CC DU HIU X QUANG TIM C BN

Gi tr ca phim X quang thng quy Cc du hiu c bn ca bng tim trn phim X quang.Lm th no phn bit tim bm sinh hay mc phi ngi ln

Phim X quang thng quy nh gi s b bng tim Cc cung tim, ch s tim lng ngc.nh gi tun hon phiGi tr ca phim X quang thng quy

Ch s tim lng ngc bnh thng (CSTLN)

Nhng trng hp CSTLN > 50%, tim bnh thng Nguyn nhn ngoi timPhim chp trc sauBo phThai phC trngHi chng lng thngLng ngc lm

>50%CSTLN > 50% trn phim thng. Trn phim nghing thy c tim b y b ra do xng c y ra sau.

Do tng gnh thtPh i thtCn ch xem cc b, cc cungNhng trng hp CSTLN > 50%, tim bt thng

MC lnTm nh phiTm tht triTiu nh triMPQuai MCCC B V CC CUNG TIMBng tim vi hai b, 7 cung. Tnh mch ch trn

ng mch ch ln

xpning mch ch ln

Cung gia phi hai b, do nh tri gin

LA v tr cc bung tim trn CLVT

Nh tri gin to ra hnh i b cung di tri.

RA LA

ng knh quai MC < 35mm Quai MCGii hn trong ca quai MC l b tri kh qun

42mmGin ln khi: Tng p Tng lu lng Thay i thnh mchQuai MC

GinThn MP

Thn MP

Cc nhnh MP triThn MP

Nu ta v ng tip tuyn t quai MC n mm tim (ng ) v o kch thc thng gc vi ng tip tuyn thn MP (ng vng)Khong cch ny c gii hn t 0 15 mm

0 mmThn MPMC15 mmTm tht triVy thn MP c gii hn t 0 15mm so vi ng tip tuynMCThn MPTm tht tri

C HAI TNH HUNG XY RAThn MP vt qua ng tip tuynThn MP lm thp di ng tip tuyn 15 mmDo gin ln MPDo teo MP

TIU CHUN TIM LN Bnh thng ch s T/N 0,5 (0,39-0,55 theo Brauwald,1998).i vi tr em

TIU CHUN TIM LN B ngang tim thay i ty tng ngi (cao hay thp):bnh thng t 10cm n 16,5cm. Nu trn hoc di 10% tr s bnh thng l bnh l.Nu phim chp theo th trc-sau (AP view) th phi gim 10% tr s o c mi l tr s thc.

Phim chp trong th th ra Bng tim b ngang.Phim chp ti ging (AP viewTim phng i 10%).Phim chp o th tm thu so vi th tm trng chnh lch 0,3 - 0,9cm (ng knh ngang tim).TIU CHUN TIM LN

Mm tim c th di c honh trong mt s bnh l tim Phi o qua bng hi d dy.D dng lng ngc Thay i bng tim.TIU CHUN TIM LN

TIU CHUN BUNG TIM LNNH PHI LNPhim ngc thng:A/B=1/4 Bnh thng.A/B>1/3 Nh (P) to.C>5,5cmNh (P) to.Chch trc phi:Nh (P) to v pha sau,che khong sng sau tim,c bit trong bnh Ebstein.

Chch trc tri:Tiu nh (P) to phnh ln.Du hiu ph:Gan to y vm honh ln cao.TMCT gin,quai Azygos gin(a>7mm) Lm sng:TM c ni.NH PHI LN

Nh (T) c bit to nht trong H van 2 l.Phim ngc thng:Tiu nh (T) nm ngay di PQ gc (T).Bnh thng ta khng th thy b Tiu nh (T).Khi Nh (T) gin to,b Tiu nh (T) s li ra khin b tim (T) c 4 cung.ng knh Nh (T)>7cm (o t b di PQ gc (T) n b phi Nh (T).NH TRI LN

Mt du hiu quan trng khc l PQ gc (T) b y ln cao.Bnh thng gc gia hai ph qun:N 600.Nam 700.Nh (T) gin ln khi gc ny 900.NH TRI LN

Nh (T) ln s y MC xung lch qua (T).Khi cho bnh nhn ung Baryte ta s thy Thc qun b y qua (P).NH TRI LN

Phim ngc nghing:Nh (T) to y PQ gc (T) ra sau, du chn bc (Walking man sign).Khi cho bnh nhn ung Baryte:Thc qun b y ra sau.NH TRI LN

Chch trc phi:Nh (T) to y thc qun ra sau.Chch trc tri:Nh (T) to che ca s Ph-Ch.PQ gc (T) b y ln,ngang ra tri.NH TRI LN

B Nh (P) v (T) c th phn bit c v b di Nh (P) ha vo TMCD trong lc b Nh (T) bng qua ng gia hng v pha (T) ca tim.B trn ca Nh (P) cng ha vo TMCT.TIU CHUN PHN BIT NH PHI NH TRI

Vch t do ca Tht (P) nm ngay sau na di xng c.Khi Tht (P) gin, s ln ra trc v qua (T),lm xoay trc ca tim ln trn.Trn CT v MRI trc ca tim xoay theo chiu kim ng h.THT PHI LN

Khi tim xoay, tiu nh (T) b xoay ra sau v vo trong, bung tht (P) dch chuyn qua (T) to nn mt phn ca b tim (T).Lc ny b (T) ca tim bu, mm tim nng cao trong khi Ch s T/N 0,55.THT PHI LN

C th phn bit vi Nh (T) ln nh c im khng y PQ gc (T) ln cao trn phim ngc thng v khng y PQ gc (T) ra sau trn phim ngc nghing.Trung tht cng b xoaybng ca TMCT nm chm vo ct sngHp trung tht trn.THT PHI LN

Rt kh chn on phn bit gia Tht (P) to v Tht (T) to.Trong mt s bnh l nh T chng Fallot,Tht (P) ln y Tht (T) qua bn v ln trn cho ra hnh nh mm tim hch ln trn, tim hnh hia (boot-shaped heart).THT PHI LN

Phim nghing:Tht (P) to s che lp khong sng sau c (bnh thng mt trc tht P ch p st vo 1/3 di ca xng c).Du hiu ph:Nh (P) to.Vm honh (P) dng cao.Cung MP c th phng.THT PHI LN

Tht T to kh nh giKhi dy Tht (T) cho hnh nh ging nh Tht (P) to trn phim ngc thng.THT TRI LN

Khi gin (H van 2 l,H van MC):Mm tim xung di vm honh.Ch s T/N > 0,6.Phim ngc nghing hoc chch trc tri:Che lp khong sng sau tim.THT TRI LN

Tng pTng lu lngGin ln thn MP

27Do teo MPThn ng mch c nht (Truncus arteriosus) (T chng Fallot)Thn MP lm thp di ng tip tuyn 15 mm

Tht tri v hoc quai MC y ng tip tuyn ra29Thn MP > 15 mm so vi ng tip tuyn

0 - 15 mmTo recapitulate:

MP Tiu nh triKhi nh tri ln v pha phi, km theo tiu nh tri ln v pha tri, to nn cung li th 4.

Tm tht triTm tht tri

Nu tim ln, Thn MP gin>50%Tht no ln?Tc l tht phi gin

>50% Tht no ln?Nu tim ln, MC ginTc l tht tri gin

Khi c mt tht ln, kh nh gi tht khc ln hay khngTht no ln?

Phn b mch phi

5 kiu phn b mch phiBnh thngTng p tnh mch phiTng p ng mch phiTng lu lngGim lu lng

Cc tiu chun nh giThn ng mch phi phiPhn b tun hon phiCc thu trn tng so vi thu diTrung tm tng so vi ngoi vi

Cc tiu chun nh gi

1. Thn ng mch phi phi

o ng knh trc ch chia iRDPA < 17 mm Bnh thng < 17mm1. Thn ng mch phi phi

Di tng hn trnT th ng, lu lng mu y > nh Khng th nh gi kch thc mch mu y tri, bng tim che2. Phn b mch phi bnh thng

Mch mu phi phn b ly tm cng ra ngoi vi cng nh dn2. Phn b mch phi bnh thngTrung tm tng hn ngoi vi

RDPA < 17 mm in diameter2. Phn b mch phi bnh thng

RDPA > 17 mm Mch phi thu trn bng hoc ln hn mch thu di = CephalizationTng p tnh mch phi

RDPA > 17 mm Thn MP vt ra ngoi ng tip tuyn23Tng p ng mch phi

Tng kch thc t ngt gia thn MP phi v cc nhnh chiaMch trung tm gin rt ln so vi mch ngoi vi = Pruning31Tng p ng mch phi

RDPA > 17 mm Ton b mch phi u ln hn so vi bnh thngTng lu lng

Lu lng bnh thngMch phi thu di ln hn thu trnKhu knh gim dn t trung tm ra ngoi viTng lu lng

Bnh thngTng lu lng

Tng p MPTng lu lng

Kh thy hnRn phi teo nht mch phi hn bnh thngGim lu lng

The SystemThose were all of the answers Now here are the questions The system is successful only if you ask the questions in this order The answers are the fundamental observations you make on the frontal film alone

AIs The Left Atrium Enlarged ?

Straight or convex at site of normal concavity Double density at site of normal indentation ATo answer that question

If Answer To Question A Is YES ALook At Pulmonary Vasculature

If Answer To Question A Is NO Then... A

BIs The Main Pulmonary Artery Big ?

Main pulmonary artery projects beyond tangent lineBTo answer that question

If Answer To Question B Is YES BLook At Pulmonary Vasculature

If Answer To Question B Is NO Then... B

CIs The Main Pulmonary Artery Concave ?

Main pulmonary artery is > 15mm away from tangent lineCTo answer that question25

If Answer To Question C Is YES Look At Configuration of AortaC

If Answer To Question C Is NO Then... C

DIs The Heart a Dilated Or Delta-Shaped Heart ?

Cardio-thoracic ratio > 65% D1. Pericardial effusion 2. Cardiomyopathy

A Is the Left Atrium Enlarged? If yes, then If no, then Look at the Pulmonary Vasculature Pulmonary venous hypertension

Choose the link Test Yourself on the ABCs to see how the system worksFor printed notes, choose the link under Cardiac Notes for The ABCs of Heart Disease

The End