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如何初步判讀腹部X光
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在這個PPT裡面,簡單介紹了判讀腹部X光的幾個面向以及常見X光變化,希望對大家有所幫助。
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如何初步判讀腹部X光
1.
如何初步判讀 腹部 X 光
2.
常見腹部 X 光種類 Abdominal
plain film 站著的PA view,上緣包含橫膈膜 KUB 躺著的AP view,照到kidney、ureter、bladder Left decubitus 左側躺,肝臟在上
3.
腹部 X 光觀察重點 A
Air B Bone C Calcification D Soft tissue Density
4.
Air – 正常腹部可看到的
air 胃 左上腹,有時會看 到air-fluid level
5.
Air – 正常腹部可看到的
air 小腸 可以看到plicae circulares
6.
Air – 正常腹部可看到的
air 大腸 可以看到Haustra, 裡面可能有stool
7.
Air – 異常的
bowel gas Perforation 小腸阻塞 大腸阻塞 Volvulus 腸壁發炎
8.
Air – 異常的
bowel gas Perforation 在CXR看到橫膈膜 下有free air
9.
Air – 異常的
bowel gas Perforation 在Left decubitus下 看到肝臟上方有air
10.
Air – 異常的
bowel gas 小腸阻塞 小腸>3cm,有stack of coin sign。可能是 obstruction or ileus
11.
Air – 異常的
bowel gas 小腸阻塞 若附近局部發炎造成 ileus,也可能看到 sentinel loop
12.
Air – 異常的
bowel gas 大腸阻塞 大腸>6cm或直腸>9cm 阻塞近端脹,但遠端無腸氣 可能是obstruction或 pseudo-obstruction
13.
Air – 異常的
bowel gas Volvulus 乙狀結腸volvulus 會有coffee bean sign
14.
Air – 異常的
bowel gas Volvulus 直腸 volvulus
15.
Air – 異常的
bowel gas 腸壁發炎 腸壁變厚,形成 thumbprinting sign
16.
Air – 異常的
bowel gas 腸壁發炎 Lead pipe colon 長期ulcerative colitis 造成haustrum消失
17.
Air – 異常的
bowel gas 腸壁發炎 Toxic megacolon 可以看到很多腸壁發炎腫脹 形成pseudo-polyps
18.
Bone – 腹部可看到的
bone Rib L spine 沒有rib相接 sacrum Iliac bone Femur head
19.
Bone – 腹部可看到的異常 骨折
髖關節腔狹窄 脊椎退化 蝕骨性變化 成骨性變化
20.
Bone – 腹部可看到的異常 退化性骨刺 髖關節腔狹窄 骨折
21.
Bone – 腹部可看到的異常 蝕骨性變化 有些骨轉移會有蝕骨性變化, 如本片的左側femur
head
22.
Bone – 腹部可看到的異常 成骨性變化 有些骨轉移會有成骨性變化, 本片為攝護腺髖骨轉移
23.
Calcification – 腹部的異常鈣化點 腎結石
膽結石 淋巴結鈣化 糞石 腎上腺鈣化 血管鈣化 慢性胰臟炎
24.
Calcification – 腹部的異常鈣化點 腎結石 90%腎結石在腹部X光中可 見。尿酸結石則看不到。
25.
Calcification – 腹部的異常鈣化點 腎結石 較小的結石會 卡在輸尿管中
26.
Calcification – 腹部的異常鈣化點 膽結石 在右上腹,只有10-15% 膽結石可以被看見 淋巴結鈣化 位置有時候需要與腎 結石做鑑別
27.
Calcification – 腹部的異常鈣化點 糞石 在Right
iliac fossa中,與 闌尾炎有高度相關性
28.
Calcification – 腹部的異常鈣化點 血管鈣化 在腹部X光中看到血管鈣化, 代表嚴重的動脈硬化
29.
Calcification – 腹部的異常鈣化點 慢性胰臟炎 在腹部X光中看到胰臟的鈣 化,暗示有慢性胰臟炎
30.
Calcification – 腹部的異常鈣化點 腎上腺鈣化 在腎臟上方,呈現三角形的鈣化 多與之前出血或TB感染有關
31.
Density – 腹部正常軟組織 Liver spleen Kidney bladder Psoas
muscle
32.
Density – 腹部異常軟組織 肝臟腫大
脾臟腫大 腎臟擴大 腹水 骨盆腔腫塊
33.
Density – 腹部異常軟組織 肝臟腫大 可以看到腸子被 推開
34.
Density – 腹部異常軟組織 脾臟腫大 可以看到腸子被 推開
35.
Density – 腹部異常軟組織 腎臟腫大 腎臟在後腹腔,不 會影響腸子空間
36.
Density – 腹部異常軟組織 腹水 KUB,腸氣飄在中央,後 面是不透光的腹水
37.
Density – 腹部異常軟組織 骨盆腔腫塊 可以看到腸子 被向上推開
38.
Summary Air Perforation、小腸阻塞、大腸阻塞、volvulus、腸壁發炎 Bone 骨折、髖關節腔狹窄、脊椎退化、蝕骨性變化、成骨性變化 Calcification 腎結石、膽結石、淋巴結鈣化、糞石、血管鈣化 慢性胰臟炎、腎上腺鈣化 Soft tissue Density 肝臟腫大、脾臟腫大、腎臟擴大、腹水、骨盆腔腫塊
39.
參考資料 Radiology Masterclass https://www.radiologymasterclass.co.uk/ Radiopaedia https://radiopaedia.org/?lang=us
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