2017/9/20 医学界临床药学频道

















     I 即吸气。从前面看,应该能看到5-7根肋骨。

     P 即透射程度。即此处X线穿透人体的程度。在心脏后面,这里的脊柱是可见的吗?

     为了更好的读片,我们将运用ABCDE法 则。如果图像上有明显的异常区域,请首先标注出来。但记住之后要系统地观察图像,以确保你没有遗漏。

     A 气道,肺,胸膜。从气管开始,然后向下走行。气管含气,所以比周围显得更暗(低密度)。检查气管是否位置居中,或是偏向一侧。气管可以被塌陷的肺牵拉至一侧,或者由于一侧张力性气胸被推移到另一侧。描述胸片时,肺叶被分成了上,中,下三个区域。 请注意这和解剖上的肺叶并不是相对应的。轮流观察双侧的肺区,检查是否对称。每一个区域都要和对侧相对比。有没有哪个区域看起来太亮(密度高)了或者太暗(密度低)了?如果有的话,判断哪一侧是异常的。确保你能看见肺纹理一直走行直到胸壁的边缘(细小的灰色纹理)。如果你看见肺的边缘围绕着暗区,那就要怀疑可能有气胸。注意,正常的胸片是看不见胸膜的。













     The systematic approaches useful when starting to interpret chest X-rays along with some basic knowledge of anatomy. This will help to make sure you don’t miss any key abnormalities.

     First of all, have a quick check to confirm the identity of the patient and comment on the orientation of the film. Is it PA or AP? Often, useful information may be written on the image. In terms of image quality, ask yourself if you can see everything you need in the picture. Then check three aspects usually in acronymic RIP.

     R is rotation. The spinous process should be at the midpoint between the medial ends of the clavicles.

     I is the inspiration. There should be 5 to 7 ribs visible anteriorly.

     P is penetration. The degree to which X-rays here pass through the body. Is this spine visible behind the heart?

     We’ll be using the ABCDE approach to chest X-ray interpretation. If there is a clear area of abnormality. Don’t hesitate to highlight it first. But remember to go through systematically afterwards to check you haven’t missed anything.

     A, airway, lungs and pleura. Start with the trachea, and your way down. The trachea contains air so it’s blacker than the surroundings. Check if it is centrally positioned or deviated to one side. The trachea can be pulled towards the side of collapse or pushed away from the side of tension pneumothorax. When describing a chest X-ray, the lobes are divided into upper, middle and lower zones. Note this did not correlate with the lung lobes. Look at each of the lung zones in turn for symmetry. Compare each zone with the opposite side. Do any areas look too black or too white? If so, decide which is the abnormal side. Make sure you can see lung markings go all the way to the edge of the chest wall. If you could see the lung edge with the black area surrounding it, suspect it’s pneumothorax. Note the pleura are not visible in healthy people.

     B, bones. Look at the ribs, clavicles, proximal end of the humerus and the thoracic spine. Check for evidence of fractures or metastatic deposits. Examine the shoulder joints for signs of arthritis or dislocation.

     C, circulation. Heart and mediastinum. Look at the size, shape and border of the heart and mediastinum. Heart size is assessed using the cardiothoracic ratio. In the PA film, the heart occupies less than 50% of the width of the thorax. A cardiothoracic ratio of greater than 50% in a PA view is abnormal and indicates cardiomegaly. Structures making up the left border of the mediastinum include the aortic knuckle, pulmonary outflow tract, left atrial appendage, and left ventricle. On the right side, the border includes the superior vena cava (SVC), the right atrium, and the inferior vena cava (IVC). These borders should be well defined.

     A blurred edge could indicate collapse or consolidation of the lung.

     D, diaphragm. Each side of the diaphragm should appear as a dome with a sharp white edge against the adjacent black lung. The right hemi-diaphragm is normally higher than the left, right about 1-3 centimeters due to the liver underneath. The costophrenic angles are the areas where the diaphragm meets the ribs actually. The cardio-phrenic angle is where the heart meets the diaphragm. These angles should be clearly defined. Often, you would see the gastric air bubble under the left hemi-diaphragm.

     E, extra features and review areas. Look for evidence of medical intervention. For example, monitoring equipment, lines and tubes. Are they correctly positioned? If the chest X-ray appears normal so far, pay attention to the review areas. The lung apexes, the hilum regions. These are the major of bronchi and major pulmonary vessels. The left hilum is higher than the right, or the same level. They should be symmetrically in size and density. Look behind the heart. Check the soft tissues. Finally review under the diaphragm.

     In summary, this is a PA chest X-ray of Mr. Smith. The film is technically adequate.On review of the film there were no obvious abnormalities. I would now like to view the patient clinically.




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