[醫如往常] Junior Clerkship Day 23: 影像醫學科 Radiology Chest X-ray CT

20151002

Morning Meeting: Chest X-ray, CT判讀

Case1

Chest herniation

1. Congenital
2. VATS 術後
3. Trauma, ex: Safety belt

http://radiopaedia.org/articles/intercostal-lung-hernia-1

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Csse2

1. Myocardial
• Infarction久了Calcification，變成LV aneurysm
• 影像比較偏apex
2. Pericardial
1. Constrictive pericarditis
2. Viral
3. TB
4. Surgery

http://radiopaedia.org/articles/left-ventricular-aneurysm

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Case3

Airway retraction

1. Congenital
• Bronchial atresia
2. Peripheral Mucous obstruction
3. Hyperinflation

做吸氣吐氣的Xray加以判讀

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Case4

PAP; Pulmonary alveolar proteinosis

1. Idiopathic: 90%
2. secondary: 5-10%
3. congenital: 2%

可以做Lung lavage
顏色從Yellow→white

http://radiopaedia.org/articles/pulmonary-alveolar-proteinosis

Crazy-paving pattern

GGO (ground glass opacity) with superimposed interlobular septal thickening and intralobular reticular thickening, seen on chest HRCT. It is a nonspecific finding that can be seen in a number of conditions. 

http://radiopaedia.org/articles/crazy-paving

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Case5

Dysphagia
Paratracheal stripe bulge
Esophageal cancer

http://radiopaedia.org/articles/right-paratracheal-stripe

http://radiopaedia.org/articles/left-paratracheal-stripe

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Case6

Saber sheath trachea

The sagittal:coronal diameter is over 2:1 and the extra-thoracic portion of the trachea is not narrowed. 

pathognomonic for COPD
約在Arch上1cm
吸氣吐氣不太會變化

http://radiopaedia.org/articles/saber-sheath-trachea-1

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Case7

HIV PJP

http://radiopaedia.org/cases/pcp-pneumocystis-jirovecii-pneumonia

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Plain Film

Radiologic Technologist Wu 教了很多

原本要去西址，結果跑到東址看

有高級的西門子x-ray，要一千萬元，照完特殊角度可以自動復位，也會自動設定電壓與吸收度。

遇到國中（國小？）到五十歲，要委婉的問：「有微量輻射線，有無懷孕可能？」

現在Plain film解析度很好，女性長頭髮要扎起來，不然會有假影。

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鄧醫師

CT可以DD Appendicitis, diverticulitis

Cardiac CT scan 要先把heart rate 72↓

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IVU 王醫師

Kub

Large Kidney Size or (不會變小): 

1. Diabetic nephropathy
2. HIV-associated nephropathy
3. Infiltrative diseases
4. AIN; Acute Interstitial Nephritis (occasionally) 
5. ADPKD; polycystic kidney
6. Obstruction
7. bilateral staghorn stone
8. Cryoglobulinemia
9. amyloidosis
10. sarcoidosis
11. MM; Multiple myeloma
12. lymphoma
13. leukemia

http://www.slideshare.net/drvamsi84/approach-to-a-case-of-aki

http://www.healthcommunities.com/acute-interstitial-nephritis-ain/index.shtml

Shape

Nephrolith; Renal Calculus

Radiopaque：可清楚看到，跟骨頭的亮度差不多，鈣的結石屬之。 

1. Calcium oxalate monohydrate (Whewellite)
2. Calcium oxalate dihydrate
3. Calcium phosphates

Poor radiopacity：隱隱約約可以看的到。

Cystine

Apatite(磷灰石)

Magnesium ammonium phosphate (磷酸銨鎂)(Struvite) 

Radiolucent：完全看不到。

1. Uric acid
2. Drug stone
3. Xanthine
4. Ammonium urate
5. 2,8-dihydroxyadenine 

http://powderpostbeetle.pixnet.net/blog/post/27571588-%5B%E6%B3%8C%E5%B0%BF%E5%A4%96%E7%A7%91%5Drenal-stone

Defecting film:

1. TCC; Transitional cell carcinoma, or renal urothelial carcinoma (UC)
2. Hematoma
3. Calculus

• Chronic Cystitis因為有fibrosis會看到Contour模糊(邊界不平整) 
• BPH看到由下往上頂
• Neurogenic bladder看到Christmas tree bladder

http://radiopaedia.org/cases/christmas-tree-bladder

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Prof. 曾醫師

Iodine水溶性顯影劑會在腸道造成脫水之後排出，新生兒不能用