CAÙC DAÁU HIEÄU
X QUANG LOÀNG NGÖÏC
BS.NGUYEÃN QUYÙ KHOAÙNG
BS.NGUYEÃN QUANG TROÏNG
KHOA CHAÅN ÑOAÙN HÌNH AÛNH
BEÄNH VIEÄN AN BÌNH -TP.HCM
April 17, 2015 1
DAØN BAØI
Ñaïi cöông.
1.Daáu hieäu boùng bôø (Silhouette sign).
2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign).
3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng
(Thoraco-abdominal sign or Iceberg sign).
4.Daáu hieäu caùnh buoàm (Sail sign).
5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi
(Hilum overlay sign & Hilum convergence sign).
7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign).
8.Daáu hieäu S-Golden (S-Golden’s sign).
9.Daáu hieäu lieàm khí (Air crescent sign).
10.Daáu hieäu luftsichel (Luftsichel sign).
11.Daáu hieäu phaúng eo (Flat waist sign).
April 17, 2015 2
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
3
DAØN BAØI
Ñaïi cöông.
1.Daáu hieäu boùng bôø (Silhouette sign).
2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign).
3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng
(Thoraco-abdominal sign or Iceberg sign).
4.Daáu hieäu caùnh buoàm (Sail sign).
5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi
(Hilum overlay sign & Hilum convergence sign).
7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign).
8.Daáu hieäu S-Golden (S-Golden’s sign).
9.Daáu hieäu lieàm khí (Air crescent sign).
10.Daáu hieäu luftsichel (Luftsichel sign).
11.Daáu hieäu phaúng eo (Flat waist sign).
April 17, 2015 4
ÑAÏI CÖÔNG
Caùc daáu hieäu X quang chính laø trieäu
chöùng hoïc X quang giuùp ta ñöa ra
nhöõng chaån ñoaùn chính xaùc.
Coù daáu hieäu chung cho moät soá beänh
lyù,nhöng cuõng coù nhöõng daáu hieäu ñaëc
hieäu cho moät beänh lyù.
Rieâng veà loàng ngöïc,cho ñeán nay ñaõ
coù nhieàu daáu hieäu ñöôïc ñöa ra vaø seõ
ñöôïc tieáp tuïc boå sung theo thôøi gian.
April 17, 2015 5
DAØN BAØI
Ñaïi cöông.
1.Daáu hieäu boùng bôø (Silhouette sign).
2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign).
3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng
(Thoraco-abdominal sign or Iceberg sign).
4.Daáu hieäu caùnh buoàm (Sail sign).
5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi
(Hilum overlay sign & Hilum convergence sign).
7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign).
8.Daáu hieäu S-Golden (S-Golden’s sign).
9.Daáu hieäu lieàm khí (Air crescent sign).
10.Daáu hieäu luftsichel (Luftsichel sign).
11.Daáu hieäu phaúng eo (Flat waist sign).
April 17, 2015 6
DAÁU HIEÄU BOÙNG BÔØ
SILHOUETTE SIGN
Daáu hieäu naøy ñöôïc ñöa ra vaøo naêm 1935 bôûi
Dr.H.Kennon Dunham,sau ñoù ñöôïc phaùt trieån bôûi
Benjamin Felson.
Ñònh nghóa: Moät boùng môø trong loàng ngöïc coù ñaäm
ñoä dòch, tieáp xuùc veà maët giaûi phaãu vôùi bôø cuûa caùc
caáu truùc coù ñaäm ñoä dòch trong loàng ngöïc
(tim,ñoäng maïch chuû,voøm hoaønh) seõ xoùa bôø tieáp
xuùc vôùi nhau.Ngöôïc laïi,neáu khoâng tieáp xuùc veà maët
giaûi phaãu thì bôø cuûa caùc caáu truùc ñoù vaãn hieän roõ
treân phim cho duø coù choàng laáp leân nhau.
Khi coù hieän töôïng xoùa bôø ta goïi laø Silhouette sign
(+).
Khi khoâng xoùa bôø ta goïi laø Silhouette sign (-).
7 April 17, 2015
DAÁU HIEÄU BOÙNG BÔØ
SILHOUETTE SIGN
Ñaây laø daáu hieäu cô
baûn vaø quan troïng
nhaát trong X quang
loàng ngöïc qui öôùc.
Trong moät soá tröôøng
hôïp,noù giuùp chuùng
ta ñònh vò ñöôïc caùc
boùng môø trong loàng
ngöïc maø khoâng caàn
ñeán phim ngöïc
nghieâng.
April 17, 2015 8
DAÁU HIEÄU BOÙNG BÔØ
SILHOUETTE SIGN
BOÙNG (SILHOUETTE) THUØY HOAËC PHAÂN THUØY TIEÁP XUÙC
Voøm hoaønh (P).
Caùc phaân thuøy ñaùy - thuøy döôùi phoåi (P).
Bôø tim (P).
Phaân thuøy trong (medial) - thuøy giöõa phoåi
(P)
ÑMC leân.
Phaân thuøy tröôùc - thuøy treân phoåi (P).
Quai ÑMC.
Phaân thuøy sau - thuøy treân phoåi (T).
Bôø (T) tim.
Phaân thuøy döôùi (inferior) - thuøy löôõi
(lingula).
ÑMC xuoáng.
Phaân thuøy ñænh & trong – thuøy döôùi phoåi
(T).
Voøm hoaønh (T).
Caùc phaân thuøy ñaùy - thuøy döôùi phoåi (T).
April 17, 2015 9
DAÁU HIEÄU BOÙNG BÔØ
SILHOUETTE SIGN
SILHOUETTE SIGN (+)
SILHOUETTE SIGN (-)
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
April 17, 2015 10
SILHOUETTE SIGN (+)
SILHOUETTE SIGN (-)
April 17, 2015 11
DAÁU HIEÄU BOÙNG BÔØ
SILHOUETTE SIGN
PHIM NGÖÏC NGHIEÂNG:
1.Voøm hoaønh (T) khoâng coøn
thaáy ôû phaàn tieáp xuùc boùng
tim.
2.Voøm hoaønh (P) ñöôïc thaáy
toaøn boä töø sau ra tröôùc.
April 17, 2015 12
DAÁU HIEÄU BOÙNG BÔØ
SILHOUETTE SIGN
SILHOUETTE SIGN (+): THYMUS
April 17, 2015 13
DAÁU HIEÄU BOÙNG BÔØ
SILHOUETTE SIGN
SILHOUETTE SIGN (+): TRAØN DÒCH MAØNG PHOÅI (P)
April 17, 2015 14
DAÁU HIEÄU BOÙNG BÔØ
SILHOUETTE SIGN
SILHOUETTE SIGN (+): XEÏP THUØY GIÖÕA (P)
April 17, 2015 15
DAÁU HIEÄU BOÙNG BÔØ
SILHOUETTE SIGN
SILHOUETTE SIGN (+): XEÏP THUØY LÖÔÕI
A.J.Chandrasekhar,M.D.Chest X-ray Atlas.
April 17, 2015 16
DAÁU HIEÄU BOÙNG BÔØ
SILHOUETTE SIGN
SILHOUETTE SIGN (+)
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
April 17, 2015 17
DAÁU HIEÄU BOÙNG BÔØ
SILHOUETTE SIGN
SILHOUETTE SIGN (-)
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
April 17, 2015 18
DAÁU HIEÄU BOÙNG BÔØ
SILHOUETTE SIGN
SILHOUETTE SIGN (-)
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
April 17, 2015 19
DAÁU HIEÄU BOÙNG BÔØ
SILHOUETTE SIGN
SILHOUETTE SIGN (-): TRAØN DÒCH MAØNG PHOÅI
KHU TRUÙ PHÍA SAU
April 17, 2015 20
DAØN BAØI
Ñaïi cöông.
1.Daáu hieäu boùng bôø (Silhouette sign).
2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign).
3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng
(Thoraco-abdominal sign or Iceberg sign).
4.Daáu hieäu caùnh buoàm (Sail sign).
5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi
(Hilum overlay sign & Hilum convergence sign).
7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign).
8.Daáu hieäu S-Golden (S-Golden’s sign).
9.Daáu hieäu lieàm khí (Air crescent sign).
10.Daáu hieäu luftsichel (Luftsichel sign).
11.Daáu hieäu phaúng eo (Flat waist sign).
April 17, 2015 21
DAÁU HIEÄU COÅ NGÖÏC
CERVICO-THORACIC SIGN
Bình thöôøng ñænh phoåi cao leân töø tröôùc ra sau.Bôø
treân cuûa trung thaát tröôùc keát thuùc ngang möùc
xöông ñoøn.
Do vaäy,bôø treân moät boùng môø trung thaát bieán maát
khi gaëp xöông ñoøn thì coù nghóa laø boùng môø naèm
moät phaàn ôû coå,moät phaàn ôû trung thaát tröôùc.Luùc
naøy ta goïi laø Cervico-thoracic sign (+):beänh lyù
thöôøng gaëp laø Böôùu giaùp thoøng.
Ngöôïc laïi,moät boùng môø trung thaát thaáy roõ ôû phía
treân xöông ñoøn thì noù phaûi naèm ôû trung thaát
sau.Luùc naøy ta goïi laø Cervico-thoracic sign
(-):beänh lyù thöôøng gaëp laø Neurinoma.
April 17, 2015 22
DAÁU HIEÄU COÅ NGÖÏC
CERVICO-THORACIC SIGN
B:CERVICO-THORACIC SIGN (+)
A:CERVICO-THORACIC SIGN (-)
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
April 17, 2015 23
DAÁU HIEÄU COÅ NGÖÏC
CERVICO-THORACIC SIGN
CERVICO-THORACIC SIGN (+):
BÖÔÙU GIAÙP THOØNG
April 17, 2015 24
DAÁU HIEÄU COÅ NGÖÏC
CERVICO-THORACIC SIGN
CERVICO-THORACIC SIGN (+):
BÖÔÙU GIAÙP THOØNG
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
April 17, 2015 25
DAÁU HIEÄU COÅ NGÖÏC
CERVICO-THORACIC SIGN
CERVICO-THORACIC SIGN (-): NEUROBLASTOMA
April 17, 2015 26
DAÁU HIEÄU COÅ NGÖÏC
CERVICO-THORACIC SIGN
CERVICO-THORACIC SIGN (-):
NEURINOMA
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
April 17, 2015 27
DAÁU HIEÄU COÅ NGÖÏC
CERVICO-THORACIC SIGN
CERVICO-THORACIC SIGN (-)
àPOSTERIOR MEDIASTINUM + CALCIFICATION à NEUROBLASTOMA
April 17, 2015 28
DAØN BAØI
Ñaïi cöông.
1.Daáu hieäu boùng bôø (Silhouette sign).
2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign).
3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng
(Thoraco-abdominal sign or Iceberg sign).
4.Daáu hieäu caùnh buoàm (Sail sign).
5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi
(Hilum overlay sign & Hilum convergence sign).
7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign).
8.Daáu hieäu S-Golden (S-Golden’s sign).
9.Daáu hieäu lieàm khí (Air crescent sign).
10.Daáu hieäu luftsichel (Luftsichel sign).
11.Daáu hieäu phaúng eo (Flat waist sign).
April 17, 2015 29
DAÁU HIEÄU NGÖÏC-BUÏNG
THORACO-ABDOMINAL SIGN (ICEBERG SIGN)
Döïa treân daáu hieäu boùng bôø ngöôøi ta ñöa ra daáu
hieäu naøy ñeå ñònh vò moät boùng môø trung thaát sau.
Neáu bôø döôùi cuûa moät boùng môø trung thaát ñi xa daàn
coät soáng roài bieán maát trong ñaäm ñoä dòch cuûa oå
buïng,thì boùng môø naøy naèm trong oå buïng (phaàn
chìm cuûa taûng baêng) vôùi phaàn noåi cuûa taûng baêng
naèm trong loàng ngöïc.Ta goïi laø Iceberg sign (+).
Neáu bôø döôùi cuûa boùng môø vaãn thaáy roõ vaø hoäi tuï veà
phía coät soáng thì boùng môø naøy naèm hoaøn toaøn
trong loàng ngöïc.Ta goïi laø Iceberg sign (-).
April 17, 2015 30
DAÁU HIEÄU NGÖÏC-BUÏNG
THORACO-ABDOMINAL SIGN (ICEBERG SIGN)
ICEBERG SIGN (+)
ICEBERG SIGN (-)
April 17, 2015 31
DAÁU HIEÄU NGÖÏC-BUÏNG
THORACO-ABDOMINAL SIGN (ICEBERG SIGN)
ICEBERG SIGN (+)
NEUROBLASTOMA
April 17, 2015 32
DAÁU HIEÄU NGÖÏC-BUÏNG
THORACO-ABDOMINAL SIGN (ICEBERG SIGN)
ICEBERG SIGN (+) :NEUROBLASTOMA
April 17, 2015 33
DAÁU HIEÄU NGÖÏC-BUÏNG
CHAÅN ÑOAÙN PHAÂN BIEÄT
ICEBERG SIGN (+) :
NEUROBLASTOMA
BOÙNG MÔØ TAM GIAÙC SAU TIM:
XEÏP THUØY DÖÔÙI PHOÅI (T)
April 17, 2015 34
DAÁU HIEÄU NGÖÏC-BUÏNG
THORACO-ABDOMINAL SIGN (ICEBERG SIGN)
ICEBERG SIGN (-) : NEUROBLASTOMA
April 17, 2015 35
DAÁU HIEÄU NGÖÏC-BUÏNG
THORACO-ABDOMINAL SIGN (ICEBERG SIGN)
ICEBERG SIGN (-): NEURINOMA
April 17, 2015 36
DAØN BAØI
Ñaïi cöông.
1.Daáu hieäu boùng bôø (Silhouette sign).
2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign).
3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng
(Thoraco-abdominal sign or Iceberg sign).
4.Daáu hieäu caùnh buoàm (Sail sign).
5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi
(Hilum overlay sign & Hilum convergence sign).
7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign).
8.Daáu hieäu S-Golden (S-Golden’s sign).
9.Daáu hieäu lieàm khí (Air crescent sign).
10.Daáu hieäu luftsichel (Luftsichel sign).
11.Daáu hieäu phaúng eo (Flat waist sign).
April 17, 2015 37
DAÁU HIEÄU CAÙNH BUOÀM
SAIL SIGN
n Boùng tuyeán öùc
bình thöôøng
(normal thymus) ôû
treû döôùi 3 tuoåi ñoâi
khi bò chaån ñoaùn
laàm laø khoái u
trung thaát.
n Hình aûnh thaáy
April 17, 2015 38
ñöôïc treân X quang
raát ña daïng,trong
ñoù daáu hieäu caùnh
buoàm laø ñieån
hình.
DAÁU HIEÄU CAÙNH BUOÀM
SAIL SIGN
THYMIC SAIL SIGN
April 17, 2015 39
April 17, 2015 40
Caáu truùc hoài aâm luoân luoân
ñaëc, ñoàng daïng
THYMIC SAIL SIGN
April 17, 2015 41
DAØN BAØI
Ñaïi cöông.
1.Daáu hieäu boùng bôø (Silhouette sign).
2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign).
3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng
(Thoraco-abdominal sign or Iceberg sign).
4.Daáu hieäu caùnh buoàm (Sail sign).
5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi
(Hilum overlay sign & Hilum convergence sign).
7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign).
8.Daáu hieäu S-Golden (S-Golden’s sign).
9.Daáu hieäu lieàm khí (Air crescent sign).
10.Daáu hieäu luftsichel (Luftsichel sign).
11.Daáu hieäu phaúng eo (Flat waist sign).
April 17, 2015 42
DAÁU HIEÄU CHE LAÁP ROÁN PHOÅI & DAÁU HIEÄU HOÄI TUÏ ROÁN PHOÅI
HILUM OVERLAY SIGN & HILUM CONVERGENCE SIGN
Daáu hieäu naøy ñöôïc ñöa ra bôûi Benjamine Felson.
Khi ñoïc phim oâng ta nhaän thaáy raèng roán phoåi hai
beân naèm caïnh boùng tim hoaëc ngay trong bôø cuûa
boùng tim ôû 98% tröôøng hôïp,chæ coù 2% tröôøng hôïp
roán phoåi naèm chìm trong bôø boùng tim # 1cm.Moái
quan heä naøy vaãn giöõ nguyeân khi coù Traøn dòch
maøng tim,Tim to hoaëc Phình ÑMP.
Moät boùng môø trung thaát tröôùc coù theå laàm vôùi Traøn
dòch maøng tim,Tim to hoaëc Phình ÑMP.
n Ta noùi Hilum convergence sign (+): Khi boùng roán phoåi
naèm ngay bôø boùng tim à Traøn dòch maøng tim,Tim to hoaëc
Phình ÑMP.
n Ta noùi Hilum overlay sign (+): Khi boùng roán phoåi ôû saâu
>1cm trong bôø boùng tim à Boùng môø trung thaát tröôùc.
April 17, 2015 43
DAÁU HIEÄU CHE LAÁP ROÁN PHOÅI & DAÁU HIEÄU HOÄI TUÏ ROÁN PHOÅI
HILUM OVERLAY SIGN & HILUM CONVERGENCE SIGN
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
April 17, 2015 44
DAÁU HIEÄU CHE LAÁP ROÁN PHOÅI & DAÁU HIEÄU HOÄI TUÏ ROÁN PHOÅI
HILUM OVERLAY SIGN & HILUM CONVERGENCE SIGN
HILUM CONVERGENCE SIGN:
PHÌNH ÑOÄNG MAÏCH PHOÅI (T)
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
April 17, 2015 45
HILUM CONVERGENCE SIGN:
TAÊNG AÙP ÑOÄNG MAÏCH PHOÅI / ÑAÛO NGÖÔÏC
PHUÛ TAÏNG
April 17, 2015 46
DAÁU HIEÄU CHE LAÁP ROÁN PHOÅI & DAÁU HIEÄU HOÄI TUÏ ROÁN PHOÅI
HILUM OVERLAY SIGN & HILUM CONVERGENCE SIGN
HILUM OVERLAY SIGN:
TERATOMA
April 17, 2015 47
DAÁU HIEÄU CHE LAÁP ROÁN PHOÅI & DAÁU HIEÄU HOÄI TUÏ ROÁN PHOÅI
HILUM OVERLAY SIGN & HILUM CONVERGENCE SIGN
HILUM OVERLAY SIGN:
THYMOMA
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
April 17, 2015 48
DAÁU HIEÄU CHE LAÁP ROÁN PHOÅI & DAÁU HIEÄU HOÄI TUÏ ROÁN PHOÅI
HILUM OVERLAY SIGN & HILUM CONVERGENCE SIGN
HILUM OVERLAY SIGN:
TERATOMA
A.J.Chandrasekhar,M.D.Chest X-ray Atlas.
April 17, 2015 49
DAØN BAØI
Ñaïi cöông.
1.Daáu hieäu boùng bôø (Silhouette sign).
2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign).
3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng
(Thoraco-abdominal sign or Iceberg sign).
4.Daáu hieäu caùnh buoàm (Sail sign).
5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi
(Hilum overlay sign & Hilum convergence sign).
7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign).
8.Daáu hieäu S-Golden (S-Golden’s sign).
9.Daáu hieäu lieàm khí (Air crescent sign).
10.Daáu hieäu luftsichel (Luftsichel sign).
11.Daáu hieäu phaúng eo (Flat waist sign).
April 17, 2015 50
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN
AIR BRONCHOGRAM SIGN
Bình thöôøng caùc pheá quaûn
trong phoåi khoâng thaáy
ñöôïc bôûi chuùng chöùa khí
vaø bao quanh bôûi caùc pheá
nang cuõng chöùa khí.
Khi nhu moâ phoåi bò ñoâng
ñaëc,caùc pheá nang laáp ñaày
dòch,trong khi loøng pheá
quaûn coøn thoâng thoaùng,luùc
naøy ta seõ thaáy roõ loøng caùc
pheá quaûn treân phim: Air
bronchogram sign (+).
April 17, 2015 51
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN
AIR BRONCHOGRAM SIGN
RUL Consolidation Strep Pneumonia
A.J.Chandrasekhar,M.D.Chest X-ray Atlas.
April 17, 2015 52
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN
AIR BRONCHOGRAM SIGN
Khi moät boùng môø coù Air bronchogram sign (+) thì
ta coù theå khaúng ñònh toån thöông ôû trong phoåi.
Air bronchogram sign (+) giuùp loaïi tröø moät toån
thöông thaønh ngöïc,maøng phoåi vaø trung thaát.
Air bronchogram sign (+) thöôøng gaëp trong Vieâm
phoåi,Phuø phoåi vaø ñoâi khi trong Nhoài maùu phoåi.
Caùc khoái u phoåi thöôøng coù Air bronchogram sign
(-), ngoaïi tröø alveolar cell carcinoma.
April 17, 2015 53
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN
AIR BRONCHOGRAM SIGN
D.Anthoine et al.L’Imagerie Thoracique.1996-1998.
April 17, 2015 54
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN
AIR BRONCHOGRAM SIGN
-AIR BRONCHOGRAM SIGN (+)
-SILHOUETTE SIGN (+) vôùi voøm hoaønh
(T).
-SILHOUETTE SIGN (-) vôùi bôø tim (T).
àVIEÂM THUØY DÖÔÙI PHOÅI (T)
Dalia Megiddo,M.D et al. Chest X-ray interpretation. Academia Medica,Jerusalem,ISRAEL.
April 17, 2015 55
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN
AIR BRONCHOGRAM SIGN
AIR BRONCHOGRAM SIGN (+):
PHUØ PHOÅI DO NGUYEÂN NHAÂN
THAÀN KINH
(CHAÁN THÖÔNG SOÏ NAÕO)
April 17, 2015 56
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN
AIR BRONCHOGRAM SIGN
AIR BRONCHOGRAM SIGN (+):
VIEÂM PHOÅI
Joseph K.T.Lee. Lee computed body tomography with MRI correlation. 1998
April 17, 2015 57
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN
AIR BRONCHOGRAM SIGN
AIR BRONCHOGRAM SIGN (+):
PHUØ PHOÅI TOÅN THÖÔNG
April 17, 2015 58
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN
AIR BRONCHOGRAM SIGN
U PHEÁ QUAÛN PHAÂN THUØY 2 PHOÅI (P)
(BRONCHIOLOALVEOLAR CARCINOMA)
Alain Blum.Scanographie volumique multicoupe.MASSON.
April 17, 2015 59
DAÁU HIEÄU KHÍ AÛNH NOÄI PHEÁ QUAÛN
AIR BRONCHOGRAM SIGN
K TIEÅU PHEÁ QUAÛN-PHEÁ NANG LAN TOÛA
April 17, 2015 60
DAØN BAØI
Ñaïi cöông.
1.Daáu hieäu boùng bôø (Silhouette sign).
2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign).
3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng
(Thoraco-abdominal sign or Iceberg sign).
4.Daáu hieäu caùnh buoàm (Sail sign).
5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi
(Hilum overlay sign & Hilum convergence sign).
7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign).
8.Daáu hieäu S-Golden (S-Golden’s sign).
9.Daáu hieäu lieàm khí (Air crescent sign).
10.Daáu hieäu luftsichel (Luftsichel sign).
11.Daáu hieäu phaúng eo (Flat waist sign).
April 17, 2015 61
DAÁU HIEÄU S-GOLDEN
S-GOLDEN’S SIGN
Moät khoái u naèm
caïnh pheá quaûn,khi
phaùt trieån seõ cheøn
eùp pheá quaûn gaây
xeïp phoåi.Bôø cuûa
vuøng phoåi xeïp cuøng
vôùi khoái u taïo thaønh
hình chöõ S.
Daáu hieäu naøy ñieån
hình thaáy ôû khoái u
pheá quaûn thuøy treân
phoåi (P).
April 17, 2015 62
DAÁU HIEÄU S-GOLDEN
S-GOLDEN’S SIGN
Non–small cell carcinoma of the bronchus
(S-Golden’s sign)
Weissleder et al.Diagnostic Imaging Expert.1998
April 17, 2015 63
DAÁU HIEÄU S-GOLDEN
S-GOLDEN’S SIGN
Dalia Megiddo,M.D et al. Chest X-ray interpretation. Academia Medica,Jerusalem,ISRAEL.
April 17, 2015 64
DAÁU HIEÄU S-GOLDEN
S-GOLDEN’S SIGN
65 April 17, 2015
XEÏP THUØY TREÂN PHOÅI (T) (caùc ñaàu muõi teân)
DO U PHEÁ QUAÛN (muõi teân)àS-GOLDEN’S SIGN
Joseph K.T.Lee. Lee computed body tomography with MRI correlation. 1998
DAØN BAØI
Ñaïi cöông.
1.Daáu hieäu boùng bôø (Silhouette sign).
2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign).
3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng
(Thoraco-abdominal sign or Iceberg sign).
4.Daáu hieäu caùnh buoàm (Sail sign).
5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi
(Hilum overlay sign & Hilum convergence sign).
7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign).
8.Daáu hieäu S-Golden (S-Golden’s sign).
9.Daáu hieäu lieàm khí (Air crescent sign).
10.Daáu hieäu luftsichel (Luftsichel sign).
11.Daáu hieäu phaúng eo (Flat waist sign).
April 17, 2015 66
DAÁU HIEÄU LIEÀM KHÍ
AIR CRESCENT SIGN
April 17, 2015 67
Khi banh naám
(fungus ball) phaùt
trieån trong moät
caáu truùc hang thì
do banh naám laên
troøn trong
hang,cho neân ta
seõ thaáy 1 lieàm khí
ôû vò trí cao à
Pulmonary
Aspergillosis
DAÁU HIEÄU LIEÀM KHÍ
AIR CRESCENT SIGN
April 17, 2015 68
DAØN BAØI
Ñaïi cöông.
1.Daáu hieäu boùng bôø (Silhouette sign).
2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign).
3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng
(Thoraco-abdominal sign or Iceberg sign).
4.Daáu hieäu caùnh buoàm (Sail sign).
5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi
(Hilum overlay sign & Hilum convergence sign).
7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign).
8.Daáu hieäu S-Golden (S-Golden’s sign).
9.Daáu hieäu lieàm khí (Air crescent sign).
10.Daáu hieäu luftsichel (Luftsichel sign).
11.Daáu hieäu phaúng eo (Flat waist sign).
April 17, 2015 69
DAÁU HIEÄU LUFTSICHEL
LUFTSICHEL SIGN
Daáu hieäu naøy ñöôïc
caùc taùc giaû ngöôøi Ñöùc
ñöa ra (luft:air.
sichel:crescent).
Khi thuøy treân phoåi (T)
bò xeïp,noù seõ bò keùo
vaøo trong vaø leân
treân.Bôø treân trong
cuûa thuøy treân seõ taïo
vôùi trung thaát moät
lieàm khí vôùi quai
ÑMC.
April 17, 2015 70
DAÁU HIEÄU LUFTSICHEL
LUFTSICHEL SIGN
April 17, 2015 71
DAØN BAØI
Ñaïi cöông.
1.Daáu hieäu boùng bôø (Silhouette sign).
2.Daáu hieäu coå-ngöïc (Cervico-thoracic sign).
3.Daáu hieäu ngöïc-buïng hay Daáu hieäu taûng baêng
(Thoraco-abdominal sign or Iceberg sign).
4.Daáu hieäu caùnh buoàm (Sail sign).
5,6.Daáu hieäu che laáp roán phoåi & Daáu hieäu hoäi tuï roán phoåi
(Hilum overlay sign & Hilum convergence sign).
7.Daáu hieäu khí aûnh noäi pheá quaûn (Air bronchogram sign).
8.Daáu hieäu S-Golden (S-Golden’s sign).
9.Daáu hieäu lieàm khí (Air crescent sign).
10.Daáu hieäu luftsichel (Luftsichel sign).
11.Daáu hieäu phaúng eo (Flat waist sign).
April 17, 2015 72
DAÁU HIEÄU PHAÚNG EO
FLAT WAIST SIGN
Khi thuøy döôùi (T) xeïp hoaøn toaøn,noù seõ keùo roán phoåi (T) xuoáng döôùi,
boùng tim bò xoay, laøm cho maát bôø ngoaøi cuûa roán phoåi (T) vaø quai
ÑMC.
April 17, 2015 73
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
74
DAÁU HIEÄU WESTEMARK
WESTEMARK’S SIGN
Daáu hieäu naøy coù
ñöôïc khi thuyeân
taéc ñoäng maïch
phoåi laøm giaûm töôùi
maùu (oligemia)
phaàn phoåi sau taéc
ngheõn.
April 17, 2015 75
DAÁU HIEÄU WESTEMARK
WESTEMARK’S SIGN
April 17, 2015 76
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
77
BÖÔÙU HAMPTON
HAMPTON’S HUMP
Khi xaûy ra Nhoài maùu
phoåi (pulmonary
infarction),thì treân
phim ngöïc xuaát hieän
böôùu Hampton.
Ñieån hình böôùu
Hampton laø boùng môø
ñoàng nhaát hình cheâm
ôû ngoaïi vi phoåi coù
ñaùy naèm treân laù taïng
maøng phoåi,ñænh troøn
höôùng veà roán phoåi.
April 17, 2015 78
BÖÔÙU HAMPTON
HAMPTON’S HUMP
April 17, 2015 79
BÖÔÙU HAMPTON
HAMPTON’S HUMP
April 17, 2015 80
BÖÔÙU HAMPTON
HAMPTON’S HUMP
WESTEMARK’S SIGN (+)
HAMPTON’S HUMP (+)
àPULMONARY EMBOLI
April 17, 2015 81
BÖÔÙU HAMPTON
HAMPTON’S HUMP
WESTEMARK’S SIGN (+)
HAMPTON’S HUMP (+)
àPULMONARY EMBOLI
April 17, 2015 82
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
83
DAÁU HIEÄU FLEISCHNER
FLEISCHNER’S SIGN
Thöôøng ñi keøm theo
daáu hieäu Westemark
laø daáu hieäu Fleischner
(Fleischner's sign):
Phình ÑMP goác (muõi
teân) do taéc ngheõn ôû
haï löu.
April 17, 2015 84
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
85
DAÁU HIEÄU THANH MAÕ TAÁU
SCIMITAR SIGN
Daáu hieäu naøy thaáy trong beänh lyù Söï trôû veà baát thöôøng vaø khoâng
hoaøn toaøn cuûa tónh maïch phoåi (Partial anomalous pulmonary venous
return-PAPVR).Caùc TM phoåi (P) thay vì ñoå veà nhó (T),thì hôïp laïi thaønh
moät thaân chung ñoå veà TMCD taïo neân hình aûnh thanh göôm Thoå Nhó
Kyø.
April 17, 2015 86
DAÁU HIEÄU THANH MAÕ TAÁU
SCIMITAR SIGN
April 17, 2015 87
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
88
DAÁU HIEÄU HÌNH SOÁ 3
FIGURE 3 SIGN (MOGUL SIGN)
Vò trí cuûa thaét eo ÑMC thöôøng ôû sau nôi xuaát phaùt ÑgM döôùi ñoøn
(T).Qua choã thaét eo ÑMC seõ phình ra sau heïp à Taïo thaønh hình soá
3 ngay döôùi quai ÑMC (Figure 3 sign).
April 17, 2015 89
DAÁU HIEÄU HÌNH SOÁ 3
FIGURE 3 SIGN (MOGUL SIGN)
AORTIC COARCTATION
April 17, 2015 90
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
91
DAÁU HIEÄU KHUYEÁT SÖÔØN
RIB NOTCHING SIGN
Trong beänh lyù thaét eo ÑMC maùu seõ
thieáu huït sau choã thaét eo,do vaäy tuaàn
hoaøn baøng heä phaùt trieån:
n A:Maùu seõ töø ÑMDÑ qua ÑgM vai
xuoáng (descending scapular artery),
tieáp noái vôùi ÑgM lieân söôøn ñeå trôû veà
ÑMC sau choã heïp.
n B:Maùu seõ töø ÑMDÑ qua ÑgM vuù
trong (internal mammary artery),tieáp
noái vôùi ÑgM lieân söôøn ñeå trôû veà
ÑMC sau choã heïp.
n Löu yù raèng doøng maùu trong ÑgM
lieân söôøn ôû beänh lyù naøy-khaùc vôùi
bình thöôøng-seõ chaûy ngöôïc veà
ÑMC,vaø khaåu kính seõ taêng leân
nhieàu so vôùi bình thöôøng. ÑgM lieân
söôøn ñaäp maïnh laøm khuyeát bôø döôùi
cung söôøn.
Aortic Stenosis: Spectrum of Diseases Depicted at Multisection CT. Carmen Sebastià, MD. (Radiographics. 2003;23:S79-S91.) April 17, 2015 92
DAÁU HIEÄU KHUYEÁT SÖÔØN
RIB NOTCHING SIGN
Aortic Stenosis: Spectrum of Diseases Depicted at Multisection CT. Carmen Sebastià, MD. (Radiographics. 2003;23:S79-S91.) April 17, 2015 93
DAÁU HIEÄU KHUYEÁT SÖÔØN
RIB NOTCHING SIGN
AORTIC COARCTATION WITH THE RIB NOTCHING
April 17, 2015 94
DAÁU HIEÄU KHUYEÁT SÖÔØN
RIB NOTCHING SIGN
AORTIC COARCTATION / TURNER’S SYNDROME (XO)
April 17, 2015 95
DAÁU HIEÄU KHUYEÁT SÖÔØN
RIB NOTCHING SIGN
NEUROFIBROMATOSIS:
Treû gaùi 15 tuoåi,khuyeát
xöông bôø döôùi moät soá
cung söôøn do u ôû caùc daây
thaàn kinh lieân söôøn.Löu yù
coù neurofibromas ôû vuøng
ñænh phoåi hai beân.
Nhö vaäy,ngoaøi nguyeân
nhaân Thaét eo ÑMC,thì
Neurofibromatosis cuõng laø
moät nguyeân nhaân gaây
khuyeát xöông ôû bôø döôùi
cung söôøn.
Pediatric Ribs: A Spectrum of Abnormalities. Ronald B. J. Glass, MD (Radiographics. 2002;22:87-104.)
April 17, 2015
96
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
97
DAÁU HIEÄU CON MEØO DÖÔÙI TAÁM MEÀN
CAT UNDER THE RUG SIGN
Daáu hieäu naøy giuùp chaån ñoaùn moät boùng môø ngoaøi phoåi
(extrapulmonary).
PLASMACYTOMA RIB
April 17, 2015 98
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
99
DAÁU HIEÄU MÖÏC THUÛY-KHÍ
SIGNE DES NIVEAUX
Daáu hieäu naøy ñöôïc phoå
bieán ôû Phaùp bôûi Joseù
REMY.Noù giuùp phaân bieät
hình aûnh möïc thuûy-khí ôû
trong nhu moâ phoåi hay ôû
maøng phoåi.
Neáu A = A’ à ÔÛ trong nhu
moâ phoåi.
Neáu P # P’ à ÔÛ maøng phoåi.
April 17, 2015 100
DAÁU HIEÄU MÖÏC THUÛY-KHÍ
SIGNE DES NIVEAUX
A = A’ = 6cm
April 17, 2015 101
P # P’
A = A’
April 17, 2015 102
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
103
DAÁU HIEÄU GOÙC SÖÔØN HOAØNH SAÂU
DEEP SULCUS SIGN
104
Daáu hieäu naøy thaáy ñöôïc
treân caùc phim chuïp beänh
nhaân ôû tö theá naèm trong
caùc phoøng chaêm soùc ñaëc
bieät (ICU).
Khi coù traøn khí maøng
phoåi,khí seõ tuï taäp ôû goùc
söôøn hoaønh tröôùc,taïo ra
daáu hieäu goùc söôøn hoaønh
saâu.Vieäc nhaän bieát daáu hieäu
naøy raát quan troïng vì ta raát
deã boû soùt hình aûnh traøn khí
maøng phoåi treân phim ngöïc
April 17, 2015
naèm.
DAÁU HIEÄU GOÙC SÖÔØN HOAØNH SAÂU
DEEP SULCUS SIGN
April 17, 2015 105
DAÁU HIEÄU GOÙC SÖÔØN HOAØNH SAÂU
DEEP SULCUS SIGN
Coù caàn thieát chuïp laïi phim
loàng ngöïc hay khoâng ?
April 17, 2015 106
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
107
DAÁU HIEÄU VIEÀN KHÍ QUANH ÑOÄNG MAÏCH
RING AROUND THE ARTERY SIGN
Daáu hieäu naøy thaáy ñöôïc chuû yeáu treân phim ngöïc nghieâng giuùp chaån
ñoaùn Traøn khí trung thaát.
April 17, 2015 108
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
109
DAÁU HIEÄU VOØM HOAØNH LIEÂN TUÏC
CONTINUOUS DIAPHRAGM SIGN
Bình thöôøng ta khoâng theå
thaáy lieân tuïc voøm hoaønh töø
(P) sang (T) do boùng tim
taïo neân daáu hieäu Silhouette
sign (+) vôùi voøm hoaønh.
Khi ta thaáy voøm hoaønh (P)
ñöôïc noái lieân tuïc qua voøm
hoaønh (T) thì coù nghóa laø coù
Traøn khí maøng tim do khí
len vaøo döôùi boùng tim.
April 17, 2015 110
DAÁU HIEÄU VOØM HOAØNH LIEÂN TUÏC
CONTINUOUS DIAPHRAGM SIGN
April 17, 2015 111
DAÁU HIEÄU VOØM HOAØNH LIEÂN TUÏC
CONTINUOUS DIAPHRAGM SIGN
April 17, 2015 112
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
113
DAÁU HIEÄU VOØM HOAØNH ÑOÂI
DOUBLE-DIAPHRAGM SIGN
Ñoâi khi Traøn khí maøng phoåi khoâng tuï taäp ôû nôi cao maø laïi khu truù döôùi ñaùy
phoåi taïo neân daáu hieäu voøm hoaønh ñoâi.
SUBPULMONIC PNEUMOTHORAX
April 17, 2015 114
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
115
DAÁU HIEÄU ÑÖÔØNG VAØO-ÑÖÔØNG RA
INLET TO OUTLET SIGN
Thöïc quaûn,ÑMC vaø oáng ngöïc laø 3 caáu truùc chaïy
xuyeân qua trung thaát töø ñöôøng vaøo (inlet) tôùi
ñöôøng ra (outlet).
Giaõn cuûa 1 trong 3 caáu truùc naøy coù theå seõ cho
boùng môø ñi töø ñöôøng vaøo tôùi ñöôøng ra.
OÁng ngöïc duø coù giaõn cuõng khoâng bao giôø ñuû lôùn
ñeå coù theå thaáy.Do ñoù:
n Boùng môø töø ñöôøng vaøo ñeán ñöôøng ra ôû beân (P)
trung thaát laø do giaõn thöïc quaûn.
n Boùng môø töø ñöôøng vaøo ñeán ñöôøng ra ôû beân (T)
trung thaát laø do phình ÑMC.
April 17, 2015 116
DAÁU HIEÄU ÑÖÔØNG VAØO-ÑÖÔØNG RA
INLET TO OUTLET SIGN
ACHALASIA
April 17, 2015 117
DAÁU HIEÄU ÑÖÔØNG VAØO-ÑÖÔØNG RA
INLET TO OUTLET SIGN
ACHALASIA
April 17, 2015 118
DAÁU HIEÄU ÑÖÔØNG VAØO-ÑÖÔØNG RA
INLET TO OUTLET SIGN
PHÌNH ÑOÄNG MAÏCH CHUÛ NGÖÏC
April 17, 2015 119
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
120
DAÁU HIEÄU BAÊNG QUA ÑÖÔØNG GIÖÕA
CROSSING MIDLINE SIGN
Moät boùng môø ôû trung
thaát sau döôùi,neáu baêng
qua ñöôøng giöõa thì nhieàu
khaû naêng boùng môø ñoù coù
nguoàn goác töø oáng tieâu
hoùa (hiatal hernia).
Ñeå xaùc ñònh ta caàn chuïp
phim loàng ngöïc coù uoáng
caûn quang Baryte.
April 17, 2015 121
DAÁU HIEÄU BAÊNG QUA ÑÖÔØNG GIÖÕA
CROSSING MIDLINE SIGN
April 17, 2015 122
DAÁU HIEÄU BAÊNG QUA ÑÖÔØNG GIÖÕA
CROSSING MIDLINE SIGN
April 17, 2015 123
DAÁU HIEÄU BAÊNG QUA ÑÖÔØNG GIÖÕA
CROSSING MIDLINE SIGN
April 17, 2015 124
DAÁU HIEÄU BAÊNG QUA ÑÖÔØNG GIÖÕA
CROSSING MIDLINE SIGN
April 17, 2015 125
DAÁU HIEÄU BAÊNG QUA ÑÖÔØNG GIÖÕA
CROSSING MIDLINE SIGN
April 17, 2015 126
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
127
DAÁU HIEÄU BAÊNG QUA THAØNH NGÖÏC
CROSSING CHEST WALL SIGN
CROSSING CHEST WALL SIGN:
BUÙI TOÙC
April 17, 2015 128
DAÁU HIEÄU BAÊNG QUA THAØNH NGÖÏC
CROSSING CHEST WALL SIGN
CROSSING CHEST WALL SIGN:
BUÙI TOÙC
April 17, 2015 129
DAÁU HIEÄU BAÊNG QUA THAØNH NGÖÏC
CROSSING CHEST WALL SIGN
CROSSING CHEST WALL SIGN:
BUÙI TOÙC
A.J.Chandrasekhar,M.D.Chest X-ray Atlas.
April 17, 2015 130
DAÁU HIEÄU BAÊNG QUA THAØNH NGÖÏC
CROSSING CHEST WALL SIGN
CROSSING CHEST WALL SIGN:
BUÙI TOÙC
April 17, 2015 131
DAØN BAØI (tieáp theo)
12.Daáu hieäu Westemark (Westemark’s sign).
13.Böôùu Hampton (Hampton’s hump).
14.Daáu hieäu Fleichner (Fleichner’s sign).
15.Daáu hieäu thanh maõ taáu (Scimitar sign).
16.Daáu hieäu hình soá 3 (Figure 3 sign).
17.Daáu hieäu khuyeát söôøn (Rib notching sign).
18.Daáu hieäu con meøo döôùi taám meàn (Cat under the rug sign).
19.Daáu hieäu möïc thuûy-khí (Signe des niveaux).
20.Daáu hieäu goùc söôøn hoaønh saâu (Deep sulcus sign).
21.Daáu hieäu vieàn khí quanh ñoäng maïch (Ring around the artery sign).
22.Daáu hieäu voøm hoaønh lieân tuïc (Continuous diaphragm sign).
23.Daáu hieäu voøm hoaønh ñoâi (Double-diaphragm sign).
24.Daáu hieäu ñöôøng vaøo-ñöôøng ra (Inlet to outlet sign).
25.Daáu hieäu baêng qua ñöôøng giöõa (Crossing midline sign).
26.Daáu hieäu baêng qua thaønh ngöïc (Crossing chest wall sign).
Keát luaän.
April 17, 2015
132
KEÁT LUAÄN
Vieäc hieåu roõ vaø nhaän bieát ñöôïc caùc
daáu hieäu X quang laø nhöõng ñieàu cô
baûn vaø thieát yeáu ñoái vôùi moãi BS X
quang.
Tuy vaäy coù nhöõng daáu hieäu raát tinh vi
vaø khoâng deã nhaän bieát.Chæ coù ñoïc
phim nhieàu môùi giuùp chuùng ta khoâng
boû soùt caùc daáu hieäu naøy.
April 17, 2015 133
CAÛM ÔN SÖÏ CHUÙ YÙ THEO DOÕI CUÛA QUYÙ BAÙC SÓ
April 17, 2015 134
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