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1
CHAÅN ÑOAÙN HÌNH AÛNH BEÄNH VAN TIM MAÉC PHAÛI
BS.NGUYEÃN QUYÙ KHOAÙNG
BS.NGUYEÃN QUANG TROÏNG
6/19/2013
2
DAØN BAØI
� Heïp van 2 laù.� Ñaïi cöông.� X quang Heïp van 2 laù nheï.� X quang Heïp van 2 laù trung bình-naëng.
�Thay ñoåi veà tim.�Thay ñoåi veà maïch maùu.�Thay ñoåi veà chuû moâ phoåi.
6/19/2013
3
DAØN BAØI
� Hôû van 2 laù.� Ñaïi cöông.� X quang Hôû van 2 laù nheï.� X quang Hôû van 2 laù trung bình.� X quang Heïp van 2 laù naëng.� Caùc theå keát hôïp.
6/19/2013
5
DAØN BAØI
� Hôû van Ñoäng maïch chuû.� Ñaïi cöông.� X quang.� Chuïp coù caûn quang.� Coäng höôûng töø.
6/19/2013
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DAØN BAØI
� Beänh lyù van Ñoäng maïch phoåi.� Beänh lyù van 3 laù.
ÖÙng duïng laâm saøng.� Keát luaän.
6/19/2013
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ÑAÏI CÖÔNGHEÏP VAN HAI LAÙ
(MITRAL STENOSIS)
� Beänh thöôøng gaëp ôû Vieät Nam.� 50% laø do Thaáp tim (RAA).Nöõ/Nam=8/1.� Caùc nguyeân nhaân khaùc:
� Vieâm noäi taâm maïc nhieãm truøng (Bacterial endocarditis).
� U nhaày nhó (T)(LA myxoma).
6/19/2013
9
X QUANGHEÏP VAN HAI LAÙ NHEÏ
� Bình thöôøng S loã van=4-6cm2.� Heïp nheï khi 2cm2 ≤ S < 4cm2.
� AÙp löïc mao maïch phoåi =10-12mmHg. � Laâm saøng: Rung taâm tröông (+).
6/19/2013
11
X QUANGHEÏP VAN HAI LAÙ NHEÏ
� X quang: � Boùng tim chöa thaáy thay ñoåi gì.� Phaân boá maïch maùu phoåi cuõng chöa
thaáy thay ñoåi.� Do vaäy,X quang tim-phoåi bình thöôøng
khoâng loaïi tröø ñöôïc Heïp van hai laù.
6/19/2013
12
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
� Heïp trung bình khi 1cm2 ≤ S < 2cm2.� AÙp löïc mao maïch phoåi =10-17mmHg.
� Heïp naëng khi S loã van < 1cm2.� AÙp löïc mao maïch phoåi ≥18mmHg.
6/19/2013
13
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
� Sinh lyù beänh:� Taéc ngheõn doøng chaûy töø Nhó (T)
xuoáng Thaát (T)�Taêng aùp löïc Nhó (T) �Daõn buoàng Nhó (T)�Taêng aùp löïc TM phoåi�Taêng aùp löïc ÑM phoåi�Taêng aùp löïc Thaát (P)�Giaõn buoàng Thaát (P).
6/19/2013
14
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
� Daõn buoàng Nhó (T) khi ñöôøng kính Nhó (T)>7cm (ño töø bôø döôùi PQ goác (T) ñeán bôø phaûi Nhó (T)).
� Pheá quaûn goác (T) bò ñaåy leân cao.� Coù hình aûnh bôø ñoâi ôû bôø (P) cuûa tim.
6/19/2013
15
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
� ÑgMC xuoáng bò ñaåy qua (T).� Phim thaúng coù uoáng Baryte:Thöïc quaûn
coù theå bò ñaåy leäch,thöôøng laø qua (P),ñoâi khi bò ñaåy leäch qua (T).
� Phim cheách tröôùc (P)(RAO) coù uoáng Baryte:Thöïc quaûn bò ñaåy ra sau roõ nhaát.
6/19/2013
20
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIMLEFT ATRIAL ENLARGEMENT is best confirmed by measuring the distance from the midinferior border of the left main bronchus to the right lateral border of the left atrial density.
-This distance is less than 7cm in 90% of normal patients and is greater than 7cm in 90% of left atrial enlargement patients,as proven by echocardiography.
-This measurement can be approximated by placing one’s right fifth finger under the left bronchus,and while keeping the fingers closed,if the left atrium is seen beyond one’s four fingertips,the left atrium is enlarged.
6/19/2013
22
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
MITRAL STENOSIS
Enlarged LAA
6/19/2013
23
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
Enlargement of the left atrial appendage.
6/19/2013
24
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
-Elevation of left main bronchus.
-Double shadow of the large left atrium (arrow).
-Right atrial border is limited below by the entry of the inferior vena cava.
6/19/2013
25
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
-Elevation of left main bronchus.
-Splaying of the carina.
-Descending aorta (arrow) has been displaced to the left by the large left atrium.
6/19/2013
26
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
RAO-MITRAL STENOSIS
Enlarged LA
6/19/2013
27
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
� Caøng ngaøy Nhó (T) caøng to ra,nhaát laø khi coù Rung nhó.Nhó (T)coù theå vöôït ra ngoaøi bôø Nhó (P).
� Cung ÑMP cuõng to ra do taêng aùp trong buoàng Thaát (P).
6/19/2013
28
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
� Tieåu nhó (T) daõn lôùn bieåu hieän baèng cung thöù 4 beân (T),ngay döôùi cung ÑM phoåi.Ñaây laø daáu hieäu coù sôùm nhaát cuûa Heïp van 2 laù.
� Bôø (T) tim cuõng coù theå bieåu hieän laø moät ñöôøng thaúng hoaëc loài ra (Mitralisation du bord gauche du coeur).
6/19/2013
29
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
� Hieän töôïng Mitralisation roõ laø nhôø Quai ÑMC nhoû do giaûm cung löôïng tim (löôïng maùu veà Thaát (T) ít).
� Neáu Quai ÑMC to,caàn phaûi chuù yù xem coù keát hôïp theâm beänh khaùc nhö Heïp van ÑMC,Hôû van ÑMC.
� Quai TM Azygos daõn (>7mm).
6/19/2013
30
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
� Thaát (T) coù kích thöôùc bình thöôøng,chæ soá T/N ≤ 0,5.
� Veà sau Thaát (P) daõn� Chæ soá T/N taêng. (Khoù chaån ñoaùn phaân bieät vôùi Daøy thaát (T) treân hình thaúng,caàn hình nghieâng (T)-Thaát (P) che laáp khoaûng saùng sau öùc).
6/19/2013
6/19/2013 31
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
� Hình aûnh ít gaëp laø voâi hoùa van hai laù(40%), voøng van 2 laù(10%) vaø ôû thaønh Nhó (T).
� Phim nghieâng (T):Nhó (T) to ñaåy PQ goác (T) ra sau (Walking man sign).
6/19/2013 33
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM-Enlarged veins.
-Bulging of the pulmonary artery.
-Double density due to enlarged left atrium.
-Right lateral displacement of esophagus.
SEVERE MITRAL STENOSIS
6/19/2013 34
X QUANGCHAÅN ÑOAÙN PHAÂN BIEÄT
Pectus excavatum-Cardiac silhouette is rotated and displaced to the patient’s left,and the left cardiac border is straight simulating mitral valve disease.
6/19/2013 35
X QUANGCHAÅN ÑOAÙN PHAÂN BIEÄT
10-year-old asymptomatic boy with an unusual contour of the left upper heart border on a chest X-ray.
6/19/2013 36
X QUANGCHAÅN ÑOAÙN PHAÂN BIEÄT
Coronal T1-weighted:Bulging of the left atrial appendage related to partial absence of the pericardium.
6/19/2013 38
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
WALKING MAN SIGN
-The right main bronchus is outlined.
-The lower lobe bronchus is displaced posteriorly (large arrowheads).
-Calcification of the wall of the left atrium (small arrowheads).
6/19/2013 41
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
-RAO:enlargement of the left atrium(large black arrow).
-The mitral valve is calcified(small black arrow).
-The pulmonary outflow tract is enlarged(white arrow).
6/19/2013 42
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
C-shaped calcification in the mitral valve ring-Lateral view.
Calcification in the wall of the left atrium.
6/19/2013 43
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
Calcification within the left atrium.
6/19/2013 44
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
Left atrial calcification
(Lateral view).
6/19/2013 45
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
-Left atrial calcification (white arrows).
-Calcified mitral valve (black arrow).
6/19/2013 46
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TIM
-Calcified mitral valve.
-Esophagus is pushed posteriorly by the enlarged left atrium.
6/19/2013 48
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
� Taêng tuaàn hoaøn phoåi thuï ñoäng (Taêng tuaàn hoaøn phoåi sau mao maïch):� Taùi phaân phoái maïch maùu phoåi xuaát
hieän sôùm khi ALTT>12mmHg.� Xuaát hieän caùc ñöôøng Kerley A,B,C,D
khi ALTT>18mmHg.Thöôøng thaáy nhaát laø Kerley B.
6/19/2013 49
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
� ÑMP to daàn�Khoù chaån ñoaùn phaân bieät giöõa CIA vôùi RM+HVD.� CIA:Nhó (T) khoâng to,khoâng coù taùi
phaân phoái.� Veà sau,ÑMP to ôû trung taâm,nhoû ôû ngoaïi
vi (Tình traïng taêng aùp ÑMP laâu ngaøy�Thaønh tieåu ñoäng maïch daøy leân).
53
CARDIAC FAILURE
-Enlarged heart size.
-No clear heart border (interstitiel edema), Kerley’s line, pleural effusion.
-Redistribution.
6/19/2013
6/19/2013 54
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
-Left ventricle has normal size.
-Dilated upper lobe vessels.
-Bulging of the left atrial appendage.
-Elevation of the left main bronchus.
-Double contour of the right heart border.
MITRAL STENOSIS
6/19/2013 55
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI-Small aortic knob.
-Bulging of the main pulmonary artery.
-Bulging of the left atrial appendage(large white arrow).
-Elevation of the left main bronchus(black arrowheads).
-Double density through the heart shadow(black arrows).
-Redistribution(small white arrows).
-The hilar vasculature is prominent(white arrowhead).
6/19/2013 56
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
-Dilated upper lobe vessels.
-Bulging of the pulmonary artery.
-Elevation of the left main bronchus.
-Double contour of the right heart border.
6/19/2013 57
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
-Left main bronchus is displaced posteriorly by the large left atrium.
-Large right ventricle touches the sternum.
MITRAL STENOSIS
6/19/2013 58
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
PULMONARY ARTERIAL ANEURYSM / SEVERE MITRAL STENOSIS
6/19/2013 61
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-CAÁP TÍNH
� Phuø phoåi moâ keõ.� Phuø phoåi pheá nang.
6/19/2013 62
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-CAÁP TÍNH
PULMONARY INTERSTITIAL EDEMA
6/19/2013 63
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-CAÁP TÍNH
PULMONARY EDEMA
6/19/2013 64
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH
� ÔÛ ngöôøi Heïp van 2 laù laâu naêm, 1/3 giöõa vaø 1/3 döôùi coù nhöõng ñoám Hemosiderine do Hb thoaùt ra ngoaøi Hoàng caàu (1/3 döôùi nhieàu hôn 1/3 giöõa).
� Hemosiderine bò aên bôûi Ñaïi thöïc baøo�Hemosiderose.
� Phaân bieät vôùiLao phoåi keâ:Noát keâ raûi khaép phoåi (caû 3 phaàn treân,giöõa vaø döôùi phoåi).
6/19/2013 65
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH
� Xô phoåi:nhöõng daûi môø saéc neùt.� Daøy dính maøng phoåi:do thoaùt
dòch�Daøy dính.� Nhöõng vuøng môø cuûa nhoài maùu phoåi
cuõ.
6/19/2013 66
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH
� Nhoài maùu phoåi (Pulmonary infarction) laø moät bieán chöùng thöôøng gaëp cuûa beänh van 2 laù vì thuyeân taéc coù nguoàn goác töø:� Hoaëc do nhöõng cuïc maùu ñoâng ôû ngoaïi
vi vì cung löôïng tim thaáp.� Hoaëc do cuïc maùu ñoâng töø Nhó (P) xuaát
hieän sau Rung nhó.
6/19/2013 67
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH
-The cardiac silhouette is typical of mitral stenosis.
-Consolidation and pleural reaction at the left base�pulmonary infarction.
6/19/2013 68
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH
HEMOSIDEROSIS IN MITRAL STENOSIS
6/19/2013 69
X QUANGHEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH
KERLEY’S B LINES & HEMOSIDEROSIS IN MITRAL STENOSIS
6/19/2013 70
ÑAÏI CÖÔNGHÔÛ VAN HAI LAÙ
(MITRAL REGURGITATION)
� Hôû van 2 laù coù theå caáp tính:Ñöùt daây chaèng-coät cô (sau Nhoài maùu cô tim,Vieâm noäi taâm maïc nhieãm truøng)�Hôû 2 laù nhöng Thaát (T) chöa kòp giaõn roäng.
� Hôû van 2 laù coù theå maïn tính:Sau RAA, hoaëc do loã van giaõn roäng (Hoäi chöùng Marfan, Beänh cô tim)…
6/19/2013 71
X QUANGHÔÛ VAN HAI LAÙ NHEÏ
� Thaát (T) vaø Nhó (T) giaõn lôùn do “overload”.� Nhó (T) coøn buø � X quang tim-phoåi bình
thöôøng duø treân Laâm saøng nghe ATTT.� Do vaäy,cuõng nhö Heïp van 2 laù,X quang
tim-phoåi bình thöôøng khoâng loaïi tröø ñöôïc Hôû van 2 laù.
6/19/2013 72
X QUANGHÔÛ VAN HAI LAÙ TRUNG BÌNH
� Nhó (T) coøn buø.� Nhó (T) to ra,nhöng aùp suaát chöa taêng
nhieàu.� Thaát (T) cuõng giaõn to vöøa phaûi.� Quai ÑMC nhoû do cung löôïng tim giaûm.
6/19/2013 73
X QUANGHÔÛ VAN HAI LAÙ NAËNG
� Nhó (T) maát buø.� Nhó (T) to ra,aùp suaát taêng cao.Neáu so
saùnh vôùi Heïp 2 laù ,thì Nhó (T) to hôn nhieàu,coù khi vöôït ra ngoaøi bôø cuûa Nhó (P).
� Thaát (T) to ra,taïo neân hình aûnh “big heart disease”.
� Treân hình nghieâng hoaëc LAO: Thaát (T) to che laáp khoaûng saùng sau tim.
6/19/2013 74
X QUANGHÔÛ VAN HAI LAÙ NAËNG
� Quai ÑMC nhoû do cung löôïng tim giaûm.� Phình cung ÑMP�”Mitralisation du bord
gauche du coeur”.� Taùi phaân phoái tuaàn hoaøn phoåi.� Caùc ñöôøng Kerley ít gaëp hôn vaø khoâng
roõ so vôùi Heïp van 2 laù.
6/19/2013 76
X QUANGHÔÛ VAN HAI LAÙ NAËNG
-Small aortic knob.
-Peribronchial cuffing due to edema.
-Bulging of the pulmonary artery.
-Left ventricular enlargement.
6/19/2013 78
X QUANGHÔÛ VAN HAI LAÙ NAËNG
-Straightening of the left heart border.
-Small aortic knob.
-Elevation of the left main bronchus.
-Bulging of the left atrial appendage.
-Huge left atrium.
-Enlargement of the cardiac silhouette.
6/19/2013 80
X QUANGHÔÛ VAN HAI LAÙ NAËNG
LATERAL VIEW:RETROGRADE BRACHIAL ARTERY CATHETERIZATION.
-Left ventricle (small arrows).
-Contrast through the incompetent mitral valve into the large left atrium (arrowheads).
-Filling of the pulmonary veins (large arrows).
MITRAL REGURGITATION
6/19/2013 81
X QUANGHÔÛ VAN HAI LAÙ NAËNG
-Small aortic knob.
-Elevation of the left main bronchus.
-Enlargement of the left ventricle and left atrium.
-The left atrium is calcified (arrowheads).
6/19/2013 82
X QUANGHÔÛ VAN HAI LAÙ NAËNG
Calcification of the left atrial wall
MITRAL REGURGITATION
6/19/2013 83
X QUANGHÔÛ VAN HAI LAÙ NAËNG
-Small aortic knob.
-Bulging of the main pulmonary artery.
-Bulging of the left atrial appendage.
-Extreme enlargement of the left atrium.
-Enlargement of the cardiac silhouette.
-Small right pleural effusion.
6/19/2013 84
X QUANGHÔÛ VAN HAI LAÙ NAËNG
Calcification of the posterior wall of the huge left atrium.
MITRAL REGURGITATION
6/19/2013 85
X QUANGHÔÛ VAN HAI LAÙ NAËNG
MITRAL REGURGITATION
-Small aortic knob.
-Elevation of the left main bronchus.
-Extreme enlargement of the left atrium (arrows).
-Enlargement of the cardiac silhouette.
87
PA view:Dilated left atrial appendage (arrows).
Displacement of the left ventricular contour toward the left chest wall.
LAT view:Dilated left atrium and ventricle.
MITRAL REGURGITATION
RETROGRADE LEFT VENTRICULOGRAM: Dilated left atrium and left atrial appendage (arrows).
6/19/2013
6/19/2013 88
X QUANGCAÙC THEÅ KEÁT HÔÏP
� Heïp+Hôû van 2 laù:Nhó (T) raát lôùn,coù ñoùng voâi ôû van 2 laù vaø thaønh Nhó (T),tim to toaøn boä.
� Hôû van 2 laù+Beänh van ÑMC(Heïp,hôû).� Hôû van 2 laù+Hôû van 3 laù.� Hôû van 2 laù+Hôû van 3 laù+Beänh van
ÑMC.
6/19/2013 90
X QUANGCAÙC THEÅ KEÁT HÔÏP
Mitral valve stenosis and regurgitation-
prosthetic mitral valve
6/19/2013 91
X QUANGCAÙC THEÅ KEÁT HÔÏP
MITRAL STENOSIS AND MITRAL REGURGITATION
-Small aortic knob.
-Enlarged pulmonary artery(2).
-Enlarged left atrial appendage(3).
-Enlarged left ventricle(4).
-Double atrial contour(1).
6/19/2013 92
X QUANGCAÙC THEÅ KEÁT HÔÏP
-Typical cardiac configuration of mitral valvular disease.
-Calcification of the mitral valve (black arrows).
-Calcific density in the left ventricle (white arrows).
(Thrombus arose in the left atrium �Prolapsed into the left ventricle �Calcified thrombus).
6/19/2013 93
X QUANGCAÙC THEÅ KEÁT HÔÏP
RAO-Calcification of the mitral valve (black arrows).-Calcific density in the left ventricle (white arrows).
MITRAL STENOSIS AND MITRAL REGURGITATION
6/19/2013 94
X QUANGCAÙC THEÅ KEÁT HÔÏP
-Small aortic knob.
-Bulging of the main pulmonary artery (white arrow).
-Enlargement of the left ventricle (large arrowheads).
-Enlargement of the left atrium.
-Prominent of the superior pulmonary veins (small arrowhead).
-Kerley’s B lines.
MITRAL STENOSIS AND MITRAL REGURGITATION
6/19/2013 96
X QUANGCAÙC THEÅ KEÁT HÔÏP
-Elevation of the left main bronchus (black arrow).
-Enlargement of the left ventricle (arrowhead).
MITRAL REGURGITATION
The aortic valvular lesions was not suspected.It is often impossible to diagnose the combined lesion on plain films.
MITRAL REGURGITATION
AND AORTIC REGURGITATION
6/19/2013 98
ÑAÏI CÖÔNGHEÏP VAN ÑOÄNG MAÏCH CHUÛ
(AORTIC STENOSIS)
� Bình thöôøng SAO=2,5-3,5 cm2.� Khi SAO < 0,7cm2�Coù trieäu chöùng laâm
saøng.� Sinh lyù beänh:Heïp van ÑMC�Taêng gaùnh
Thaát (T)�Daøy ñoàng taâm Thaát (T). � Giaõn sau heïp ôû ÑMC leân,thaáy roõ treân
phim LAO.
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X QUANGHEÏP VAN ÑOÄNG MAÏCH CHUÛ
� Bôø tim beân (T) baàu do daøy ñoàng taâm Thaát (T),chæ soá T/N # 0,55.
� ÑMC leân cong qua (P).� Quai ÑMC khoâng to vì löu löôïng ÑMC
giaûm.� Veà sau:
� Moûm tim chuùc xuoáng do giaõn thaát (T).� Ñoùng voâi ôû van ÑMC (85%-sau RAA).
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X QUANGHEÏP VAN ÑOÄNG MAÏCH CHUÛ
� Phoái hôïp:Heïp van ÑMC+Heïp van 2 laù.� ÔÛ ngöôøi treû,Heïp van ÑMC baåm sinh=
Van 2 maûnh (Bicuspid valve).� Chaån ñoaùn phaân bieät:
� Cao huyeát aùp.� Xô vöõa ÑMC.
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X QUANGHEÏP VAN ÑOÄNG MAÏCH CHUÛ
Calcifications in the heart lie on a line drawn between the sterno-diaphragmatic angle
and the carina.
CALCIFIED AORTIC VALVE
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X QUANGHEÏP VAN ÑOÄNG MAÏCH CHUÛ
Ascending aorta shows slight post-stenotic
dilatation.
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X QUANGHEÏP VAN ÑOÄNG MAÏCH CHUÛ
-Aortic valve calcification (arrow).
-Posterior displacement of the left ventricle behind the line of the inferior vena cava.
AORTIC STENOSIS
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X QUANGHEÏP VAN ÑOÄNG MAÏCH CHUÛ
-Rounded left heart border (arrowheads).
-Dilated ascending aorta (small arrows).
-The aortic knob is not enlarged.
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X QUANGHEÏP VAN ÑOÄNG MAÏCH CHUÛ
LAO
-Bulging of the ascending aorta because of post-stenotic dilatation (arrowheads).
-Calcified aortic valve (black arrow).
AORTIC STENOSIS
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COÄNG HÖÔÛNG TÖØHEÏP VAN ÑOÄNG MAÏCH CHUÛ
GRADIENT-ECHO MR
-Aortic valve (arrow).
-The signal void in the entire ascending aorta due to marked turbulence caused by severe aortic stenosis.
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X QUANGHÔÛ VAN ÑOÄNG MAÏCH CHUÛ
� Nguyeân nhaân thöôøng gaëp nhaát laø sau RAA.
� Caùc nguyeân nhaân khaùc bao goàm:Giang mai,Vieâm noäi taâm maïc nhieãm truøng,Hoäi chöùng Marfan,Chaán thöông,ÑMC boùc taùch,Vieâm khôùp daïng thaáp,Thoaùi hoùa sau gheùp van sinh hoïc.
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X QUANGHÔÛ VAN ÑOÄNG MAÏCH CHUÛ
� Sinh lyù beänh:Maùu phuït ngöôïc vaøo Thaát (T) trong kyø taâm tröông�Giaõn buoàng thaát (T).Thaát (T) giaõn�Giaõn voøng van 2 laù�Hôû van 2 laù�Giaõn buoàng Nhó (T).
� Moûm tim chuùc xuoáng döôùi vaø ra sau�Bôø (T) tim thoai thoaûi vaø ñænh tim ôû döôùi voøm hoaønh (T).
� Chæ soá T/N > 0,6.
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X QUANGHÔÛ VAN ÑOÄNG MAÏCH CHUÛ
� ÑMP khoâng to,coù khi nhö loõm vaøo.� ÑMC leân thöôøng khoâng giaõn,neáu ÑMC
leân giaõn roõ,phaûi coi chöøng coù keát hôïp vôùi Heïp van ÑMC.
� Quai ÑMC haàu nhö khoâng thay ñoåi.� Chieáu X quang:ÑMC ñaäp maïnh.
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X QUANGHÔÛ VAN ÑOÄNG MAÏCH CHUÛ
-Enlarged left ventricle.The apex is displaced downward (large arrow).
-The aorta is slightly prominent but there is no post-stenotic dilatation (small arrows).
AORTIC REGURGITATION
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X QUANGHÔÛ VAN ÑOÄNG MAÏCH CHUÛ
-Enlarged left ventricle.
-The aorta is slightly prominent but there is no post-stenotic dilatation.
AORTIC REGURGITATION
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X QUANGHÔÛ VAN ÑOÄNG MAÏCH CHUÛ
-Enlarged left ventricle.
-The aorta is slightly prominent but there is no post-stenotic dilatation.
AORTIC REGURGITATION
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X QUANGHÔÛ VAN ÑOÄNG MAÏCH CHUÛ
-Dilated left ventricle.
-Post-stenotic dilatation of the ascending aorta (arrow).
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X QUANGHÔÛ VAN ÑOÄNG MAÏCH CHUÛ
-Calcified aortic valve (ring of arrowheads).
-Posterior displacement of the dilated left ventricle (row of arrowheads) behind the line of the inferior vena cava (large arrow).
AORTIC STENOSIS & REGURGITATION
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X QUANGHÔÛ VAN ÑOÄNG MAÏCH CHUÛ
RETROGRADE AORTOGRAM IN AORTIC REGURGITATION
Reflux flow (arrows) in the dilated left ventricle.
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COÄNG HÖÔÛNG TÖØ HÔÛ VAN ÑOÄNG MAÏCH CHUÛ
GRADIENT-ECHO MR
Regurgitant flow from the aortic valve into the left ventricle (arrow)�
AORTIC REGURGITATION
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ÑAÏI CÖÔNGBEÄNH VAN ÑOÄNG MAÏCH PHOÅI MAÉC PHAÛI
(ACQUIRED PULMONARY VALVULAR LESIONS)
� Beänh hieám khi ñôn ñoäc vaø hieám khi naëng.
� Beänh coù theå thaáy trong Hoäi chöùng carcinoid.
� Hình aûnh X quang thöôøng keát hôïp toån thöông caùc van tim khaùc.
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ÑAÏI CÖÔNGBEÄNH VAN BA LAÙ MAÉC PHAÛI
(ACQUIRED TRICUSPID LESIONS)
� Töông ñoái gaëp nhieàu hôn beänh van ÑMP maéc phaûi.
� Beänh thöôøng gaëp nhaát sau RAA(Beänh haàu nhö luoân luoân keát hôïp vôùi beänh lyù van 2 laù vaø beänh lyù van ÑMC).
� Caùc nguyeân nhaân khaùc:Vieâm noäi taâm maïc nhieãm truøng,Chaán thöông ngöïc,Böôùu carcinoid…
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X QUANGBEÄNH VAN BA LAÙ MAÉC PHAÛI
� Giaõn buoàng Thaát (P) vaø Nhó (P).� Thöôøng khoâng voâi hoùa van 3 laù.� Giaõn TMC treân,TM azygos.� Daáu hieäu phuï:Gan to,ñoäi voøm hoaønh (P)
leân cao.� Khi Hôû van 3 laù+Heïp van 2 laù�Daáu taùi
phaân phoái vaø ñöôøng Kerley gaàn nhö bieán maát.
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X QUANGBEÄNH VAN BA LAÙ MAÉC PHAÛI
-Huge right atrium.
-Left lower lobe collapse from compression by the dilated heart (arrow).
TRICUSPID STENOSIS AND REGURGITATION.
RIGHT HEART FAILURE.
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X QUANGBEÄNH VAN BA LAÙ MAÉC PHAÛI
-Enlarged right atrium (large arrows).
-Decrease in the pulmonary vasculature.
-Small aortic knob.
-Typical left border of mitral valve disease (small arrow).
-Elevation of the right hemi-diaphragm.
TRICUSPID STENOSIS+AORTIC STENOSIS+MITRAL STENOSIS
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KEÁT LUAÄN
� Beänh van tim maéc phaûi phaàn lôùn do RAA.
� Toån thöông thöôøng gaëp nhaát ôû van 2 laù, tieáp ñeán laø van ÑMC.
� Coù theå chæ Heïp ñôn thuaàn,Hôû ñôn thuaàn, coù theå Heïp-Hôû keát hôïp,coù theå toån thöông nhieàu van cuøng moät luùc.
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