1、胸部超声 的入门,A lifesaving, safety-enhancing, efficiency-promoting technology.,胸部超声简介,Ultrasound has long shown its utility for plain organs. Although the lung has traditionally been excluded from its repertoire,studies have proven that this belief was unfounded. Since 1989 in ICU, using devoted logistic
2、s, the concept of whole body ultrasound was developed and extended to the lungs for managing critical situations.Lung ultrasonography is becoming a standard tool in critical care.,胸部超声看什么？,1. Pleural line and A-lines.,胸部超声看什么？,1. Pleural line and A-lines.,胸部超声看什么？,2.B-lines,胸部超声看什么？,2.B-lines,胸部超声看什
3、么?,3.Z-lines or O-lines,胸部超声看什么？,3.Z-lines or O-lines,胸部超声看什么？,胸部超声的应用,1.探头选择 2.体表位置 3.深度,胸部超声的应用,胸部超声的应用,胸部超声的应用,胸部超声的应用,胸部超声的应用,胸部超声的应用,Interstitial syndrome. These vertical comet-tail artifacts arise strictly from the pleural line, are well defined (laserlike), hyperechoic, move with lung sliding
4、, spread to the edge ofthe screen without fading, and erase A lines (dotted arrows indicate their theoretical location). This pattern defines B lines. Several B lines in a single view, reminiscent of a rocket at lift-off, are called lung rockets, or B lines (featuring here, B3 lines). Diffuse lung r
5、ockets indicate interstitial syndrome. One or two B lines in a single view, referred to as the b line, have no pathologic significance. This patient had cardiogenic pulmonary edema.,胸部超声的价值,胸部超声的价值,胸部超声的前景,Can Chest Ultrasonography Replace Standard Chest Radiography for Evaluation of Acute Dyspnea i
6、n the ED?,胸部超声的表现,Conventional two-dimensional echographic imaging of the normal lung. The pleural line is visualized as a bright hyperechogenic interface lateral to the rib. Normal horizontal artifacts are shown (A-lines).,胸水的超声表现,Two-dimensional echographic image of a basal free pleural effusion a
7、ppearing as an anechoic free space between the pleural line and the diaphragm. A portion of atelectatic lung is shown.,肺挫伤的超声表现,Left: normal image, with one isolated B-line (arrows). Right: ultrasonographic pattern of AIS, with several merging B-lines arising from the pleural line; note the absence
8、of A-lines.,肺挫伤的超声表现,Sonographic pattern of parenchymal lung consolidation. PPLs, either isolated (left panel) or multiple (right panel), arrows, appear as hypoechoic pleural-based focal images allowing ultrasound transmission, from which B-line-like artifacts arise (asterisks).,肺栓塞的超声表现,Two typical
9、 lung infarcts after pulmonary embolism.,肺栓塞的超声表现,Pulmonary embolism sonogram. A 47-yr-old patient with pulmonary embolism. The patient suffered from severe dyspnea and breath-depending thoracic pain. The sonogram depicts two triangular, hypoechoic, pleural-based parenchymal lesions within the area
10、of thoracic pain.,脓胸的超声表现,In a case of lung abscess, the air-fluid level within lung parenchyma (arrowhead) does not extend to the parietal pleura.,脓气胸的超声表现,In a case of pyopneumothorax, the air-fluid level extends to the parietal pleura, shown as a horizontal line (arrowhead). During real-time sono
11、graphy, the gliding sign disappears above the air-fluid level, indicating pneumothorax (arrow). The movement of the air-fluid level synchronized with respiration is called the curtain sign. The suspended microbubble sign is also noted within the effusion.,胸膜粘连的表现,(A) Chest ultrasonography in the sev
12、enth intercostal space in the midaxillary line. The linear-array type of transducer is held at 45 degrees related to the longitudinal direction.(B) Chest ultrasonographic images; the arrow indicates pleura and the triangle indicates the distinct focal point. The distinct focal point in the visceral pleura is observed as it moved during several respirations.,谢谢,
