CT bung cap

7/24/2019 CT bung cap

1/57

CT BNG CPBS TH NGC HIU

BS V TN C


2/57

GII THIU Bngcp: duhiutrmtrngvi gi, khng do chnthng

Cnchnonnhanh, chnh xc, iutrkpthi

CT l phngtinphbin, nhanh, hiuqu, chnh xc

Cnc kthutchpCT ph hp.


3/57

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


4/57

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


5/57

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


6/57

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


7/57

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


8/57

Lunghtipcndy thnh rut

Bowel wall thickening at CT: simplifying the diagnosis, Insights Imaging 2014


9/57

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


10/57

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


11/57

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


12/57

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


13/57

So snh cc duhiuVRT4 duhiuquan trngnht:

Rutthaln

Dy thnh

Tngquang thnh

Thm nhimmchung quanh


14/57

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%).


15/57

LunghcKQ CT VRT BN c triuchng

Proposed Algorithm for Interpretation of Appendicitis CT

in Symptomatic Patients- AJR 2005


16/57

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


17/57

Mucocele RT

Khidchgiihnr vng manhtrng

inhnh khng vim quanh RT

tngquang, ngvi thnh

Ntdy thnh khu tr gimucinous cystadenocarcinoma


18/57

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


19/57

VIM TI THA 1025% bn c ti tha

Thng itrng chuhng

itrng (P) thngtgiihn

Kthut # VRT

C ththytrn CT khng tim tngphnnum


20/57

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


21/57

Vim ti tha

Dy thnh itrng vinhiuti tha, ti thavim, thm nhimm

ThycRT bnh thng


22/57

VIM HCH MC TREOVIM HI MANH TRNG (+) khi hchto hay dy thnh himanh trng

RT v mmctreo bnh thng


23/57

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


24/57

NHI MU MC NI Do xonmtphnmcni

Bnhtgiihn

DuhiuCT: Vng mmcnivim, giihnr, thm nhimchung quanh

Rutv rutthabnh thng


25/57

Vim bmm, nhimumcni


26/57

BNH CROHN Hay gp hitrng cuiv itrng (P)

C thlin quan rutthachronic granulomatousappendicitis


27/57

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


28/57

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?


29/57

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


30/57

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


31/57

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


32/57

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


33/57


34/57

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


35/57

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


36/57

Thiumu M

MIP tcnhnh hitrng Hp nhiuon SMA.

Quai hngtrng nhimu (*) thnh rutkhng tngquang,kh trong thnh rut, m quanh rutv cc mchthng


37/57

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


38/57

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


39/57

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


40/57

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


41/57

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)


42/57

XH hotng


43/57

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)


44/57

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


45/57

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.


46/57

Angiodysplasia


47/57

Lot t trng v u itrng chuhng


48/57

Chymu ngmt


49/57

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(+)


50/57

Thngt trng


51/57

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


52/57

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


53/57

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


54/57

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


55/57


56/57

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


57/57

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

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