胸部X光 常見的異常
Chest X Ray
| 常見問題 Questions | 說明 Explanation |
|---|---|
| 劑量 Radiation dose | 一張胸部X光檢查的劑量0.02毫西弗，是很低的劑量，不會對身體有不好的影響。 (台灣人每年接受天然背景輻射劑量1.6毫西弗，相當於80張胸部X光的劑量；一趟台北往返美國西岸的飛行劑量0.09毫西弗，相當於4.5張胸部X光的劑量。資料來源：行政院原子能委員會) We are exposed to natural sources of radiation all the time. According to recent estimates, the average person in Taiwan receives an effective dose of about 1.6 mSv per year from natural radiation, which includes cosmic radiation from outer space. These natural “background doses” vary according to where you live. The amount of radiation exposure in an x-ray procedure varies depending on the part of the body receiving the x-ray. The exposures of a single chest x-ray is about 0.02 mSv. The amount of radiation from 80 adult chest x-ray (0.02mSv × 80) is about the same as one year of natural background radiation that we are all exposed to as part of our daily living. |
| 結節 Pulmonary nodules | 肺部出現不正常之不透光陰影稱為肺結節，可能原因眾多，且可能單發或多發。一般是以大小的變化來鑑別是否為腫瘤。鈣化結節一般為良性，雖然機會很少，但少數惡性腫瘤會也有鈣化形成，因此鈣化性結節病不能排除惡性的可能，一般建議追蹤是最好的處理方式。 Many people have lung nodules. These abnormal growths are rarely cancerous. Respiratory illnesses and infections can cause nodules to form in the lungs. On X-rays or scans, these growths may look like a shadow or spot on the lung. If you have a pulmonary nodule, your healthcare provider may want to perform additional tests to determine the cause and rule out lung cancer. |
| 肺浸潤 Pulmonary infiltrate | 常代表肺部局部發炎，造成肺間質組織的水腫，並沿著淋巴系統往外擴散，在胸部X光片上則表現出條狀或片狀的白色陰影，可能是單側也可能兩側都有。肺浸潤現象可能出現在任何急慢性肺部感染、肺結核、甚至肺癌等，通常也會有發燒、咳嗽、呼吸困難等症狀。 The term pulmonary infiltrate is considered a context-dependent, non-specific and imprecise descriptive term when used in radiology reports. It refers to “an abnormal substance that accumulates gradually within cells or body tissues” or “any substance or type of cell that occurs within or spreads as through the interstices (interstitium and/or alveoli) of the lung, that is foreign to the lung, or that accumulates in greater than normal quantity within it. |
| 肋膜肥厚 Pleural thickening | 在X光片上發現肺肋膜形成邊緣濃密不均、不規則的柔軟組織陰影，稱為肋膜肥厚。過去抽菸，較嚴重肺部感染，或環境化學物質污染後，可能造成肋膜纖維化，也就是增厚現象。 Pleural thickening is a descriptive term given to describe any form of thickening involving either the parietal or visceral pleura. It can occur with both benign and malignant pleural disease. |
| 右側橫隔膜不平整 Uneven right hemidiaphragm | 橫隔膜(diaphragm)是分隔胸腔和腹腔的一層肌肉膜，在影像上通常呈現平滑弧形線條。「右側橫隔膜不平整」是指右邊的橫隔膜邊緣沒有平常那樣平滑，出現凸起、下陷、波浪或變形的情況。可能原因包括：姿勢或呼吸影響(檢查當下吸氣不足，或拍片時身體偏斜，造成影像看起來不平整;年長者則常見橫隔膜肌肉輕度收縮不對稱)、右下肺或橫隔膜附近的病變(肺部塌陷、肺炎或積液、肺腫瘤壓迫橫隔膜)、肝臟腫大或病變(因為肝臟就在右橫隔膜下方，腫大會把橫隔膜推高，產生不平整的外觀)、橫隔膜疝氣或膈神經麻痺。醫師會根據臨床症狀判斷是否需要進一步檢查(例如：胸部電腦斷層CT、超音波、MRI)，建議諮詢胸腔內科門診。 The diaphragm is a muscular membrane that separates the thoracic cavity (chest) from the abdominal cavity. On medical imaging, it typically appears as a smooth, curved line. “Irregularity of the right diaphragm” refers to a condition where the edge of the right diaphragm is not as smooth as usual, showing signs of bulging, indentation, waviness, or deformation. Possible causes include postural or respiratory factors (such as insufficient inhalation during the scan or body misalignment during imaging, which can make the diaphragm appear uneven; in elderly individuals, mild asymmetrical contraction of the diaphragm muscles is also common), diseases affecting the lower right lung or nearby diaphragm area (such as lung collapse, pneumonia or pleural effusion, and lung tumors compressing the diaphragm), liver enlargement or liver disease (since the liver is located just below the right diaphragm, an enlarged liver can push the diaphragm upward, creating an irregular appearance), and diaphragmatic hernia or phrenic nerve palsy. A physician will assess whether further evaluation is necessary based on clinical symptoms. Additional tests may include chest CT scan, ultrasound, or MRI. Consultation with a pulmonology specialist is recommended. |
| 橫膈膜上升 Elevated diaphragm | 正常的右側橫膈略高於左側 (約高1/2個至1個肋骨間距，約1至2公分)，通常正面胸部X光橫膈圓頂高度約與第六肋骨前緣或第十一肋骨後緣等高。若左側高於或接近右側高度、右側橫膈異常偏高或兩側橫膈位置皆偏高應考慮是否有橫膈上移。可能為吸氣不足所造成，建議至胸腔科門診追蹤。 The diaphragm is a thin, dome-shaped muscular structure that functions as a respiratory pump and is the primary muscle for inspiration. Elevated hemidiaphragm occurs when one side of the diaphragm becomes weak from muscular disease or loss of innervation due to phrenic nerve injury. |
| 肋橫膈角鈍化 Costophrenic angle blunting | 肋-横膈-角 (CP angle) 指的是在胸腔外側 ，亦即左右兩側的最下端，由肋骨骨架和橫膈交錯所形成的夾角，此處在人體呈坐姿或站姿時，乃是胸腔的最低點。胸部X光片中，這個部位的肺野呈現透X光性很好的全黑色。鈍化可能是少量肋膜腔積水或過去曾經肋膜炎或肋膜腔積水造成單側或兩側胸部X光下方夾角鈍化，應配合過去病史及臨床症狀做判斷。 Blunting of the costophrenic angle (also known as blunting of the costophrenic sulcus) is a chest radiograph sign usually indicative of a small pleural effusion. Other causes of costophrenic angle blunting include lung disease in the region of the costophrenic angle, and lung hyperexpansion. |
| 縱膈腔擴大 Widening of mediastinum | 包括心臟肥大、主動脈瘤、淋巴結腫大、畸型瘤、淋巴瘤、胸腺瘤、甲狀腺異位於胸腔，及後胸腔縱膈之神經瘤、脊柱中脊髓膜囊腫等，應加照側面照瞭解陰影位置，必要時做電腦斷層、核磁共振、抽吸細胞病理等檢查。 Widening of the mediastinum is most often due to technical factors such as patient positioning or the projection used. Rotation, incomplete inspiration, or an AP view, may all exaggerate the width of the mediastinum, as well as heart size. The main pathological causes to consider include masses and widening of vessels. |
| 肋膜尾 Pleural tail | 肋膜多出一段像尾巴狀的顯像；可能是曾經肺部發炎所留下的疤痕或纖維化。 It is formed by distorted blood vessel(s) and a focal area of atelectatic lung adjacent to pleural thickening. Histologically, pleural tails reflected thickened, fibrotic connective tissue septae with indrawing of the visceral pleura. |
| 肺纖維化 Pulmonary fibrosis | 早期肺部纖維化，X光可能仍看不出來而仍呈正常。局部纖維化可能網狀、線狀、毛玻璃狀網結節狀等局部肺紋增加，原因可能是良性陳舊性癒合性之發炎變化及慢性不活動性肺結核，但也能是早期肺塵埃沉著症、矽肺症、石綿沉著症之表現，也可以是過敏性肺炎、類肉瘤症、硬皮症等，且也可是淋巴瘤或癌細胞淋巴轉移的表現。以良性原因較多，與舊片比較及經由病史追蹤複檢是最重要之鑑別方法，受檢者大都不必太恐慌。但初次發現者，應建議一段期間內應再照一次 X 光片複檢比較，如無變化、追蹤即可，但如有變化，應進一步詳查病因及適當之治療。 Pulmonary fibrosis is a group of serious lung diseases that affect the respiratory system. The healthy lung tissue is destroyed and replaced by connective tissue. Pulmonary fibrosis scars and thickens lung tissue. It impacts the connecting tissue in the lung and the alveoli (air sacs inside the lungs). The lung damage gradually gets worse over time. |
