胸腹部影像学精要：影像解剖、影像表现、诊断与鉴别诊断

第一部分 胸部 ........................................ 1

第一章 纵隔 ............................................................. 2

第一节　解剖 ......................................................... 2

一、位置和分区 ................................................. 2

二、影像学标志 ................................................. 2

三、检查方式选择 ............................................. 3

第二节　常规胸片对纵隔的评估 ......................... 4

一、边缘掩盖征 ................................................. 4

二、侧向效应 ..................................................... 4

第三节　弥漫性纵隔疾病 ..................................... 7

一、急性纵隔炎 ................................................. 7

二、慢性纵隔炎和多灶性纤维硬化 ................. 8

第四节　纵隔肿块 ................................................. 8

一、前纵隔 ......................................................... 9

胸内甲状腺肿 ............................................. 9

胸腺增生 ................................................... 10

胸腺瘤和胸腺癌 ....................................... 11

胸腺囊肿 ................................................... 12

胸腺神经内分泌肿瘤；胸腺和

纵隔类癌 ............................................... 12

性腺外生殖细胞肿瘤 ............................... 13

脂肪肉瘤 ................................................... 15

肉瘤 ........................................................... 15

囊性肿块 ................................................... 16

淋巴管瘤和囊状水瘤 ............................... 18

二、中纵隔 ....................................................... 18

结节病 ....................................................... 19

淋巴瘤 ....................................................... 19

Castleman病（血管滤泡性淋巴组织

增生） ...................................................... 21

三、后纵隔 ....................................................... 22

神经源性肿瘤 ........................................... 23

髓外造血 ................................................... 25

Bochdalek疝、Morgagni疝和

Larrey疝 ................................................ 25

第五节　创伤合并纵隔损伤：纵隔气肿 ................ 27

第二章　心脏和心包.................................................... 29

第一节　心脏 ........................................................... 29

一、解剖 ............................................................... 29

心脏的边界 ....................................................... 29

心腔 ................................................................... 29

二、疾病 ............................................................... 31

心衰 ................................................................... 31

冠心病与心肌梗死 ........................................... 35

心肌疾病 ........................................................... 41

心脏肿瘤 ........................................................... 49

获得性瓣膜病 ................................................... 57

第二节　心包................................................................ 63

一、解剖 ................................................................... 63

二、疾病 ................................................................... 65

心包炎 ................................................................... 65

缩窄性心包炎 ....................................................... 65

心包肿块 ............................................................... 66

心包间皮瘤 ........................................................... 66

第三章　大血管............................................................ 70

第一节　主动脉 ....................................................... 70

一、解剖 ............................................................... 70

二、发育 ............................................................... 71

三、先天性异常 ................................................... 71

主动脉上血管起源的变异 ............................... 71

迷走右锁骨下动脉和Kommerell憩室 ............ 72

动脉导管未闭 ................................................... 73

主动脉狭窄 ....................................................... 74

双主动脉弓 ....................................................... 75

右主动脉弓 ....................................................... 76

先天性腹主动脉狭窄 ....................................... 76

四、主动脉疾病 ....................................................... 77

主动脉瘤 ........................................................... 77

急性主动脉综合征 ........................................... 83

主动脉夹层 ....................................................... 83

壁内血肿 ........................................................... 85

主动脉穿通性溃疡 ........................................... 86

主动脉破裂 ....................................................... 87

Leriche综合征 .................................................. 89

珊瑚礁主动脉 ................................................... 89

主动脉炎 ........................................................... 92

血管炎 ............................................................... 93

恶性血管肿瘤 ................................................... 94

主动脉瘘 ........................................................... 96

锁骨下盗血综合征 ........................................... 97

胸廓出口和胸廓入口综合征 ........................... 98

第二节　腔静脉与大静脉 ..................................... 100

一、解剖 ............................................................. 100

二、发育 ............................................................. 100

三、先天性畸形 ................................................. 101

永存左上腔静脉 ............................................. 101

左侧下腔静脉和重复下腔静脉 ..................... 101

奇静脉或半奇静脉延续 ................................. 102

四、疾病 ............................................................. 103

胡桃夹综合征 ................................................. 103

May—Thurner综合征 ...................................... 103

上腔静脉综合征 ............................................. 103

腔静脉血栓形成 ............................................. 105

腔静脉内瘤栓形成 ......................................... 105

第三节　肺血管系统 ............................................. 108

一、解剖 ............................................................. 108

二、发育 ............................................................. 108

三、先天性异常 ................................................. 108

肺动脉不发育 ................................................. 108

肺动脉吊带 ..................................................... 109

异常肺静脉回流 ............................................. 109

四、常见疾病 ..................................................... 109

肺动脉瘤 ......................................................... 109

肺动脉栓塞 ......................................................111

肺动脉高压 ..................................................... 113

肺动静脉畸形 ................................................. 114

第四章　肺和胸膜...................................................... 118

第一节　解剖 ......................................................... 118

一、胸膜和叶间裂 ............................................. 118

二、气管和肺段 ................................................. 118

三、血管 ............................................................. 119

四、肺静脉 ......................................................... 121

五、肺实质 ......................................................... 121

第二节　气管和支气管系统 ................................. 124

一、正常变异：气管性支气管 .......................... 124

二、气管狭窄和骨化性气管支气管病 ............. 124

三、支气管扩张 ................................................. 125

四、细支气管炎 ................................................. 125

五、闭塞性细支气管炎 ..................................... 127

六、 肺气肿、α1抗胰蛋白酶缺乏症和慢性

阻塞性肺疾病 ............................................. 127

七、肺不张 ......................................................... 128

第三节　肺 ............................................................. 131

一、先天性肺畸形 ............................................. 131

肺实质畸形 ..................................................... 131

二、感染 ............................................................. 135

肺炎 ................................................................. 135

化脓性栓塞 ..................................................... 136

结核 ................................................................. 137

曲霉病 ............................................................. 138

Swyer—James—MacLeod综合征（单侧

透明肺） ........................................................ 142

三、肿瘤 ............................................................. 142

肺结节 ............................................................. 142

肺癌 ................................................................. 144

错构瘤 ............................................................. 147

四、弥漫性肺疾病 ............................................. 148

间质性肺病：特发性间质性肺炎 .................. 148

结节病 ............................................................. 153

朗格汉斯细胞组织细胞增生症 ..................... 154

肺淋巴管平滑肌瘤病和结节性硬化累及肺部 ...... 155

囊性肺纤维化 ................................................. 155

五、尘肺 ............................................................. 156

矽肺 ................................................................. 157

石棉肺 ............................................................. 158

其他尘肺病 ..................................................... 159

六、外源性过敏性肺泡炎 ................................. 160

七、肺损伤 ......................................................... 161

吸入烟雾、火焰或有毒气体所致损伤 ........... 161

吸入其他物质所致损伤 ................................. 161

八、血管炎 ......................................................... 161

韦格纳肉芽肿 ................................................. 161

Churg—Strauss综合征 ..................................... 162

九、结缔组织疾病 ............................................. 163

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