CT bung cap
Transcript of CT bung cap
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CT BNG CPBS TH NGC HIU
BS V TN C
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GII THIU Bngcp: duhiutrmtrngvi gi, khng do chnthng
Cnchnonnhanh, chnh xc, iutrkpthi
CT l phngtinphbin, nhanh, hiuqu, chnh xc
Cnc kthutchpCT ph hp.
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K THUT Ctmngcho CT mchmu, siniu, simt
Khng tim tng phn TM: trong trnghp: Sihniu, ngmt
Tnthngngvi, xuthuyt
nhgi mtrong u gan, thngthn
Tim tng phn TM: trong hu ht cc trng hp Liu1.5-2 ml/kg hoctnh theo nngiod
Tc tim thay i
3 mL/s, kim 20G: khi chquan tm th TM 4-5 mL/s, kim 18G: khi chpc th M, bnhl mchmu
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K THUT- Cc th sau tim Th M
M sm:15-20s, chttngphnchc trong M, chavo m.Chnh: bnh l M, XH, thiu mu rut,u tynitit
M tr: 35-40s, cutrc M cpmu tngquang, tngquang nhTMca.Chnhtrong xc nhbnchtu gan, ty
TM ca: 60-70s, th nhu m gan, tngquang nhTM gan.Chnhtrong astrnghp
Thn: 80-100s,tngquang vv tythn. nhgi tnthngthn
Mun: 3ph: th cn bngtrong nhgi u gan 10ph: khost hemangioma khng inhnh v car. ngmt 15ph: nhgi bi tithniu, chswashout u thngthn
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TIP CN C CT BNG CP Tm cc duhiutngqut:
Thm nhimm
Dy thnh rut
Gin rut
Dch bng Kh tdo
Xc nh, loitrcc bnhl thnggp
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Cc duhiutngqut
Kh tdo Thngl thngrut
Thm nhimm: Thngchra vtr v bnchttnthng
Nguyn nhn trung tm hay gnvng thm nhimmnht
Dch bng Khng chiu
nhgi mdch, c thphihpsiu m
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Cc duhiutngqut
Gin rut Do tchay litrut
Tm quai rutxp: gi tcruthay VPM
Dy thnh rut
Thm nhimmnhiu, khng tngxngdy thnh- gi vim Khu tr, khng u, khng ngtm- gi c tnh
Dy u, ngtm, ngnht: thnglnh tnh
trcar. bitha tt, lymphoma.
Dy lan ta>5cm: thngdo thiumu, vim, nhimkiutngquang gip thu hp
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Lunghtipcndy thnh rut
Bowel wall thickening at CT: simplifying the diagnosis, Insights Imaging 2014
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CC BNH L THNG GP Vim ruttha
Cc VRT
Vim ti tha Vim hchmctreo, himanh trng
Vim bmm
Nhimu mcni
BnhCrohn
Car RT, manh, itrng thng
Tcrut
Thiumu mctreo
Xuthuyttiu ha
Thngrut Vim ti mt
Vim tycp
Vphnh MC
Bnhmchmu gan lch
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VIM RUT THA Kthut:
Thng thng: Th TM, vng bng, chu
C cndng chttngphn? Khng: 90% sens
C: 98% sens Cc duhiuVRT
TiRT
Ngoi RT
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Duhiutiruttha ngknh ngoi - ngoi
10 mm (610 mm: khng xc nh)
Thnh Dy 2-3 mm; tngquang; tch lp; hitrong thnh
Siphn: C 1/3 BN
chiuthp
Tngkhnngthng
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Duhiungoi ruttha
Duhiu manh trng Dy thnh nhmanh trng
dy lan ta, t chiuhn
Duhiuvim HCP Thm nhimmquanh ruttha Dch, p xe
Hch
Vim dy cc cutrc ln cn: itrng ln, chuhng, hitrng cui,bng quang
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So snh cc duhiuVRT4 duhiuquan trngnht:
Rutthaln
Dy thnh
Tngquang thnh
Thm nhimmchung quanh
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Ktqukhng xc nh Thng c nhiuduhiugi RT
Ktqukhng xc nh: khi chcmtduhiuhay duhiunghi ng
30% BN CT khng xc nhbVRT
Tiu chunmiiviRT kkhngxc nh: ksau khi trithnhphnc thxp>6.6mm (se84.0%, a sp 88.7%, ac 87.4%).
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LunghcKQ CT VRT BN c triuchng
Proposed Algorithm for Interpretation of Appendicitis CT
in Symptomatic Patients- AJR 2005
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VRT mntnh nhngha
auko di 3 tun, mtsau ctRT
GPB: vim hotngmntnh hay x
Khng phn bitcviVRT cp
Thnh dy nh Tngquang thnh
Khng c hocthm nhimmnh
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Mucocele RT
Khidchgiihnr vng manhtrng
inhnh khng vim quanh RT
tngquang, ngvi thnh
Ntdy thnh khu tr gimucinous cystadenocarcinoma
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BinchngVRT
Hoit
Thng
pxe quanh ruttha
Vim phc mc Tchitrng do vim quanh ruttha
Gieo rcnhimtrng theo hTM ca- mctreo: vimtcTM, tngp ca, p xe gan
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VIM TI THA 1025% bn c ti tha
Thng itrng chuhng
itrng (P) thngtgiihn
Kthut # VRT
C ththytrn CT khng tim tngphnnum
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VIM TI THA
DuhiuCT Thm nhimmquanh itrng: 98%.
Dy ngtm thnh rut> 4 mm #70%
Thycti tha> 80%
Tdcht
Bng kh ngoi rut
Khivim, p xe.
Binchng: Vim rutthathpht
Tcrut R
Thngvo trong phc mc
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Vim ti tha
Dy thnh itrng vinhiuti tha, ti thavim, thm nhimm
ThycRT bnh thng
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VIM HCH MC TREOVIM HI MANH TRNG (+) khi hchto hay dy thnh himanh trng
RT v mmctreo bnh thng
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VIM BM M L m mnhnh ra khithanh mcitrng, c thxon,
vim thpht
Bnhtgiihn (+) quan trng
:
Khimmnh, vinmcao trn thanh mc ng, ntmcao trung tm do huytkhi
Dy thnh rutln cn, thm nhimmmctreo, dy phc mckhu tr
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NHI MU MC NI Do xonmtphnmcni
Bnhtgiihn
DuhiuCT: Vng mmcnivim, giihnr, thm nhimchung quanh
Rutv rutthabnh thng
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Vim bmm, nhimumcni
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BNH CROHN Hay gp hitrng cuiv itrng (P)
C thlin quan rutthachronic granulomatousappendicitis
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CARCINOMA RT, MANH, I TRNG THNG
chnh caVRT, vim ti tha
DuhiuCT: Dy thnh manh trng hay yRT dngnt, khng ngtm
Vng chuyntiptngt
Hchln
Gy tcVRT thpht
C ththnggiVRT
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TC RUT 4%- 20% BN aubngcp
CT trlicc cu hi: C tcrut?
Vtr tc?
Nguyn nhn? Mcnng?
C TR quai kn, TR tht, thiumu rut?
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TC RUT (+) = quai rutgin (>2.5cm)+ xponxa
Vtr tc= chuyntip: kthutMPR Tm duphn trong rutnon
itddy xunghay trctrng ln
nng: Mcxponxa, gin ongn Hon ton: onxa xphon ton, chtcnquang trong lng
rutkhng qua cchtcsau 3-24g
Khng hon ton: onxa khng xphon ton, chtcnquangqua chtcchm, t
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TC RUT Nguyn nhn
Tithnh rut: u, vim, hematoma, thiumu
Ngoi rut: dnh, thot v, hematoma, lcnimc
Trong lng rut: simt, chtb, dvt
*Tcdo dnh # 60-80%: Vng chuyntiptngt, khng thynguyn nhn
inhnh c dumchim
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TC RUTTR quai kn, TR tht TR ngin: c thmthay nhiuimdcquai rut
TR quai kn: 2 imknhau
TR tht: c nhhngmchmu. as TR quai kn
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TC RUTTR quai kn, TR tht
TR quai kn:
Quai rut dchhnh chU, C gy gin ongn
Hai onxp(nv i) knhau vtr xon
Dumchim Mchmu mctreo hnh nan hoa
Btthngngimchmu mctreo
TR tht: Duhiuthiumu rut
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THIU MU MC TREO
Ng. nhn: Tcng, tnhmchcp, mntnh
Gimtimu
Khc: tcrut, u, vim, chnthng, do
Huqu: RL thong quahoitxuyn thnh
KthutCT: Khng thuc: XH, xva, ccmu ng
Th M, TM
Ti toMPR, 3D
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Thiumu M
MDCT mchmu: sens 96%
hnch: thromboembolie nh/ nhnh ngoivi
Duhiuchiu: Thnh rutkhng tngquang, tngquang chm, khng cn xng
Huytkhitcmchtrong mm
Duhiukhng chiu: Thnh rut: Dy tch lp, tngm
Gin, tcrut
Dch bng, ph, XH mctreo Kh trong thnh rut, TM ca
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Thiumu M
MIP tcnhnh hitrng Hp nhiuon SMA.
Quai hngtrng nhimu (*) thnh rutkhng tngquang,kh trong thnh rut, m quanh rutv cc mchthng
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Thiumu TM
HuytkhiTM cp: t gp, tvong cao Triuchngkhng chiu, thng tr
Yutthunli: Bmsinh, di truyn
Tngp TM ca, vim, PT, chnthng, thucngathai V cn
CT: Dy thnh rutnng
Ph mctreo nng Nhiumm bng h
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Thiumu mctreo khng tcnghn
Do cung lngtim, V
Dng chychmco mchtngthiuoxy rut CT:
Dy thnh rutlan ta, tngquang
Xplng + tngquang IVC, AO
Bttngphnmnhthn, mctreo. Thiumu itrng thngdo gimtimu, gimHA
CT: dy thnh do ph lpdinim
ph rutdo bihon V nhanh: p TM trung tm:
LnIVC, ph quanh khongca, dchsau phc mc Khng tngquang thnh rutnon
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XUT HUYT TIU HA
CT thunli: Phbin
Xm lntithiu
Khost ton brutv cc cutrc khc: mt, ty
XHTH di: CT dnccng nhnl lachnutin chochnonv iutr
XHTH trn: CT huch trong mtstrnghp Se,sp: 33%- 42% v 89%- 100%
Rt ngnthigian chnonHnch, loibcc ththutxm lnv tnkm hn
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XHTH-MDCT
Kthut: nhiuth
Trctim: Pht hintngmc sntrong lng rut
Th M, TM (th rut), +/- th mun
Cc duhiuXHTH cp
XH hotng
XH mi
Nguyn nhn XH
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Cc duhiuXHTH1. XH hotng
Tch tdnchtcnquang trong lng rut
Ta mu (c chttngphn) trong lng rutth M
tngm thay ihnh dng
inhnh pht hinXH hotng> 0.30.5 ml/min > chpmch(0.5 ml/min)
< xhnh vi99m Tc (0.1 ml/min)
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XH hotng
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Thot mchthuccnquang hotng bnhnhn XHTH do lott trng.
CT th ngmchthythot mchthuccnquang trong t trng
Chpngmchgan chung thythot mchthuccnquang(mitn) tmtnhnh t trng nh(umitn)
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Cc duhiuXHTH2. XH mi: ccmu ng
Khi ngngXH hocchanngngpht hin(1)
Tngmtrong lng rut
NgngchnonXHTH mi > 60 HU
Mu ngchim (Sentinel clot):Khimu mcao nht# gnvtr XH nht
* Lu cashp
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Cc duhiuXHTH3. Nguyn nhn
Mchmu: thnggpnht, 3060% lonsnmch
U: 510%Trn (15), di(612)
1, vim thcqun
2, gin TM 3, ung thdd
4, lot dd
5, vim dd, t trng
6, vim itrng
7, lonsnmch 8, bnhl mchmu
9, ti tha
10, u itrng
11, lot trctrng
12, trXH.
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Angiodysplasia
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Lot t trng v u itrng chuhng
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Chymu ngmt
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THNG RUT
Do lot ddy, vim ti tha, vim, thiumu rut, chnthng, u, tcrut
CT: Vim phc mc
Kh trong bng.
Xc nhvtr thng: Tdch, kh, thm nhimm, dy thnh rut, tngquang phc mc
khu tr
Vtr kh tdo: Quanh gan, ddy: thngdo thngddy, t trng
Vng chu: gi thngitrng, ruttha
MPR, ungtngphn(+)
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Thngt trng
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VIM TI MT
Ti mtcng Thnh dy >3mm, tngquang
Rilontimu gan khu tr
Duhiut chiu:
Dch, thm nhimmquanh ti mt Tngmdchmt
Binchng Hoit, thng
Vim ti mtsinh hi
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VIM TY CP
CT
nhgi giai on
XH, hoit, lan rng
Nguyn nhn: simt, u
Binchngmchmu: giphnh,huytkhi
BT n28% (trnghpnh)
Vim tyvng #1018%
Kthut Khng thuc: si, xuthuyt
M, TM: nhgi nhu m, lan rng,binchng
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V PHNH MC
asvvo sau phc mcbn (T)trong phc mc Tam chng: aubng, khiptheo mch, gimHA.
Kthut: Nhiuth:
BN huytngnnh Bmvntcnhanh, lt ctmng, MPR
BN nng, CT khng cnquang
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V PHNH MC
Trctim: Thm nhimmquanh MC
Mu quanh MC
Duhnh lim: XH trong huytkhihay trong thnh MC
Mtlin tcngvi nimcSau tim
Vng hoitthnh khng tngquang, mthp
Thot mchchtcnquang
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BNH MCH MU GAN- LCH
HuytkhiM, TM gan, lch, cac thbiuhinaubngcp
Nhimu: Vng gimm, khng tngquang hnh chm ngoivi
Nhimu gan himdo 2 nguncpmu Nhimu lch c thton b
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PROTOCOL CT BNG CPKhng tim M TM mun
Siniuqun +
Vim ti mt, siOMC +qua gan, ty
+
VRT, ti tha +
Tcrut, thngrut* +Thiumu rut + + +
Xuthuyttiu ha + + + +/-
Vim tycp +qua ty
+ +
VphnhMC bng* + + +Thngqui (khng khu tr) +
*Trong cc c th ch chp khng thuc