1、Radiodiagnosis in the Respiratory System,呼吸系统X线诊断,贵州省人民医院放射科 唐雷,Section 1 The lungs,The thoracic cage 胸廓The thoracic cage is in symmetry（对称） or not. The ribs and the other bones seen, appear to be normal, or in destruction（骨质破坏）, or malformation（畸形）, and deformation（变形）. The intercostal spaces （肋间隙）
2、are symmetrical or not, broadened, or narrowed. Soft tissues seem normal or abnormal.,2. The lungs Location :If lesions are limited by boundaries of a lobe（肺叶） or a segment（肺段）, the location of the lesion is defined and described directly with the specific lobe or segment.If the lesion has a massive
3、 range and vague margin, it can be described according to the upper, middle or lower regions from top to bottom, and inner, middle or outer zones from inside to outside of the lung fields.,Lung fields（肺野） and pulmonary zones（肺带）,Lung lobes（肺叶） and segments（肺段),Lung lobes（肺叶） and segments（肺段),Sizes o
4、f opacities can be described according to the number of intercostal spaces, lobes and segmengts and/ or direct measurements.If a lesion is round, the diameter can indicate its size.,(2) Sizes of opacities:,(3)Shapes of shadows:,miliary shape 粟粒状 Spots or patches 斑点状或斑片状 Single small nodule 单发小结节状 Mu
5、ltiple nodules 多发结节状 Mass 团块状 Fog-like shadow 云雾状阴影 Consolidation 实变 Calcification 钙化 Flocculent opacities 絮状阴影 Stripe-like opacities 索条状影 Cavity shadows 空洞影 Honeycomb shadows 蜂窝状影 Reticular shadows 网状阴影,The margins of lesions can be manifested as fuzzy（模糊）, clear（清晰）, sharp（锐利）, smooth（光整）, irregul
6、ar, radiating（放射状）, spiculation（毛刺状）, and etc.(5)Relationship between lessions and the surrounding tissues: Pulmonary atelectasis（肺不张） pulls adjacent mediastinum to the affected side. Lung cancer can infiltrate（侵犯） thoracic vertebrae（胸椎） and adjacent ribs.,(4)Margins :,3. The pulmonary hilum （肺门）： H
7、ilar enlargement, decrease, nodules, mass, calcification, reationship with mediastinum, alteration of density, and displacement. 4. The mediastinum（纵隔）: Observation should include location of the trachea（气管）, width of the mediastinum; location, size, shape, displacement of the heart and great vessel
8、s. 5. The diaphragm（膈肌）: Assessment should involve shape of surface, and sharpness of the costophrenic angles（肋膈角）.,Cases in the lungs,Case 1. 正常胸片,The thoracic cage remains symmetrical. All the seen bones are nothing remarkable. The trachea locates centrally without deviation. The lungs are clear,
9、while the lung markings are natural and regular. Both pulmonary hila show neither enlargement nor decrease. The heart and great vessels appear normal in their position, size and shape. The diaphragm has a smooth surface with sharp costophrenic angles.Diagnosis: Normal in the lungs, heart, and diaphr
10、agm.,Case 2. 患儿2y，咳嗽1周,The thoracic cage remains symmetrical. All the seen bones are nothing remarkable. The trachea locates centrally without deviation. The lungs markings become thickened in the inner and middle zones of bilateral middle and lower lung fields. Some scattered patch-like infiltratio
11、ns mix with the thickened lung markings. Their margins appear vague. Both pulmonary hila show blurred, but not in evident enlargemen. There is nothing remarkable in the heart and great vessels. The diaphragm has a smooth surface with sharp costophrenic angles.Diagnosis: Bronchopneumonia.（支气管肺炎）,Case
12、 3. 男，18y，咳嗽1周、发热2天,The thoracic cage remains symmetrical. All the seen bones are nothing remarkable. The trachea locates centrally without deviation.There is a large patchy homogeneous opacity in the right middle lobe with a slightly fuzzy margin. It covers the right pulmonary hilum. The rest of th
13、e lungs remain clear. The left pulmonary hilum has no enlargement. No suspected signs are found in the heart and great vessels. The diaphragm has a smooth surface with sharp costophrenic angles.Diagnosis: Pneumonia（肺炎） in the right middle lobe. Re-examination is suggested after treatment.,Case 4. 高热
14、、咳嗽、脓痰10天,There is a large round-like opacity in the posterior segment of the left lower lung with a fuzzy margin, in the size of 2.0cm3.0cm.A cavity can be found with an air-fluid level （气液平面）in the shadow, which involves the left pulmonary hilum and adjacent lung.Nothing is special in the heart, d
15、iaphragm and right lung.Diagnosis: A pulmonary abscess in the posterior segment of the left lower lung .,Case 5. 腮腺腺样囊性癌术后3年，复发2月,The thoracic cage remains symmetrical. All the seen bones are nothing remarkable. Multiple nodules with clear margins are dis-played diffusely in both lungs in different
16、sizes. Both pulmonary hila show neither enlargement nor decrease. The heart and great vessels appear normal in their position, size and shape. The diaphragm has a smooth surface with sharp costophrenic angles.Diagnosis: Based on the history of adenoid cystic carcinoma, multiple pulmonary metastases are considered in bilateral lungs.,
