胸部X光判讀整理

首先，檢查X光片拍得好不好

1. 兩側Clavicle的medial ends距midline是否等距→ 若不等距，可能有Rotation
2. Diaphragm位置是否到10'th~11'th肋間→ 若沒有，病人可能沒吸飽氣
3. Thoracic vertebrae應該要隱約可見→ 表示X ray有適當的穿透度

位置資訊：

• Mediastinum前中後分界：1.心臟後緣到IVC連線 2.Vertebral body前緣後1cm連線 
• Lun在CP angle最低處到L2，積水在此可積300ml
• Clavicle的位置在PA view比AP低 (PA約在2'th rib；AP在4'th rib)
• Standing position時，在Stomach常可以看到Air-fluid level (supine無)

依序檢查

1. A: Airway & Mediastinum
2. B: Bone
3. C: Cardiac & Great vessels
4. D: Diaphragm (& CP angles)
5. E: Else (lung)

Alveolar Pattern vs Interstitial Pattern

肺部最小的解剖及呼吸單位：Acinus  (3~5個acinus構成1Pulmonary lobule)

Alveolar pattern: 侵犯air space的疾病

 (ex: CHF, pulmonary edema, pneumonia)

Interstitial pattern: 侵犯Interlobular septa (造成septa水腫or變厚)

(ex: TB, Histoplasmosis, Silicosis, Asbestosis, Farmer's lung, Mushroom worker's disease, sarcoidosis, scleroderma, RA)



描述病灶：6種Abnormalities

1. Air space disease: Consolidation
2. Atelectasis - Collapse
3. Pleural fluid accumulation: Effusion
4. Masses, tumor, tumor-like lesion
5. Overinflation: Emphysema
6. Interstitial change: Fibrosis & Edema

1. Consolidation
利用Silhoutte sign & Cervicothoracic sign定位

Silhoutte sign: 看Aorta, Heart, Diaphragm
正常情況下，Aorta, Heart, Diaphragm被空氣包圍，界限很明顯

若Aorta, Heart, Diaphragm緊貼著病灶，它們的正常界限就會消失
若Aorta, Heart, Diaphragm沒有緊貼病灶(例：在病灶後方後方)，界限依然可見

Cervicothoracic sign: 區分 Neck or Intrathoracic structure

Neck structure: 物體在clavicle上方處的界限不明顯
Intrathoracic structure: 物體在clavice上方處的界限依然可見

2. Atelectasis - Collapse

Left diaphragm與heart的border正常可見，若消失且無肺積水→LLL collapse

3. Masses

• Extrapulmonary masses: sharp margins, tapered border, convexity toward lung
• 邊緣Spiculation(像針狀): malignancy
• Calcification: benign (尤其是中央鈣化or Pop corn)
• Mediastinal mass: Anterior mediastinum最好發 (3T1L: Thymus, Thyroid, Teratoma, Lymphoma)

4. Emphysema

• 最可靠的sign: decreased vascularity