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CC DU HIU X QUANG TIM C BN
Gi tr ca phim X quang thng quy Cc du hiu c bn ca bng tim trn phim X quang.Lm th no phn bit tim bm sinh hay mc phi ngi ln
Phim X quang thng quy nh gi s b bng tim Cc cung tim, ch s tim lng ngc.nh gi tun hon phiGi tr ca phim X quang thng quy
Nhng trng hp CSTLN > 50%, tim bnh thng Nguyn nhn ngoi timPhim chp trc sauBo phThai phC trngHi chng lng thngLng ngc lm
>50%CSTLN > 50% trn phim thng. Trn phim nghing thy c tim b y b ra do xng c y ra sau.
Do tng gnh thtPh i thtCn ch xem cc b, cc cungNhng trng hp CSTLN > 50%, tim bt thng
MC lnTm nh phiTm tht triTiu nh triMPQuai MCCC B V CC CUNG TIMBng tim vi hai b, 7 cung. Tnh mch ch trn
ng mch ch ln
xpning mch ch ln
Cung gia phi hai b, do nh tri gin
LA v tr cc bung tim trn CLVT
Nh tri gin to ra hnh i b cung di tri.
RA LA
ng knh quai MC < 35mm Quai MCGii hn trong ca quai MC l b tri kh qun
42mmGin ln khi: Tng p Tng lu lng Thay i thnh mchQuai MC
GinThn MP
Thn MP
Cc nhnh MP triThn MP
Nu ta v ng tip tuyn t quai MC n mm tim (ng ) v o kch thc thng gc vi ng tip tuyn thn MP (ng vng)Khong cch ny c gii hn t 0 15 mm
0 mmThn MPMC15 mmTm tht triVy thn MP c gii hn t 0 15mm so vi ng tip tuynMCThn MPTm tht tri
C HAI TNH HUNG XY RAThn MP vt qua ng tip tuynThn MP lm thp di ng tip tuyn 15 mmDo gin ln MPDo teo MP
TIU CHUN TIM LN B ngang tim thay i ty tng ngi (cao hay thp):bnh thng t 10cm n 16,5cm. Nu trn hoc di 10% tr s bnh thng l bnh l.Nu phim chp theo th trc-sau (AP view) th phi gim 10% tr s o c mi l tr s thc.
Phim chp trong th th ra Bng tim b ngang.Phim chp ti ging (AP viewTim phng i 10%).Phim chp o th tm thu so vi th tm trng chnh lch 0,3 - 0,9cm (ng knh ngang tim).TIU CHUN TIM LN
Mm tim c th di c honh trong mt s bnh l tim Phi o qua bng hi d dy.D dng lng ngc Thay i bng tim.TIU CHUN TIM LN
TIU CHUN BUNG TIM LNNH PHI LNPhim ngc thng:A/B=1/4 Bnh thng.A/B>1/3 Nh (P) to.C>5,5cmNh (P) to.Chch trc phi:Nh (P) to v pha sau,che khong sng sau tim,c bit trong bnh Ebstein.
Chch trc tri:Tiu nh (P) to phnh ln.Du hiu ph:Gan to y vm honh ln cao.TMCT gin,quai Azygos gin(a>7mm) Lm sng:TM c ni.NH PHI LN
Nh (T) c bit to nht trong H van 2 l.Phim ngc thng:Tiu nh (T) nm ngay di PQ gc (T).Bnh thng ta khng th thy b Tiu nh (T).Khi Nh (T) gin to,b Tiu nh (T) s li ra khin b tim (T) c 4 cung.ng knh Nh (T)>7cm (o t b di PQ gc (T) n b phi Nh (T).NH TRI LN
Mt du hiu quan trng khc l PQ gc (T) b y ln cao.Bnh thng gc gia hai ph qun:N 600.Nam 700.Nh (T) gin ln khi gc ny 900.NH TRI LN
Nh (T) ln s y MC xung lch qua (T).Khi cho bnh nhn ung Baryte ta s thy Thc qun b y qua (P).NH TRI LN
Phim ngc nghing:Nh (T) to y PQ gc (T) ra sau, du chn bc (Walking man sign).Khi cho bnh nhn ung Baryte:Thc qun b y ra sau.NH TRI LN
Chch trc phi:Nh (T) to y thc qun ra sau.Chch trc tri:Nh (T) to che ca s Ph-Ch.PQ gc (T) b y ln,ngang ra tri.NH TRI LN
B Nh (P) v (T) c th phn bit c v b di Nh (P) ha vo TMCD trong lc b Nh (T) bng qua ng gia hng v pha (T) ca tim.B trn ca Nh (P) cng ha vo TMCT.TIU CHUN PHN BIT NH PHI NH TRI
Vch t do ca Tht (P) nm ngay sau na di xng c.Khi Tht (P) gin, s ln ra trc v qua (T),lm xoay trc ca tim ln trn.Trn CT v MRI trc ca tim xoay theo chiu kim ng h.THT PHI LN
Khi tim xoay, tiu nh (T) b xoay ra sau v vo trong, bung tht (P) dch chuyn qua (T) to nn mt phn ca b tim (T).Lc ny b (T) ca tim bu, mm tim nng cao trong khi Ch s T/N 0,55.THT PHI LN
C th phn bit vi Nh (T) ln nh c im khng y PQ gc (T) ln cao trn phim ngc thng v khng y PQ gc (T) ra sau trn phim ngc nghing.Trung tht cng b xoaybng ca TMCT nm chm vo ct sngHp trung tht trn.THT PHI LN
Rt kh chn on phn bit gia Tht (P) to v Tht (T) to.Trong mt s bnh l nh T chng Fallot,Tht (P) ln y Tht (T) qua bn v ln trn cho ra hnh nh mm tim hch ln trn, tim hnh hia (boot-shaped heart).THT PHI LN
Phim nghing:Tht (P) to s che lp khong sng sau c (bnh thng mt trc tht P ch p st vo 1/3 di ca xng c).Du hiu ph:Nh (P) to.Vm honh (P) dng cao.Cung MP c th phng.THT PHI LN
Tht T to kh nh giKhi dy Tht (T) cho hnh nh ging nh Tht (P) to trn phim ngc thng.THT TRI LN
Khi gin (H van 2 l,H van MC):Mm tim xung di vm honh.Ch s T/N > 0,6.Phim ngc nghing hoc chch trc tri:Che lp khong sng sau tim.THT TRI LN
Tng pTng lu lngGin ln thn MP
27Do teo MPThn ng mch c nht (Truncus arteriosus) (T chng Fallot)Thn MP lm thp di ng tip tuyn 15 mm
Tht tri v hoc quai MC y ng tip tuyn ra29Thn MP > 15 mm so vi ng tip tuyn
0 - 15 mmTo recapitulate:
MP Tiu nh triKhi nh tri ln v pha phi, km theo tiu nh tri ln v pha tri, to nn cung li th 4.
Tm tht triTm tht tri
Nu tim ln, Thn MP gin>50%Tht no ln?Tc l tht phi gin
>50% Tht no ln?Nu tim ln, MC ginTc l tht tri gin
Khi c mt tht ln, kh nh gi tht khc ln hay khngTht no ln?
Phn b mch phi
5 kiu phn b mch phiBnh thngTng p tnh mch phiTng p ng mch phiTng lu lngGim lu lng
Cc tiu chun nh giThn ng mch phi phiPhn b tun hon phiCc thu trn tng so vi thu diTrung tm tng so vi ngoi vi
Cc tiu chun nh gi
1. Thn ng mch phi phi
o ng knh trc ch chia iRDPA < 17 mm Bnh thng < 17mm1. Thn ng mch phi phi
Di tng hn trnT th ng, lu lng mu y > nh Khng th nh gi kch thc mch mu y tri, bng tim che2. Phn b mch phi bnh thng
Mch mu phi phn b ly tm cng ra ngoi vi cng nh dn2. Phn b mch phi bnh thngTrung tm tng hn ngoi vi
RDPA < 17 mm in diameter2. Phn b mch phi bnh thng
RDPA > 17 mm Mch phi thu trn bng hoc ln hn mch thu di = CephalizationTng p tnh mch phi
RDPA > 17 mm Thn MP vt ra ngoi ng tip tuyn23Tng p ng mch phi
Tng kch thc t ngt gia thn MP phi v cc nhnh chiaMch trung tm gin rt ln so vi mch ngoi vi = Pruning31Tng p ng mch phi
RDPA > 17 mm Ton b mch phi u ln hn so vi bnh thngTng lu lng
Lu lng bnh thngMch phi thu di ln hn thu trnKhu knh gim dn t trung tm ra ngoi viTng lu lng
Bnh thngTng lu lng
Tng p MPTng lu lng
Kh thy hnRn phi teo nht mch phi hn bnh thngGim lu lng
The SystemThose were all of the answers Now here are the questions The system is successful only if you ask the questions in this order The answers are the fundamental observations you make on the frontal film alone
AIs The Left Atrium Enlarged ?
Straight or convex at site of normal concavity Double density at site of normal indentation ATo answer that question
If Answer To Question A Is YES ALook At Pulmonary Vasculature
If Answer To Question A Is NO Then... A
BIs The Main Pulmonary Artery Big ?
Main pulmonary artery projects beyond tangent lineBTo answer that question
If Answer To Question B Is YES BLook At Pulmonary Vasculature
If Answer To Question B Is NO Then... B
CIs The Main Pulmonary Artery Concave ?
Main pulmonary artery is > 15mm away from tangent lineCTo answer that question25
If Answer To Question C Is YES Look At Configuration of AortaC
If Answer To Question C Is NO Then... C
DIs The Heart a Dilated Or Delta-Shaped Heart ?
Cardio-thoracic ratio > 65% D1. Pericardial effusion 2. Cardiomyopathy
A Is the Left Atrium Enlarged? If yes, then If no, then Look at the Pulmonary Vasculature Pulmonary venous hypertension
Choose the link Test Yourself on the ABCs to see how the system worksFor printed notes, choose the link under Cardiac Notes for The ABCs of Heart Disease
The End