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4.other acquired heart disease
1. 6/19/2013 1
CHAÅN ÑOAÙN HÌNH AÛNH
BEÄNH TIM MAÉC PHAÛI KHAÙC
BS.NGUYEÃN QUYÙ KHOAÙNG
BS.NGUYEÃN QUANG TROÏNG
2. 6/19/2013 2
DAØN BAØI
Beänh ñoäng maïch chuû.
Beänh tim do cao huyeát aùp.
Phình ÑMC.
Hoäi chöùng Marfan.
Beänh Takayasu.
Beänh cô tim.
Beänh cô tim giaõn nôû.
Beänh cô tim phì ñaïi.
Beänh cô tim haïn cheá.
3. 6/19/2013 3
DAØN BAØI
Nhoài maùu cô tim vaø caùc bieán chöùng.
Thieáu maùu cô tim.
Nhoài maùu cô tim.
Caùc bieán chöùng cuûa Nhoài maùu cô tim:
Thoâng lieân thaát.
Hoäi chöùng Dressler.
Phình thaát.
Ñöùt nhuù cô.
4. 6/19/2013 4
DAØN BAØI
Beänh maøng tim.
Traøn dòch maøng tim.
Vieâm maøng tim co thaét.
Nang maøng tim.
Môõ ngoaøi maøng tim.
5. 6/19/2013 5
BEÄNH TIM DO CAO HUYEÁT AÙP
Thaát (T) daøy ñoàng taâm Bôø (T) baøu sau
ñoù bôø (T) traûi daøi,moûm tim nhö chuùc
xuoáng döôùi voøm hoaønh (T).
ÑMC leân cong qua (P) vaø bung roäng
(>6cm)(Deùroulement aortique).
Chaån ñoaùn phaân bieät:Heïp van ÑMC
vaø Xô vöõa ñoäng maïch ôû ngöôøi giaø.
6. 6/19/2013 6
BEÄNH TIM DO CAO HUYEÁT AÙP
ÑMC coù theå ñoùng voâi.
Tuaàn hoaøn phoåi bình thöôøng.
Khi coù Suy tim coù Taùi phaân phoái
tuaàn hoaøn phoåi,Phuø phoåi caáp.
17. 6/19/2013 17
PHÌNH ÑOÄNG MAÏCH CHUÛ
-Saccular mass in the right mediastinum
(large arrows).
-Curvilinear calcification (small arrow).
-The trachea is displaced posteriorly
(double black arrows).
-Curvilinear calcification (small arrow).
SACCULAR ANEURYSM OF ASCENDING AORTA
18. 6/19/2013 18
PHÌNH ÑOÄNG MAÏCH CHUÛ
-The ascending aorta (large arrow).
-The trachea is displaced to the right side.
-A streak of calcium (small arrows) in the
intima denotes a thin aortic wall.
FUSIFORM ANEURYSM OF
THE ENTIRE THORACIC
AORTA
19. 6/19/2013 19
PHÌNH ÑOÄNG MAÏCH CHUÛ
-The lucency representing the
intima flap (arrows) extends from
the aortic root around the arch.
-The false lumen is less dense than
the true lumen.
-Aortic regurgitation.
AORTIC DISSECTION
20. 6/19/2013 20
PHÌNH ÑOÄNG MAÏCH CHUÛ
-The intima flap (arrows)
extending from the aortic
root distally into the
abdomen.
-Communication between
the false lumen and the
true lumen (curved
arrow).
AORTIC DISSECTION
21. 6/19/2013 21
PHÌNH ÑOÄNG MAÏCH CHUÛ
AORTIC DISSECTION:T:true lumen,F:false lumen,I:intimal
flap,LV:contrast in the LV Aortic insufficiency.
22. 6/19/2013 22
PHÌNH ÑOÄNG MAÏCH CHUÛ
Lobular mass density (arrows)
on the left side of the heart.
LAO
FUSIFORM ANEURYSM OF DESCENDING AORTA
24. 6/19/2013 24
PHÌNH ÑOÄNG MAÏCH CHUÛ
3 YEARS PRIOR: Normal
appearing aorta.
Enlargement of the aortic
knob (arrow).
AORTIC DISSECTION
25. 6/19/2013 25
PHÌNH ÑOÄNG MAÏCH CHUÛ
Enlarged, elongated,
tortuous, descending aorta.
TWO WEEKS LATER
-Increase in the width of the
descending aorta (large arrows).
-Left pleural effusion (small arrows).
DISSECTING ANEURYSM
26. 6/19/2013 26
PHÌNH ÑOÄNG MAÏCH CHUÛ
ASYMPTOMATIC FIVE DAYS LATER:Left hemothorax,the aortic
outline has been obliterated by the blood
RUPTURE OF AORTIC ANEURYSM
27. 6/19/2013 27
PHÌNH ÑOÄNG MAÏCH CHUÛ
A:left hilar mass (arrow).
B:mass adjacent to the proximal descending aorta (arrow).
SACCULAR ANEURYSM
32. 6/19/2013 32
PHÌNH ÑOÄNG MAÏCH CHUÛ
FALSE ANEURYSM: The intima and media
are penetrated.False aneurysm typically has
a narrow neck.
(TRUE ANEURYSM: contain all three layers).
34. 6/19/2013 34
PHÌNH ÑOÄNG MAÏCH CHUÛ
-False aneurysm in the region of
the ligamentum arteriosum.
-The patient was involved in an
automobile accident 3 months
previously.
TRAUMATIC AORTIC ANEURYSM
35. 6/19/2013 35
PHÌNH ÑOÄNG MAÏCH CHUÛ
18-year-old involved in
motorcycle accident.
-Widening of the mediastinum.
47. DẤU HIỆU MẢNG VÔI
(CALCIUM SIGN)
Mảng vữa xơ của ĐMC nằm ở lớp áo trong, nếu vôi hoá ta sẽ
thấy. Khi bị phình ĐMC bóc tách, máu len vào lớp áo giữa,
làm gia tăng khoảng cách giữa lớp intima và adventitia. Nghĩ
đến phình ĐMC bóc tách khi khoảng cách từ mảng vôi hoá
đến bờ ngoài quai ĐMC > 10 mm.
54. 6/19/2013 54
PHÌNH ÑOÄNG MAÏCH CHUÛ
AORTIC DISSECTION
WITH LEFT RENAL
ISCHEMIA
-Arrow:intimal flap.
-K:ischemia of the
posterior aspect of the
left kidney.
55. 6/19/2013 55
PHÌNH ÑOÄNG MAÏCH CHUÛ
RUPTURED AORTIC
DISSECTION
-Arrowheads:intimal flap.
-Arrow:nasogastric tube.
-Hemorrhage infiltrates
the soft tissues around the
descending aorta.
66. 6/19/2013 66
PHÌNH ÑOÄNG MAÏCH CHUÛ
LUETIC AORTITIS
-“Egg-shell” calcification
extends from the aortic
annulus through the entire
thoracic aorta.
-Calcification of the
ascending aorta is also seen
in pure atherosclerosis
and,rarely,in Takayasu’s
arteritis.
67. 6/19/2013 67
PHÌNH ÑOÄNG MAÏCH CHUÛ
Ascending aortic aneurysm with stenotic bicuspid aortic valve (arrows)
is domed in this systolic frame REITER’S SYNDROME
68. 6/19/2013 68
PHÌNH ÑOÄNG MAÏCH CHUÛ
Erosion of the vertebral bodies due
to pulsations of an aneurysm.
Aortography reveals the saccular
aneurysm (arrows).
Note:bulging of the intervertebral
cartilage (which resists erosion).
69. 55 yo male patient with abdominal pain and
back pain
76. 6/19/2013 76
HOÄI CHÖÙNG MARFAN
-The aneurysm involves both the sinuses of Valsalva and the proximal
half of the ascending aorta.
-Aortic regurgitation.
ANNULOAORTIC ECTASIA
77. 6/19/2013 77
HOÄI CHÖÙNG MARFAN
-The aneurysm involves both the
sinuses of Valsalva and the
proximal half of the ascending
aorta.
-Aortic regurgitation.
ANNULOAORTIC ECTASIA
85. 6/19/2013 85
BEÄNH TAKAYASU
THORACIC AORTOGRAM:No direct filling of any of the major arteries arising from
the aorta except the coronary arteries.
Delayed film (right):collateral channels faintly fill the carotid and vertebral systems.
89. 6/19/2013 89
BEÄNH TAKAYASU
-Ascending aortic aneurysm.
-Stenosis of the proximal left common
carotid artery (arrowheads) and left
subclavian artery (open arrowheads).
90. 6/19/2013 90
BEÄNH TAKAYASU
Extensive thin-line
calcification associated with
a diffusely dilated aorta in a
30-year-old woman.
TAKAYASU’S ARTERITIS
92. 6/19/2013 92
BEÄNH CÔ TIM
ÑAÏI CÖÔNG
Phaân loaïi:
Beänh cô tim giaõn nôû (Dilated
cardiomyopathy).
Beänh cô tim phì ñaïi (Hypertrophic
obstructive cardiomyopathy).
Beänh cô tim haïn cheá (Restrictive
cardiomyopathy).
93. 6/19/2013 93
BEÄNH CÔ TIM
BEÄNH CÔ TIM GIAÕN NÔÛ
Coøn goïi laø Beänh cô tim sung huyeát.
Nguyeân nhaân:Phaàn lôùn khoâng tìm ra
nguyeân nhaân.
Di truyeàn:6,5%.
Dinh döôõng:Thieáu Vitamin B1.
Nghieän röôïu,Thuoác (Adriamycine).
Nhieãm truøng (Vi khuaån,virus).
Beänh collagen maïch maùu.
Sau sanh…
94. 6/19/2013 94
BEÄNH CÔ TIM
BEÄNH CÔ TIM GIAÕN NÔÛ
Laâm saøng:Thöôøng thaàm laëng vaø töø töø.
Khôûi ñaàu thöôøng laø Suy tim.
Coù töøng ñôït Nhoài maùu phoåi.
Coù khi loaïn nhòp.
Coù theå ñoät töû.
95. 6/19/2013 95
BEÄNH CÔ TIM
BEÄNH CÔ TIM GIAÕN NÔÛ
X quang:
Giaõn nôû caùc buoàng tim+Co boùp
keùm Tim to hình baàu,deã laàm vôùi
Traøn dòch maøng tim,Beänh Ebstein.
Hôû van 2 laù,Hôû van 3 laù.
Taùi phaân phoái tuaàn hoaøn phoåi.
96. 6/19/2013 96
BEÄNH CÔ TIM
BEÄNH CÔ TIM GIAÕN NÔÛ
Sieâu aâm:
Giaõn roäng caùc buoàng tim.
EF giaûm roõ.
Thöôøng coù spontaneous contrast
(“smoke”) trong buoàng Thaát (T),coù theå
thaáy Huyeát khoái trong Thaát (T).
Hôû van 2 laù,3 laù.
99. 6/19/2013 99
BEÄNH CÔ TIM
BEÄNH CÔ TIM GIAÕN NÔÛ
-Enlarged all chambers.
-Redistribution.
-Slight pulmonary edema.
-Small right pleural effusion.
AFTER FULL TREATMENT
-Normal heart size.
-Normal pulmonary vasculature.
100. 6/19/2013 100
BEÄNH CÔ TIM
BEÄNH CÔ TIM PHÌ ÑAÏI
Ñaëc ñieåm laø phì ñaïi khoâng ñoái xöùng
Thaát (T) (Vaùch lieân thaát daøy hôn thaønh
sau thaát (T)) vaø buoàng tim khoâng giaõn.
Nguyeân nhaân:
Di truyeàn:50%.
Taêng Catecholamin.
Roái loaïn chuyeån hoùa Calci.
101. 6/19/2013 101
BEÄNH CÔ TIM
BEÄNH CÔ TIM PHÌ ÑAÏI
Cô cheá:
Thaønh thaát daøy do phì ñaïi caùc teá baøo
cô tim Caûn trôû söï höùng ñaày maùu.
Do söï daøy khoâng caân ñoái cuûa vaùch
lieân thaát Ngheõn buoàng toáng Thaát(T).
Do coät cô bò dòch chuyeån ra
tröôùc Chuyeån ñoäng ra tröôùc cuûa van
2 laù trong thì taâm thu Hôû van 2 laù.
102. 6/19/2013 102
BEÄNH CÔ TIM
BEÄNH CÔ TIM PHÌ ÑAÏI
Laâm saøng:
Khoù thôû do RLCN taâm tröông Thaát (T).
Côn ñau thaét ngöïc:Thieáu maùu cô tim
do taêng khoái löôïng cô tim.
Ngaát khi gaéng söùc:do loaïn nhòp,coù theå
ñoät töû.
103. 6/19/2013 103
BEÄNH CÔ TIM
BEÄNH CÔ TIM PHÌ ÑAÏI
X quang:
Tim to ít hoaëc vöøa.
Neáu coù Hôû van 2 laù thì Nhó (T) to.
Angiography:Loøng tim nhoû,hôû van 2 laù.
Chaån ñoaùn phaân bieät:
Heïp van ÑMC (Beänh cô tim phì ñaïi
khoâng coù phình ÑMC leân).
Hieän nay chaån ñoaùn nhôø Sieâu aâm,MRI.
104. 6/19/2013 104
BEÄNH CÔ TIM
BEÄNH CÔ TIM PHÌ ÑAÏI
Sieâu aâm:
ASH (+):Asymmetric septal hypertrophy.
(Duøng TM mode ño ôû thì taâm tröông:
IVS/LVPW≥1,3).
SAM (+):Systolic anterior motion of MV.
Ngheõn buoàng toáng Thaát (T)(△P thay ñoåi
moãi ngaøy).
Hôû 2 laù vôùi ñoä naëng thay ñoåi moãi ngaøy.
109. 6/19/2013 109
BEÄNH CÔ TIM
BEÄNH CÔ TIM PHÌ ÑAÏI
End-diastolic RAO left
ventriculogram Normal
size and shape of the
left ventricle.
End-systolic RAO left ventriculogram
Small left ventricular cavity with mild mitral
regurgitation.Increased distance between the
ventricular cavity and the coronary arteries
Myocardium becomes thickened in systole
HCM (Hypertrophic cardiomyopathy).
112. 6/19/2013 112
BEÄNH CÔ TIM
BEÄNH CÔ TIM PHÌ ÑAÏI
Asymmetric septal thickening (23mm) and a small left ventricular cavity.
113. 6/19/2013 113
BEÄNH CÔ TIM
BEÄNH CÔ TIM PHÌ ÑAÏI
End-diastolic magnetic
resonance angiogram
Asymmetric hypertrophy
with septal thickening (S).
End-systolic magnetic
resonance angiogram
Myocardial thickening that
affects the entire myocardium.
114. 6/19/2013 114
BEÄNH CÔ TIM
BEÄNH CÔ TIM PHÌ ÑAÏI
Oblique cine MRA (outfow 2-
chamber view) Prolapse
(arrow) of the posterior mitral
leaflet in early systole.
Oblique cine MRA (outfow 2-
chamber view) Prolapse of the
posterior mitral leaflet with a small
signal intensity loss due to
regurgitation (arrow) HCM.
122. 6/19/2013 122
BEÄNH CÔ TIM
BEÄNH CÔ TIM HAÏN CHEÁ
Trong ñoù hay gaëp nhaát laø Amyloidosis.
Do laéng ñoïng moät protein baát thöôøng
ôû nhieàu moâ,cô quan.
Thaâm nhieãm laøm daøy taát caû caùc thaønh
phaàn cuûa tim:cô,vaùch,van Hôû taát caû
caùc van tim.
TDMT töø ít ñeán vöøa.
20% beänh nhaân cheát vì Suy tim.
123. 6/19/2013 123
BEÄNH CÔ TIM
BEÄNH CÔ TIM HAÏN CHEÁ
-Amyloid infiltration in the
ventricular septum,left
ventricular free wall and
apex (arrows).
-Enlarged atria.
124. 6/19/2013 124
BEÄNH CÔ TIM
BEÄNH CÔ TIM HAÏN CHEÁ
Laâm saøng: Beänh lyù hieám.
Meät khi gaéng söùc.
Phuø chi.
Suy tim.
X quang:
Tim to ít.
Taêng aùp TM phoåi.
ÑM phoåi (P) & (T) to ít.
125. 6/19/2013 125
BEÄNH CÔ TIM
BEÄNH CÔ TIM HAÏN CHEÁ
Sieâu aâm:
Daøy ñoái xöùng Thaát (T).
Thaønh sau Thaát (T) vaø vaùch lieân thaát
coù hoài aâm laám taám (ground-glass).
Hôû van 2 laù,3 laù naëng hôn Hôû van
ÑMC,ÑMP.
TDMT (+) (++).
126. 6/19/2013 126
BEÄNH CÔ TIM
BEÄNH CÔ TIM HAÏN CHEÁ
Chaån ñoaùn phaân bieät:
Heïp TM phoåi.
Myxome nhó (T).
Vieâm maøng ngoaøi tim co thaét.
Chaån ñoaùn xaùc ñònh:Giaûi phaãu beänh.
128. 6/19/2013 128
BEÄNH CÔ TIM
BEÄNH CÔ TIM HAÏN CHEÁ
-Thickening of the LV due to
infiltration.
-Thickening of the valves
and biatrial enlargement.
129. 6/19/2013 129
BEÄNH CÔ TIM
BEÄNH CÔ TIM HAÏN CHEÁ
SPIN-ECHO MRI:
-Variable high density signal within
the myocardium.
-Dilated right atrium (closed curved
arrow).
-Enlarged IVC (open curved arrow).
-IVS has an abnormal contour
(straight arrow) High right
ventricular pressures.
RESTRICTIVE CARDIOMYOPATHY
(AMYLOID CARDIOMYOPATHY).
130. 6/19/2013 130
LEFT VENTRICULAR ABNORMALITIES
IN THE CARDIOMYOPATHIES
DILATED RESTRICTIVE HYPERTROPHIC
1.LV cavity size
2.Free wall
thickness
3.Mitral
regurgitation
4.Wall motion
5.Mural thrombi
6.Systolic
function
7.Diastolic
function
8.Ejection
fraction
9.Cardiac output
-Increased
-Slightly increased,
normal,or decreased
-Mild to moderate
-Global hypokinesis
-Frequently
-Decreased
-Normal
-Decreased
-Decreased
-Normal to increased
-Slightly to
moderately increased
-Variable
-Normal to decreased
-Occasionally
-Normal
-Decreased
-Normal to decreased
-Normal to decreased
-Normal to decreased
-Septal to free wall ratio
> 1.3
-Obstruction(-):none to mild
Obstruction(+):mild to severe
-Hyperkinetic
-None
-Normal to increased
-Normal to decreased
-Normal to increased
-Decreased,normal,or
increased
131. 6/19/2013 131
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
THIEÁU MAÙU CÔ TIM
Goïi laø Thieáu maùu cuïc boä cô tim hay Suy
ñoäng maïch vaønh maïn khi cô tim khoâng
ñöôïc töôùi maùu ñaày ñuû do beänh lyù cuûa
ñoäng maïch vaønh.
Coù nhieàu nguyeân nhaân,nhöng >90% laø
do Xô vöõa ñoäng maïch.
132. 6/19/2013 132
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
THIEÁU MAÙU CÔ TIM
Chaån ñoaùn döïa vào:Lâm sàng, ECG, các
men tim, Sieâu aâm,Chuïp ÑM vaønh,
MSCT,MRI,nhấp nháy đồ.
X quang qui öôùc:
Boùng tim bình thöôøng.
Ñoùng voâi ôû ÑM vaønh.
134. 6/19/2013 134
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
THIEÁU MAÙU CÔ TIM
RIGHT CORONARY ARTERY
A.Plaque of atheroma (arrow).
B.Encircled lumen of the artery
(arrow-two years later).
135. 6/19/2013 135
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
THIEÁU MAÙU CÔ TIM
Calcification of the proximal branches of both anterior
descending and circumflex coronary arteries.
136. 6/19/2013 136
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
THIEÁU MAÙU CÔ TIM
Calcification in the left anterior
descending (LAD) and the left
circumflex arteries.
137. 6/19/2013 137
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
THIEÁU MAÙU CÔ TIM
Calcification in the left
main coronary artery
138. 6/19/2013 138
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
THIEÁU MAÙU CÔ TIM
COLORS ALL STRUCTURES WITH AN
ATTENUATION OF GREATER THAN
130HU PINK No calcium is present
in the LAD or diagonal branch.
Calcification in the LAD artery.
139. 6/19/2013 139
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
THIEÁU MAÙU CÔ TIM
Calcification in the LM, LAD
arteries.
Calcification in the circumflex
artery
147. 6/19/2013 147
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
THIEÁU MAÙU CÔ TIM
Normal perfusion
Myocardial ischemia:LAD and right
coronary artery territories.
148. 6/19/2013 148
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
NHOÀI MAÙU CÔ TIM
Beänh coù taàn suaát töû vong cao #30%.
90% ôû beänh nhaân Xô vöõa ñoäng maïch.
Maûng xô vöõa bò nöùt,loeùt taïo laäp cuïc
maùu ñoâng laøm taéc ngheõn caáp tính ÑMV.
149. 6/19/2013 149
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
NHOÀI MAÙU CÔ TIM
Hoäi chöùng Suy ÑMV caáp (laâm saøng):
Taéc ngheõn ÑMV taïm thôøi<30 phuùt:
Côn ñau thaét ngöïc khoâng oån ñònh.
Taéc ngheõn ÑMV<60 phuùt:
Nhoài maùu cô tim khoâng soùng Q.
Taéc ngheõn ÑMV>60 phuùt:
Nhoài maùu cô tim coù soùng Q.
150. 6/19/2013 150
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
NHOÀI MAÙU CÔ TIM
X quang qui öôùc:
Boùng tim hôi to hoaëc to.
OAP khi vuøng nhoài maùu >25% khoái
thaát (T).
151. 6/19/2013 151
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
NHOÀI MAÙU CÔ TIM
-Enlarged heart size.
-Pulmonary edema due to left
heart failure.
ACUTE MYOCARDIAL INFARCTION
152. 6/19/2013 152
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
BIEÁN CHÖÙNG
Thoâng lieân thaát:0,5-1% caùc tröôøng hôïp.
Xuaát hieän vaøi tuaàn vaøi thaùng sau NMCT.
2/3 naèm ôû phaàn tröôùc gaàn moûm.1/3 naèm
ôû phaàn sau.
Hoäi chöùng Dressler:<20%.
Xuaát hieän vaøi tuaàn vaøi thaùng sau NMCT.
Tim to do Traøn dòch maøng tim.
Traøn dòch maøng phoåi,Vieâm ñaùy phoåi.
153. 6/19/2013 153
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
BIEÁN CHÖÙNG
6 weeks after myocardial infarction:
-Pericardial effusion.
-Bilateral pleural effusions.
-Consolidation of the left lung base. DRESSLER’S SYNDROME
154. 6/19/2013 154
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
BIEÁN CHÖÙNG
4 weeks after myocardial
infarction:
-Pericardial effusion.
-Left pleural effusion.
-Consolidation of the left
lung base.
6 weeks later.
-Decreased heart size.
-Decreased
pleuropneumonic process.
3 months later.
-Normal heart size.
-Normal lung fields.
DRESSLER’S SYNDROME
155. 6/19/2013 155
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
BIEÁN CHÖÙNG
Phình thaát:12-15% caùc tröôøng hôïp.
True aneurysm: NMCT Phình thaát.
Thöôøng ôû vuøng moûm phía tröôùc.
False aneurysm: Leõ ra vôõ tim nhöng
nhôø maøng ngoaøi tim bao boïc Phình
to ra.Thöôøng ôû vuøng sau beân hoaëc
maët döôùi.
X quang:Bôø tim phình ra,coù theå ñoùng
voâi.
166. 6/19/2013 166
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
BIEÁN CHÖÙNG
Chaån ñoaùn phaân bieät:
Nang maøng tim:Thöôøng ôû goùc taâm
hoaønh (P).
U tuyeán öùc:ÔÛ treân vaø tröôùc.
False aneurysm: Thöôøng vôõ,hieám
khi coøn soáng soùt (Trong vaùch khoâng
coù maïch maùu).
167. 6/19/2013 167
NHOÀI MAÙU CÔ TIM & BIEÁN CHÖÙNG
BIEÁN CHÖÙNG
Ñöùt nhuù cô:1% sau NMCT.
X quang boùng tim gaàn nhö bình
thöôøng,ñoâi khi tim to do giaõn Thaát
(T),Nhó (T) tuøy möùc ñoä.
Chuïp buoàng tim,SA tim:Sa van 2
laù,van 2 laù phaát phôùi.
168. 6/19/2013 168
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
Nguyeân nhaân:Coù raát nhieàu nguyeân nhaân.
X quang TDMT:Muoán coù thay ñoåi treân X
quang,löôïng dòch phaûi>200ml.
Bình thöôøng giöõa laù thaønh vaø laù taïng coù
# 20ml dòch giuùp maøng tim tröôït leân
nhau.
174. 6/19/2013 174
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
NORMAL PERICARDIUM
-The pericardial cavity is seen
as a high-attenuation stripe
(arrows) flanked by
mediastinal and epicardial fat.
-CS:coronary sinus.
175. 6/19/2013 175
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
NORMAL PERICARDIUM
-The pericardial cavity is seen
as thin band of low signal
(arrows) flanked by
mediastinal and epicardial fat.
176. 6/19/2013 176
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
Fluoroscopy (coù gía trò):Tim khoâng ñaäp
hoaëc giaûm ñaäp.
Phim naèm ngöûa:Dòch doàn leân treân Tim
to troøn hôn vaø cuoáng tim ngaén.
Choïc doø dòch vaø bôm hôi vaøo ta thaáy
ñöôïc möïc thuûy-khí ôû khoang maøng tim.
178. 6/19/2013 178
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
Cheïn tim (cardiac tamponade):Xaûy ra
khoâng tuøy thuoäc vaøo löôïng dòch,maø tuøy
thuoäc vaøo thôøi gian taïo dòch nhanh hay
chaäm.
Laâm saøng:Khi hít vaøo,HA taâm thu giaûm
10mmHg.
179. 6/19/2013 179
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
X quang:
Boùng tim to nhanh theo thôøi gian.
TMCT giaõn,quai TM azygos phoàng.
Fluoroscopy:Tim ñaäp giaûm.
180. 6/19/2013 180
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
PERICARDIAL EFFUSION (“water-bottle” configuration)
-Enlarged heart size with clear heart border.
-Normal pulmonary vasculature.
181. DẤU HIỆU BẦU NƯỚC
(WATER-BOTTLE SIGN)
Tràn dịch màng tim nhiều, khiến bóng tim bè ra như bầu nước.
184. 6/19/2013 184
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
-Symmetric enlargement of the
cardiac silhouette (arrowheads).
-Decreased pulmonary
vasculature.
-Obliteration of the right
cardiophrenic angle (large
arrow).
PERICARDIAL EFFUSION
185. 6/19/2013 185
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
Following pericardial tap and air
injection air-fluid level (large
arrow),true cardiac border
(small arrows),note the normal
thickness of the pericardium.
189. 6/19/2013 189
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
Water-bottle configuration.
Note the distance between
the right heart border and
the Swan-ganz catheter as
it passes through right
atrium (arrows).
Increased density of the
fluid-filled pericardiac sac
(P) is bordered anteriorly
and posteriorly by the
lucencies of the
epicardial and the
medisatinal fat.
Notice the separation
between the right
heart border of
pericardium (arrows)
and the lateral extent
of the cavity of the
RA.
191. 6/19/2013 191
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
INTRAVENOUS CARBON DIOXIDE INJECTION (left lateral decubitus position)
Carbon dioxide in the RA and SVC (black arrows).
The pericardiac space is widened (between white arrows).(Normal ≤ 4mm).
Either pericardial effusion or a thickened pericardium.
192. 6/19/2013 192
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
INTRAVENOUS CARBON DIOXIDE
INJECTION (left lateral decubitus position)
Carbon dioxide in the RA and SVC (b,d).
The pericardiac space is widened (a,c).
(Normal ≤ 4mm).
Either pericardial effusion or a thickened
pericardium.
193. 6/19/2013 193
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
DIAGNOSTIC PNEUMOPERICARDIUM
After removal of 25ml of
pericardial fluid and replacement
with 25ml carbon dioxide (g).
Thickened parietal pericardium
TUBERCULOUS PERICARDITIS
195. 6/19/2013 195
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
A band of fluid attenuation
(arrows) surrounding the heart.
SPIN-ECHO MRI:Pericardial effusion is
seen as a homogeneous signal void
(arrows) surrounding the heart,
subjacent to the pericardial fat.
197. 6/19/2013 197
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
SPIN-ECHO MRI:The increased signal tissue surrounding in the space
between the visceral pericardium and the external cardiac contour
(long arrows) is the inflamed parietal pericardium
TUBERCULOUS PERICARDITIS.
198. 6/19/2013 198
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
STAB INJURY TO THE
EPIGASTRIUM
-Fibrosis of the right
upper lobe was an
incidental finding.
A FEW DAYS LATER
-Cardiac enlargement.
-Decreased pulmonary
vasculature.
CARDIAC TAMPONADE
Following evacuation of the
pericardial blood.
Normal heart size.
(free air under the right
diaphragm due to
abdominal surgery).
199. 6/19/2013 199
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
SUPERIOR VENA CAVAGRAM
-Dilated SVC.
-Reflux into the azygos vein and IVC.
CARDIAC TAMPONADE
200. 6/19/2013 200
BEÄNH MAØNG TIM
TRAØN DÒCH MAØNG TIM
CARDIAC TAMPONADE WITH RIGHT VENTRICULAR COLLAPSE (ARROWHEADS)
201. 6/19/2013 201
BEÄNH MAØNG TIM
VIEÂM MAØNG TIM CO THAÉT
Tuoåi 30-50,Nam/Nöõ=3/1.
Nguyeân nhaân:Sau Vieâm maøng ngoaøi tim
caáp,sau chaán thöông,sau phaãu thuaät
maøng ngoaøi tim,lao,Coxackie,
Histoplasmose, H.influenza type A,B
Autoimmune:RAA,Lupus…
202. 6/19/2013 202
BEÄNH MAØNG TIM
VIEÂM MAØNG TIM CO THAÉT
X quang:
Tim khoâng to hoaëc to ít.
Nhó (T) to trong 20% tröôøng hôïp.Khi
Vieâm co thaét maùu trôû veà tim khoù khaên.
Ñoùng voâi (50%) ôû nhó (P),hieám khi ôû nhó
(T) vì maët sau khoâng coù pericarde,Thaát
(T) ít hôn thaát (P) do thaát (T) ñaäp maïnh
(Ngöôïc vôùi ñoùng voâi trong cô tim).
203. 6/19/2013 203
BEÄNH MAØNG TIM
VIEÂM MAØNG TIM CO THAÉT
X quang:
TMCT giaõn do maùu khoù veà tim.
TDMP coù theå keøm theo (60%).
Chaån ñoaùn phaân bieät:Beänh cô tim haïn
cheá.
Maøng tim khoâng daøy,khoâng ñoùng voâi.
Cô tim daøy vaø söï co boùp giaûm trong 2
thì (taâm thu vaø taâm tröông).
204. 6/19/2013 204
BEÄNH MAØNG TIM
VIEÂM MAØNG TIM CO THAÉT
CT vaø MRI raát coù ích trong chaån ñoaùn
Vieâm maøng ngoaøi tim co thaét.
50% beänh nhaân coù voâi hoùa maøng ngoaøi
tim,deã daøng nhaän thaáy treân CT.
Daøy maøng tim deã thaáy treân MRI.
205. 6/19/2013 205
BEÄNH MAØNG TIM
VIEÂM MAØNG TIM CO THAÉT
-Normal heart size.
-Dilated SVC (arrows).
-Dilated azygos vein (arrowheads).
-Dilated HV.
-Dilated IVC.
CONSTRICTIVE PERICARDITIS
206. 6/19/2013 206
BEÄNH MAØNG TIM
VIEÂM MAØNG TIM CO THAÉT
SPIN-ECHO MRI: Intermediate signal intensity band between the
epicardial fat and the pericardial fat (curved arrow and black arrows)
is thickened pericardium CONSTRICTIVE PERICARDITIS
207. 6/19/2013 207
BEÄNH MAØNG TIM
VIEÂM MAØNG TIM CO THAÉT
The pericardium is irregularly thickened (arrows)
CONSTRICTIVE PERICARDITIS.