응급실에서 접하는 의학적 영상 Chest Radiograph (Plain) Brain CT 건국대학교 충주병원 영상의학과 응급실에서 접하는 의학적 영상 Chest Radiograph (Plain) Brain CT 건국대학교 충주병원 영상의학과 최 영 칠

응급실에서 접하는 의학적 영상 I - Chest Radiograph

조직의 X선 감약도 . (이 순서대로 크다 – 사진상 희다) 1. Bone density; 골 2. Water density; 근육, 혈액, 삼출액, 흉수등 3. Fat density; 지방 4. Air density; 공기 .

흉부X선사진에서 볼 것 1. 기관지와 폐혈관을 포함하는 폐실질 종격동과 심장 및 대혈관 횡경막과 흉벽 및 흉곽의 골격

폐실질; 폐엽의 구분

정상 Chest PA and Lateral

Alveolar Dz. Airway Dz. Interstitial Dz. Vascular Dz. Neoplastic Dz * Alveolar Dz * Airway Dz * Interstitial Dz * Vascular Dz * Neoplastic Dz * Mediastinal Dz * Pleural, Diaph. and Th. Wall Dz * Congenital Dz

Alveolar vs Interstitial lesion

Silhouette sign

Hematogeneous vs Lymphangitic Metastasis

Diffuse nodular lesion

Atelectasis

Pneumonia

Tuberculosis

Bronchiectasis

Lung cancer

Emphysema

Trauma

Diaphragmatic Hernia

Effusion

.

응급실에서 접하는 의학적 영상 II - Brain CT

정상 brain CT

정상 brain CT

* Stroke * Trauma * Tumor * Infection * Congenital Anomaly

I. Stroke; loss of a neurologic function secondary to parenchymal A new, often acute, loss of a neurologic function secondary to parenchymal ischemia or hemorrhage.

A. Cerebral infarction Large vessel occlusions Small vessel infarctions Cardiac emboli Blood disorders Vasculitis...

Vascular Territories

Hyperacute infarction (<12 hours, or within first few hours) Normal (50% to 60%) Hyperdense artery sign Obscuration of lentiform nucleus

Acute Infarction (12 - 24 hours) Low density in basal ganglia Loss of gray-white matter differentiation   (loss of insular ribbon, obscuration of cortex-white matter border) sulcal effacement

Acute Infarction (1 - 3 days) (4 - 7 days) Increasing mass effect   Wedge-shaped low density involves both gray and white matter   Hemorrhagic transformation may occur (4 - 7 days)   Gyral enhancement   Mass effect, edema persists

B. Primary intracranial hemorrhage Very common    Hypertension    Aneurysm    Vascular malformation    Prematurity

Location of Hypertensive Hemorrhage   Putamen/external capsule      60% to 65%   Thalamus                      15% to 25%   Pons                               5% to 10%   Cerebellum                        2% to 5%   Subcortical white matter           1% to 2%

Imaging of ICH Acute Subacute Chronic

C. Nontraumatic SAH Aneurysm Vascular malformation

II. Trauma Traumatic Craniocerebral Lesions Skull & Scalp lesions Extracerebral hemorrhage EDH SDH SAH Intraaxial lesions Diffuse axonal injury (shearing injury) Cortical contusion Deep cerebral gray matter and brainstem injury Intraventricular/choroid plexus hemorrhage

Skull fracture, Scalp hematoma/laceration

Cortical contusion

Epidural hematoma

Subdural hematoma Acute Subacute Chronic

Subarachnoid hemorrhage

Diffuse axonal injury (shearing injury)