ
-Calcified aortic valve (ring of
arrowheads).
-Posterior displacement of
th...
6/19/2013 123
X QUANG
HÔÛ VAN ÑOÄNG MAÏCH CHUÛ
RETROGRADE AORTOGRAM IN
AORTIC REGURGITATION
Reflux flow (arrows) in the di...
6/19/2013 124
COÄNG HÖÔÛNG TÖØ
HÔÛ VAN ÑOÄNG MAÏCH CHUÛ
GRADIENT-ECHO MR
Regurgitant flow from the
aortic valve into the l...
6/19/2013 125
ÑAÏI CÖÔNG
BEÄNH VAN ÑOÄNG MAÏCH PHOÅI MAÉC PHAÛI
(ACQUIRED PULMONARY VALVULAR LESIONS)
Beänh hieám khi ñôn ...
6/19/2013 126
ÑAÏI CÖÔNG
BEÄNH VAN BA LAÙ MAÉC PHAÛI
(ACQUIRED TRICUSPID LESIONS)
Töông ñoái gaëp nhieàu hôn beänh van
ÑMP...
6/19/2013 127
X QUANG
BEÄNH VAN BA LAÙ MAÉC PHAÛI
Giaõn buoàng Thaát (P) vaø Nhó (P).
Thöôøng khoâng voâi hoùa van 3 laù.
...
6/19/2013 128
X QUANG
BEÄNH VAN BA LAÙ MAÉC PHAÛI
-Huge right atrium.
-Left lower lobe collapse
from compression by the
di...
6/19/2013 129
X QUANG
BEÄNH VAN BA LAÙ MAÉC PHAÛI
-Enlarged right atrium (large
arrows).
-Decrease in the pulmonary
vascul...
6/19/2013 130
ÖÙNG DUÏNG THÖÏC TEÁ
6/19/2013 131
KEÁT LUAÄN
Beänh van tim maéc phaûi phaàn lôùn do
RAA.
Toån thöông thöôøng gaëp nhaát ôû van 2 laù,
tieáp ñe...
6/19/2013 132
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3.acquired valvular heart disease

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3.acquired valvular heart disease

  1. 1. 1 CHAÅN ÑOAÙN HÌNH AÛNH BEÄNH VAN TIM MAÉC PHAÛI BS.NGUYEÃN QUYÙ KHOAÙNG BS.NGUYEÃN QUANG TROÏNG 6/19/2013
  2. 2. 2 DAØN BAØI Heïp van 2 laù. Ñaïi cöông. X quang Heïp van 2 laù nheï. X quang Heïp van 2 laù trung bình-naëng. Thay ñoåi veà tim. Thay ñoåi veà maïch maùu. Thay ñoåi veà chuû moâ phoåi. 6/19/2013
  3. 3. 3 DAØN BAØI Hôû van 2 laù. Ñaïi cöông. X quang Hôû van 2 laù nheï. X quang Hôû van 2 laù trung bình. X quang Heïp van 2 laù naëng. Caùc theå keát hôïp. 6/19/2013
  4. 4. 4 DAØN BAØI Heïp van Ñoäng maïch chuû. Ñaïi cöông. X quang. Coäng höôûng töø. 6/19/2013
  5. 5. 5 DAØN BAØI Hôû van Ñoäng maïch chuû. Ñaïi cöông. X quang. Chuïp coù caûn quang. Coäng höôûng töø. 6/19/2013
  6. 6. 6 DAØN BAØI Beänh lyù van Ñoäng maïch phoåi. Beänh lyù van 3 laù. ÖÙng duïng laâm saøng. Keát luaän. 6/19/2013
  7. 7. 7 ÑAÏI CÖÔNG HEÏP VAN HAI LAÙ (MITRAL STENOSIS) Beänh thöôøng gaëp ôû Vieät Nam. 50% laø do Thaáp tim (RAA).Nöõ/Nam=8/1. Caùc nguyeân nhaân khaùc: Vieâm noäi taâm maïc nhieãm truøng (Bacterial endocarditis). U nhaày nhó (T)(LA myxoma). 6/19/2013
  8. 8. 8 ÑAÏI CÖÔNG HEÏP VAN HAI LAÙ 6/19/2013
  9. 9. 9 X QUANG HEÏP VAN HAI LAÙ NHEÏ Bình thöôøng S loã van=4-6cm2. Heïp nheï khi 2cm2 ≤ S < 4cm2. AÙp löïc mao maïch phoåi =10-12mmHg. Laâm saøng: Rung taâm tröông (+). 6/19/2013
  10. 10. 10 X QUANG HEÏP VAN HAI LAÙ NHEÏ NORMAL MITRAL VALVE MITRAL STENOSIS 6/19/2013
  11. 11. 11 X QUANG HEÏP VAN HAI LAÙ NHEÏ X quang: Boùng tim chöa thaáy thay ñoåi gì. Phaân boá maïch maùu phoåi cuõng chöa thaáy thay ñoåi. Do vaäy,X quang tim-phoåi bình thöôøng khoâng loaïi tröø ñöôïc Heïp van hai laù. 6/19/2013
  12. 12. 12 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG Heïp trung bình khi 1cm2 ≤ S < 2cm2. AÙp löïc mao maïch phoåi =10-17mmHg. Heïp naëng khi S loã van < 1cm2. AÙp löïc mao maïch phoåi ≥18mmHg. 6/19/2013
  13. 13. 13 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG Sinh lyù beänh: Taéc ngheõn doøng chaûy töø Nhó (T) xuoáng Thaát (T) Taêng aùp löïc Nhó (T) Daõn buoàng Nhó (T) Taêng aùp löïc TM phoåi Taêng aùp löïc ÑM phoåi Taêng aùp löïc Thaát (P) Giaõn buoàng Thaát (P). 6/19/2013
  14. 14. 14 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM Daõn buoàng Nhó (T) khi ñöôøng kính Nhó (T)>7cm (ño töø bôø döôùi PQ goác (T) ñeán bôø phaûi Nhó (T)). Pheá quaûn goác (T) bò ñaåy leân cao. Coù hình aûnh bôø ñoâi ôû bôø (P) cuûa tim. 6/19/2013
  15. 15. 15 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM ÑgMC xuoáng bò ñaåy qua (T). Phim thaúng coù uoáng Baryte:Thöïc quaûn coù theå bò ñaåy leäch,thöôøng laø qua (P),ñoâi khi bò ñaåy leäch qua (T). Phim cheách tröôùc (P)(RAO) coù uoáng Baryte:Thöïc quaûn bò ñaåy ra sau roõ nhaát. 6/19/2013
  16. 16. 16 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM 6/19/2013
  17. 17. 17 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM 6/19/2013
  18. 18. 18 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM 6/19/2013
  19. 19. 19 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM 6/19/2013
  20. 20. 20 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM LEFT ATRIAL ENLARGEMENT is best confirmed by measuring the distance from the midinferior border of the left main bronchus to the right lateral border of the left atrial density. -This distance is less than 7cm in 90% of normal patients and is greater than 7cm in 90% of left atrial enlargement patients,as proven by echocardiography. -This measurement can be approximated by placing one’s right fifth finger under the left bronchus,and while keeping the fingers closed,if the left atrium is seen beyond one’s four fingertips,the left atrium is enlarged. 6/19/2013
  21. 21. 21 PULMONARY EDEMA / MITRAL STENOSIS AFTER TREATMENT 6/19/2013
  22. 22. 22 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM MITRAL STENOSIS Enlarged LAA 6/19/2013
  23. 23. 23 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM Enlargement of the left atrial appendage. 6/19/2013
  24. 24. 24 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM -Elevation of left main bronchus. -Double shadow of the large left atrium (arrow). -Right atrial border is limited below by the entry of the inferior vena cava. 6/19/2013
  25. 25. 25 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM -Elevation of left main bronchus. -Splaying of the carina. -Descending aorta (arrow) has been displaced to the left by the large left atrium. 6/19/2013
  26. 26. 26 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM RAO-MITRAL STENOSIS Enlarged LA 6/19/2013
  27. 27. 27 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM Caøng ngaøy Nhó (T) caøng to ra,nhaát laø khi coù Rung nhó.Nhó (T)coù theå vöôït ra ngoaøi bôø Nhó (P). Cung ÑMP cuõng to ra do taêng aùp trong buoàng Thaát (P). 6/19/2013
  28. 28. 28 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM Tieåu nhó (T) daõn lôùn bieåu hieän baèng cung thöù 4 beân (T),ngay döôùi cung ÑM phoåi.Ñaây laø daáu hieäu coù sôùm nhaát cuûa Heïp van 2 laù. Bôø (T) tim cuõng coù theå bieåu hieän laø moät ñöôøng thaúng hoaëc loài ra (Mitralisation du bord gauche du coeur). 6/19/2013
  29. 29. 29 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM Hieän töôïng Mitralisation roõ laø nhôø Quai ÑMC nhoû do giaûm cung löôïng tim (löôïng maùu veà Thaát (T) ít). Neáu Quai ÑMC to,caàn phaûi chuù yù xem coù keát hôïp theâm beänh khaùc nhö Heïp van ÑMC,Hôû van ÑMC. Quai TM Azygos daõn (>7mm). 6/19/2013
  30. 30. 30 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM Thaát (T) coù kích thöôùc bình thöôøng,chæ soá T/N ≤ 0,5. Veà sau Thaát (P) daõn Chæ soá T/N taêng. (Khoù chaån ñoaùn phaân bieät vôùi Daøy thaát (T) treân hình thaúng,caàn hình nghieâng (T)-Thaát (P) che laáp khoaûng saùng sau öùc). 6/19/2013
  31. 31. 6/19/2013 31 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM Hình aûnh ít gaëp laø voâi hoùa van hai laù(40%), voøng van 2 laù(10%) vaø ôû thaønh Nhó (T). Phim nghieâng (T):Nhó (T) to ñaåy PQ goác (T) ra sau (Walking man sign).
  32. 32. 6/19/2013 32 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM MITRAL STENOSIS
  33. 33. 6/19/2013 33 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM -Enlarged veins. -Bulging of the pulmonary artery. -Double density due to enlarged left atrium. -Right lateral displacement of esophagus. SEVERE MITRAL STENOSIS
  34. 34. 6/19/2013 34 X QUANG CHAÅN ÑOAÙN PHAÂN BIEÄT Pectus excavatum-Cardiac silhouette is rotated and displaced to the patient’s left,and the left cardiac border is straight simulating mitral valve disease.
  35. 35. 6/19/2013 35 X QUANG CHAÅN ÑOAÙN PHAÂN BIEÄT 10-year-old asymptomatic boy with an unusual contour of the left upper heart border on a chest X-ray.
  36. 36. 6/19/2013 36 X QUANG CHAÅN ÑOAÙN PHAÂN BIEÄT Coronal T1-weighted:Bulging of the left atrial appendage related to partial absence of the pericardium.
  37. 37. 6/19/2013 37 X QUANG CHAÅN ÑOAÙN PHAÂN BIEÄT PARTIAL ABSENCE OF THE PERICARDIUM
  38. 38. 6/19/2013 38 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG WALKING MAN SIGN -The right main bronchus is outlined. -The lower lobe bronchus is displaced posteriorly (large arrowheads). -Calcification of the wall of the left atrium (small arrowheads).
  39. 39. 6/19/2013 39 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
  40. 40. 6/19/2013 40 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM
  41. 41. 6/19/2013 41 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM -RAO:enlargement of the left atrium(large black arrow). -The mitral valve is calcified(small black arrow). -The pulmonary outflow tract is enlarged(white arrow).
  42. 42. 6/19/2013 42 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM C-shaped calcification in the mitral valve ring-Lateral view. Calcification in the wall of the left atrium.
  43. 43. 6/19/2013 43 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM Calcification within the left atrium.
  44. 44. 6/19/2013 44 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM Left atrial calcification (Lateral view).
  45. 45. 6/19/2013 45 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM -Left atrial calcification (white arrows). -Calcified mitral valve (black arrow).
  46. 46. 6/19/2013 46 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM -Calcified mitral valve. -Esophagus is pushed posteriorly by the enlarged left atrium.
  47. 47. 6/19/2013 47 X QUANG THAY ÑOÅI VEÀ TIM Mitral annular calcification in asymptomatic patients.
  48. 48. 6/19/2013 48 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI Taêng tuaàn hoaøn phoåi thuï ñoäng (Taêng tuaàn hoaøn phoåi sau mao maïch): Taùi phaân phoái maïch maùu phoåi xuaát hieän sôùm khi ALTT>12mmHg. Xuaát hieän caùc ñöôøng Kerley A,B,C,D khi ALTT>18mmHg.Thöôøng thaáy nhaát laø Kerley B.
  49. 49. 6/19/2013 49 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI ÑMP to daàn Khoù chaån ñoaùn phaân bieät giöõa CIA vôùi RM+HVD. CIA:Nhó (T) khoâng to,khoâng coù taùi phaân phoái. Veà sau,ÑMP to ôû trung taâm,nhoû ôû ngoaïi vi (Tình traïng taêng aùp ÑMP laâu ngaøy Thaønh tieåu ñoäng maïch daøy leân).
  50. 50. 50 Tuần hoàn phổi bình thường Tái phân phối mạch máu phổi 6/19/2013
  51. 51. 516/19/2013
  52. 52. 52 Dày vách liên tiểu thùy 6/19/2013
  53. 53. 53 CARDIAC FAILURE -Enlarged heart size. -No clear heart border (interstitiel edema), Kerley’s line, pleural effusion. -Redistribution. 6/19/2013
  54. 54. 6/19/2013 54 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI -Left ventricle has normal size. -Dilated upper lobe vessels. -Bulging of the left atrial appendage. -Elevation of the left main bronchus. -Double contour of the right heart border. MITRAL STENOSIS
  55. 55. 6/19/2013 55 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI -Small aortic knob. -Bulging of the main pulmonary artery. -Bulging of the left atrial appendage(large white arrow). -Elevation of the left main bronchus(black arrowheads). -Double density through the heart shadow(black arrows). -Redistribution(small white arrows). -The hilar vasculature is prominent(white arrowhead).
  56. 56. 6/19/2013 56 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI -Dilated upper lobe vessels. -Bulging of the pulmonary artery. -Elevation of the left main bronchus. -Double contour of the right heart border.
  57. 57. 6/19/2013 57 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI -Left main bronchus is displaced posteriorly by the large left atrium. -Large right ventricle touches the sternum. MITRAL STENOSIS
  58. 58. 6/19/2013 58 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI PULMONARY ARTERIAL ANEURYSM / SEVERE MITRAL STENOSIS
  59. 59. 6/19/2013 59 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
  60. 60. 6/19/2013 60 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
  61. 61. 6/19/2013 61 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-CAÁP TÍNH Phuø phoåi moâ keõ. Phuø phoåi pheá nang.
  62. 62. 6/19/2013 62 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-CAÁP TÍNH PULMONARY INTERSTITIAL EDEMA
  63. 63. 6/19/2013 63 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-CAÁP TÍNH PULMONARY EDEMA
  64. 64. 6/19/2013 64 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH ÔÛ ngöôøi Heïp van 2 laù laâu naêm, 1/3 giöõa vaø 1/3 döôùi coù nhöõng ñoám Hemosiderine do Hb thoaùt ra ngoaøi Hoàng caàu (1/3 döôùi nhieàu hôn 1/3 giöõa). Hemosiderine bò aên bôûi Ñaïi thöïc baøo Hemosiderose. Phaân bieät vôùiLao phoåi keâ:Noát keâ raûi khaép phoåi (caû 3 phaàn treân,giöõa vaø döôùi phoåi).
  65. 65. 6/19/2013 65 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH Xô phoåi:nhöõng daûi môø saéc neùt. Daøy dính maøng phoåi:do thoaùt dòch Daøy dính. Nhöõng vuøng môø cuûa nhoài maùu phoåi cuõ.
  66. 66. 6/19/2013 66 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH Nhoài maùu phoåi (Pulmonary infarction) laø moät bieán chöùng thöôøng gaëp cuûa beänh van 2 laù vì thuyeân taéc coù nguoàn goác töø: Hoaëc do nhöõng cuïc maùu ñoâng ôû ngoaïi vi vì cung löôïng tim thaáp. Hoaëc do cuïc maùu ñoâng töø Nhó (P) xuaát hieän sau Rung nhó.
  67. 67. 6/19/2013 67 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH -The cardiac silhouette is typical of mitral stenosis. -Consolidation and pleural reaction at the left base pulmonary infarction.
  68. 68. 6/19/2013 68 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH HEMOSIDEROSIS IN MITRAL STENOSIS
  69. 69. 6/19/2013 69 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH KERLEY’S B LINES & HEMOSIDEROSIS IN MITRAL STENOSIS
  70. 70. 6/19/2013 70 ÑAÏI CÖÔNG HÔÛ VAN HAI LAÙ (MITRAL REGURGITATION) Hôû van 2 laù coù theå caáp tính:Ñöùt daây chaèng-coät cô (sau Nhoài maùu cô tim,Vieâm noäi taâm maïc nhieãm truøng) Hôû 2 laù nhöng Thaát (T) chöa kòp giaõn roäng. Hôû van 2 laù coù theå maïn tính:Sau RAA, hoaëc do loã van giaõn roäng (Hoäi chöùng Marfan, Beänh cô tim)…
  71. 71. 6/19/2013 71 X QUANG HÔÛ VAN HAI LAÙ NHEÏ Thaát (T) vaø Nhó (T) giaõn lôùn do “overload”. Nhó (T) coøn buø X quang tim-phoåi bình thöôøng duø treân Laâm saøng nghe ATTT. Do vaäy,cuõng nhö Heïp van 2 laù,X quang tim-phoåi bình thöôøng khoâng loaïi tröø ñöôïc Hôû van 2 laù.
  72. 72. 6/19/2013 72 X QUANG HÔÛ VAN HAI LAÙ TRUNG BÌNH Nhó (T) coøn buø. Nhó (T) to ra,nhöng aùp suaát chöa taêng nhieàu. Thaát (T) cuõng giaõn to vöøa phaûi. Quai ÑMC nhoû do cung löôïng tim giaûm.
  73. 73. 6/19/2013 73 X QUANG HÔÛ VAN HAI LAÙ NAËNG Nhó (T) maát buø. Nhó (T) to ra,aùp suaát taêng cao.Neáu so saùnh vôùi Heïp 2 laù ,thì Nhó (T) to hôn nhieàu,coù khi vöôït ra ngoaøi bôø cuûa Nhó (P). Thaát (T) to ra,taïo neân hình aûnh “big heart disease”. Treân hình nghieâng hoaëc LAO: Thaát (T) to che laáp khoaûng saùng sau tim.
  74. 74. 6/19/2013 74 X QUANG HÔÛ VAN HAI LAÙ NAËNG Quai ÑMC nhoû do cung löôïng tim giaûm. Phình cung ÑMP ”Mitralisation du bord gauche du coeur”. Taùi phaân phoái tuaàn hoaøn phoåi. Caùc ñöôøng Kerley ít gaëp hôn vaø khoâng roõ so vôùi Heïp van 2 laù.
  75. 75. 6/19/2013 75 X QUANG HÔÛ VAN HAI LAÙ NAËNG MITRAL REGURGITATION
  76. 76. 6/19/2013 76 X QUANG HÔÛ VAN HAI LAÙ NAËNG -Small aortic knob. -Peribronchial cuffing due to edema. -Bulging of the pulmonary artery. -Left ventricular enlargement.
  77. 77. 6/19/2013 77 X QUANG HÔÛ VAN HAI LAÙ NAËNG MITRAL REGURGITATION
  78. 78. 6/19/2013 78 X QUANG HÔÛ VAN HAI LAÙ NAËNG -Straightening of the left heart border. -Small aortic knob. -Elevation of the left main bronchus. -Bulging of the left atrial appendage. -Huge left atrium. -Enlargement of the cardiac silhouette.
  79. 79. 6/19/2013 79 X QUANG HÔÛ VAN HAI LAÙ NAËNG Enlarged left atrium. MITRAL REGURGITATION
  80. 80. 6/19/2013 80 X QUANG HÔÛ VAN HAI LAÙ NAËNG LATERAL VIEW:RETROGRADE BRACHIAL ARTERY CATHETERIZATION. -Left ventricle (small arrows). -Contrast through the incompetent mitral valve into the large left atrium (arrowheads). -Filling of the pulmonary veins (large arrows). MITRAL REGURGITATION
  81. 81. 6/19/2013 81 X QUANG HÔÛ VAN HAI LAÙ NAËNG -Small aortic knob. -Elevation of the left main bronchus. -Enlargement of the left ventricle and left atrium. -The left atrium is calcified (arrowheads).
  82. 82. 6/19/2013 82 X QUANG HÔÛ VAN HAI LAÙ NAËNG Calcification of the left atrial wall MITRAL REGURGITATION
  83. 83. 6/19/2013 83 X QUANG HÔÛ VAN HAI LAÙ NAËNG -Small aortic knob. -Bulging of the main pulmonary artery. -Bulging of the left atrial appendage. -Extreme enlargement of the left atrium. -Enlargement of the cardiac silhouette. -Small right pleural effusion.
  84. 84. 6/19/2013 84 X QUANG HÔÛ VAN HAI LAÙ NAËNG Calcification of the posterior wall of the huge left atrium. MITRAL REGURGITATION
  85. 85. 6/19/2013 85 X QUANG HÔÛ VAN HAI LAÙ NAËNG MITRAL REGURGITATION -Small aortic knob. -Elevation of the left main bronchus. -Extreme enlargement of the left atrium (arrows). -Enlargement of the cardiac silhouette.
  86. 86. 6/19/2013 86 SIEÂU AÂM HÔÛ VAN HAI LAÙ
  87. 87. 87 PA view:Dilated left atrial appendage (arrows). Displacement of the left ventricular contour toward the left chest wall. LAT view:Dilated left atrium and ventricle. MITRAL REGURGITATION RETROGRADE LEFT VENTRICULOGRAM: Dilated left atrium and left atrial appendage (arrows). 6/19/2013
  88. 88. 6/19/2013 88 X QUANG CAÙC THEÅ KEÁT HÔÏP Heïp+Hôû van 2 laù:Nhó (T) raát lôùn,coù ñoùng voâi ôû van 2 laù vaø thaønh Nhó (T),tim to toaøn boä. Hôû van 2 laù+Beänh van ÑMC(Heïp,hôû). Hôû van 2 laù+Hôû van 3 laù. Hôû van 2 laù+Hôû van 3 laù+Beänh van ÑMC.
  89. 89. 6/19/2013 89 X QUANG CAÙC THEÅ KEÁT HÔÏP
  90. 90. 6/19/2013 90 X QUANG CAÙC THEÅ KEÁT HÔÏP Mitral valve stenosis and regurgitation- prosthetic mitral valve
  91. 91. 6/19/2013 91 X QUANG CAÙC THEÅ KEÁT HÔÏP MITRAL STENOSIS AND MITRAL REGURGITATION -Small aortic knob. -Enlarged pulmonary artery(2). -Enlarged left atrial appendage(3). -Enlarged left ventricle(4). -Double atrial contour(1).
  92. 92. 6/19/2013 92 X QUANG CAÙC THEÅ KEÁT HÔÏP -Typical cardiac configuration of mitral valvular disease. -Calcification of the mitral valve (black arrows). -Calcific density in the left ventricle (white arrows). (Thrombus arose in the left atrium Prolapsed into the left ventricle Calcified thrombus).
  93. 93. 6/19/2013 93 X QUANG CAÙC THEÅ KEÁT HÔÏP RAO -Calcification of the mitral valve (black arrows). -Calcific density in the left ventricle (white arrows). MITRAL STENOSIS AND MITRAL REGURGITATION
  94. 94. 6/19/2013 94 X QUANG CAÙC THEÅ KEÁT HÔÏP -Small aortic knob. -Bulging of the main pulmonary artery (white arrow). -Enlargement of the left ventricle (large arrowheads). -Enlargement of the left atrium. -Prominent of the superior pulmonary veins (small arrowhead). -Kerley’s B lines. MITRAL STENOSIS AND MITRAL REGURGITATION
  95. 95. 6/19/2013 95 X QUANG CAÙC THEÅ KEÁT HÔÏP MITRAL STENOSIS AND MITRAL REGURGITATION
  96. 96. 6/19/2013 96 X QUANG CAÙC THEÅ KEÁT HÔÏP -Elevation of the left main bronchus (black arrow). -Enlargement of the left ventricle (arrowhead). MITRAL REGURGITATION The aortic valvular lesions was not suspected.It is often impossible to diagnose the combined lesion on plain films. MITRAL REGURGITATION AND AORTIC REGURGITATION
  97. 97. 6/19/2013 97 X QUANG HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG THAY ÑOÅI VEÀ TIM SEVERE MITRAL VALVE DISEASE
  98. 98. 6/19/2013 98 ÑAÏI CÖÔNG HEÏP VAN ÑOÄNG MAÏCH CHUÛ (AORTIC STENOSIS) Bình thöôøng SAO=2,5-3,5 cm2. Khi SAO < 0,7cm2 Coù trieäu chöùng laâm saøng. Sinh lyù beänh:Heïp van ÑMC Taêng gaùnh Thaát (T) Daøy ñoàng taâm Thaát (T). Giaõn sau heïp ôû ÑMC leân,thaáy roõ treân phim LAO.
  99. 99. 6/19/2013 99 X QUANG HEÏP VAN ÑOÄNG MAÏCH CHUÛ Bôø tim beân (T) baàu do daøy ñoàng taâm Thaát (T),chæ soá T/N # 0,55. ÑMC leân cong qua (P). Quai ÑMC khoâng to vì löu löôïng ÑMC giaûm. Veà sau: Moûm tim chuùc xuoáng do giaõn thaát (T). Ñoùng voâi ôû van ÑMC (85%-sau RAA).
  100. 100. 6/19/2013 100 X QUANG HEÏP VAN ÑOÄNG MAÏCH CHUÛ Phoái hôïp:Heïp van ÑMC+Heïp van 2 laù. ÔÛ ngöôøi treû,Heïp van ÑMC baåm sinh= Van 2 maûnh (Bicuspid valve). Chaån ñoaùn phaân bieät: Cao huyeát aùp. Xô vöõa ÑMC.
  101. 101. 6/19/2013 101 X QUANG HEÏP VAN ÑOÄNG MAÏCH CHUÛ
  102. 102. 6/19/2013 102 X QUANG HEÏP VAN ÑOÄNG MAÏCH CHUÛ AORTIC STENOSIS
  103. 103. 6/19/2013 103 X QUANG HEÏP VAN ÑOÄNG MAÏCH CHUÛ AORTIC STENOSIS
  104. 104. 6/19/2013 104 X QUANG HEÏP VAN ÑOÄNG MAÏCH CHUÛ Calcifications in the heart lie on a line drawn between the sterno-diaphragmatic angle and the carina. CALCIFIED AORTIC VALVE
  105. 105. 6/19/2013 105 X QUANG HEÏP VAN ÑOÄNG MAÏCH CHUÛ Ascending aorta shows slight post-stenotic dilatation.
  106. 106. 6/19/2013 106 X QUANG HEÏP VAN ÑOÄNG MAÏCH CHUÛ -Aortic valve calcification (arrow). -Posterior displacement of the left ventricle behind the line of the inferior vena cava. AORTIC STENOSIS
  107. 107. 6/19/2013 107 X QUANG HEÏP VAN ÑOÄNG MAÏCH CHUÛ -Normal heart size. -Dilated ascending aorta.
  108. 108. 6/19/2013 108 X QUANG HEÏP VAN ÑOÄNG MAÏCH CHUÛ Calcified aortic valve. AORTIC STENOSIS
  109. 109. 6/19/2013 109 X QUANG HEÏP VAN ÑOÄNG MAÏCH CHUÛ -Rounded left heart border (arrowheads). -Dilated ascending aorta (small arrows). -The aortic knob is not enlarged.
  110. 110. 6/19/2013 110 X QUANG HEÏP VAN ÑOÄNG MAÏCH CHUÛ LAO -Bulging of the ascending aorta because of post-stenotic dilatation (arrowheads). -Calcified aortic valve (black arrow). AORTIC STENOSIS
  111. 111. 6/19/2013 111 X QUANG HEÏP VAN ÑOÄNG MAÏCH CHUÛ
  112. 112. 6/19/2013 112 X QUANG HEÏP VAN ÑOÄNG MAÏCH CHUÛ AORTIC AND MITRAL STENOSIS
  113. 113. 6/19/2013 113 COÄNG HÖÔÛNG TÖØ HEÏP VAN ÑOÄNG MAÏCH CHUÛ GRADIENT-ECHO MR -Aortic valve (arrow). -The signal void in the entire ascending aorta due to marked turbulence caused by severe aortic stenosis.
  114. 114. 6/19/2013 114 X QUANG HÔÛ VAN ÑOÄNG MAÏCH CHUÛ Nguyeân nhaân thöôøng gaëp nhaát laø sau RAA. Caùc nguyeân nhaân khaùc bao goàm:Giang mai,Vieâm noäi taâm maïc nhieãm truøng,Hoäi chöùng Marfan,Chaán thöông,ÑMC boùc taùch,Vieâm khôùp daïng thaáp,Thoaùi hoùa sau gheùp van sinh hoïc.
  115. 115. 6/19/2013 115 X QUANG HÔÛ VAN ÑOÄNG MAÏCH CHUÛ Sinh lyù beänh:Maùu phuït ngöôïc vaøo Thaát (T) trong kyø taâm tröông Giaõn buoàng thaát (T).Thaát (T) giaõn Giaõn voøng van 2 laù Hôû van 2 laù Giaõn buoàng Nhó (T). Moûm tim chuùc xuoáng döôùi vaø ra sau Bôø (T) tim thoai thoaûi vaø ñænh tim ôû döôùi voøm hoaønh (T). Chæ soá T/N > 0,6.
  116. 116. 6/19/2013 116 X QUANG HÔÛ VAN ÑOÄNG MAÏCH CHUÛ ÑMP khoâng to,coù khi nhö loõm vaøo. ÑMC leân thöôøng khoâng giaõn,neáu ÑMC leân giaõn roõ,phaûi coi chöøng coù keát hôïp vôùi Heïp van ÑMC. Quai ÑMC haàu nhö khoâng thay ñoåi. Chieáu X quang:ÑMC ñaäp maïnh.
  117. 117. 6/19/2013 117 X QUANG HÔÛ VAN ÑOÄNG MAÏCH CHUÛ
  118. 118. 6/19/2013 118 X QUANG HÔÛ VAN ÑOÄNG MAÏCH CHUÛ -Enlarged left ventricle.The apex is displaced downward (large arrow). -The aorta is slightly prominent but there is no post-stenotic dilatation (small arrows). AORTIC REGURGITATION
  119. 119. 6/19/2013 119 X QUANG HÔÛ VAN ÑOÄNG MAÏCH CHUÛ -Enlarged left ventricle. -The aorta is slightly prominent but there is no post-stenotic dilatation. AORTIC REGURGITATION
  120. 120. 6/19/2013 120 X QUANG HÔÛ VAN ÑOÄNG MAÏCH CHUÛ -Enlarged left ventricle. -The aorta is slightly prominent but there is no post-stenotic dilatation. AORTIC REGURGITATION
  121. 121. 6/19/2013 121 X QUANG HÔÛ VAN ÑOÄNG MAÏCH CHUÛ -Dilated left ventricle. -Post-stenotic dilatation of the ascending aorta (arrow).
  122. 122. 6/19/2013 122 X QUANG HÔÛ VAN ÑOÄNG MAÏCH CHUÛ -Calcified aortic valve (ring of arrowheads). -Posterior displacement of the dilated left ventricle (row of arrowheads) behind the line of the inferior vena cava (large arrow). AORTIC STENOSIS & REGURGITATION
  123. 123. 6/19/2013 123 X QUANG HÔÛ VAN ÑOÄNG MAÏCH CHUÛ RETROGRADE AORTOGRAM IN AORTIC REGURGITATION Reflux flow (arrows) in the dilated left ventricle.
  124. 124. 6/19/2013 124 COÄNG HÖÔÛNG TÖØ HÔÛ VAN ÑOÄNG MAÏCH CHUÛ GRADIENT-ECHO MR Regurgitant flow from the aortic valve into the left ventricle (arrow) AORTIC REGURGITATION
  125. 125. 6/19/2013 125 ÑAÏI CÖÔNG BEÄNH VAN ÑOÄNG MAÏCH PHOÅI MAÉC PHAÛI (ACQUIRED PULMONARY VALVULAR LESIONS) Beänh hieám khi ñôn ñoäc vaø hieám khi naëng. Beänh coù theå thaáy trong Hoäi chöùng carcinoid. Hình aûnh X quang thöôøng keát hôïp toån thöông caùc van tim khaùc.
  126. 126. 6/19/2013 126 ÑAÏI CÖÔNG BEÄNH VAN BA LAÙ MAÉC PHAÛI (ACQUIRED TRICUSPID LESIONS) Töông ñoái gaëp nhieàu hôn beänh van ÑMP maéc phaûi. Beänh thöôøng gaëp nhaát sau RAA(Beänh haàu nhö luoân luoân keát hôïp vôùi beänh lyù van 2 laù vaø beänh lyù van ÑMC). Caùc nguyeân nhaân khaùc:Vieâm noäi taâm maïc nhieãm truøng,Chaán thöông ngöïc,Böôùu carcinoid…
  127. 127. 6/19/2013 127 X QUANG BEÄNH VAN BA LAÙ MAÉC PHAÛI Giaõn buoàng Thaát (P) vaø Nhó (P). Thöôøng khoâng voâi hoùa van 3 laù. Giaõn TMC treân,TM azygos. Daáu hieäu phuï:Gan to,ñoäi voøm hoaønh (P) leân cao. Khi Hôû van 3 laù+Heïp van 2 laù Daáu taùi phaân phoái vaø ñöôøng Kerley gaàn nhö bieán maát.
  128. 128. 6/19/2013 128 X QUANG BEÄNH VAN BA LAÙ MAÉC PHAÛI -Huge right atrium. -Left lower lobe collapse from compression by the dilated heart (arrow). TRICUSPID STENOSIS AND REGURGITATION. RIGHT HEART FAILURE.
  129. 129. 6/19/2013 129 X QUANG BEÄNH VAN BA LAÙ MAÉC PHAÛI -Enlarged right atrium (large arrows). -Decrease in the pulmonary vasculature. -Small aortic knob. -Typical left border of mitral valve disease (small arrow). -Elevation of the right hemi- diaphragm. TRICUSPID STENOSIS+AORTIC STENOSIS+MITRAL STENOSIS
  130. 130. 6/19/2013 130 ÖÙNG DUÏNG THÖÏC TEÁ
  131. 131. 6/19/2013 131 KEÁT LUAÄN Beänh van tim maéc phaûi phaàn lôùn do RAA. Toån thöông thöôøng gaëp nhaát ôû van 2 laù, tieáp ñeán laø van ÑMC. Coù theå chæ Heïp ñôn thuaàn,Hôû ñôn thuaàn, coù theå Heïp-Hôû keát hôïp,coù theå toån thöông nhieàu van cuøng moät luùc.
  132. 132. 6/19/2013 132
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