【原】【医学知识】你不知道的事：放射学的秘密（5）

《Radiology Secrets Plus》是由宾夕法尼亚大学E. Pretorius和Jeffrey Solomon博士主编的以问答形式深入浅出的介绍相关放射性与影像诊断学内容的图书。该书总结了影像诊断学在实践过程中需要注意的100个知识要点，本公众号将持续推送翻译介绍。上一期我们介绍了：肾及肾上腺肿瘤造影与影像诊断原则，部分介绍性器官影像评价的相关知识。本期推送的主要内容主要涉及血管介入治疗部分和骨组织部分，敬请期待!

41. 在清醒镇静术前需要准备以下设备：药物拮抗剂、恰当的气道重建与正压通气、氧疗和心脏除颤器除颤。

 The following equipment should be present when administering conscious sedations: pharmacologic antagonists, appropriate equipment to establish airway and provide positive pressure ventilation, supplemental oxygen, and defibrillator. 

42. 下腔静脉（IVC）过滤器应尽可能地放置在最低处的肾静脉。 
Inferior vena cava (IVC) filters should be placed below the lowest renal vein when possible. 

43. 假性动脉瘤、动脉瘤和动静脉瘘必需进行双侧栓塞处理，以防止脉络通路的重建，从而引起疾病复发。

Embolization on both sides of a pseudoaneurysm, aneurysm, or arteriovenous (AV) fistula is necessary to prevent reconstitution of flow via collaterals, which causes recurrence of the lesion.

 

44. 颈静脉肝内门体（TIPS）布局最常见的两大局部分流指证是：食管静脉曲张破裂和门静脉高压，这对内镜治疗和治疗难治性腹水带来很大的困难。另外，TIPS布局也可作为对晚期肝脏疾病和门静脉高压症患者进行肝移植手术的重要参考。

The two most common indication for placement of a transjugular intrahepatic portosystemic shunt (TIPS) are variceal bleeding related to portal hypertension that is refractory to endoscopic therapy or for ascites refractory to medical management. TIPS placement may act as an effective bridge to liver transplantation for patients with end-stage liver disease and the manifestations of portal hypertension. 

45. Segond骨折、前交叉韧带撕裂和半月板损伤，三者之间存在高度关联性。

There is high association between Segond fracture and anterior cruciate ligament (ACL) tear and meniscal injury. 

46. 当发现内踝关节骨折时，不要忘记关注腓骨近端有无Maisonneuve骨折。(注：Maisonneuve骨折指由外旋暴力导致的腓骨近端骨折， 常常合并下胫腓分离、内踝骨折、三角韧带撕裂、前距腓韧带断裂、骨间韧带损伤、下胫腓韧带撕裂、后踝骨折等损伤,属于旋前-外旋三度损伤，踝关节不稳定。该骨折1840年由法国医师Maisonneuve首先报道，故此得名。）

When you see a fracture of the medial malleolus, do not forget to look at the proximal fibula for Maisonneuve fracture.

47. 在颈椎X线平片中，如果无法准确分辨低处的颈椎，则应该通过swimmer’s view或者CT来明确。主要明确点是第七颈椎（C7）和第一胸椎（T1）。（对于swimmer's view的翻译，欢迎读者补充）

On a cervical spine radiograph, if you cannot visualize the lower cervical spine, obtain either a swimmer's view or CT. You must visualize C7&T1 to clear the cervical spine.

48. 骨质疏松症的发生有很多次要原因。 对多发性骨髓瘤与内分泌因素的医学讨论需要建立在同一原发性骨质疏松疾病的基础上。

Osteoporosis has many secondary causes. Medical evaluation for multiple myeloma and endocrine diseases should be performed before one assumes primary osteoporosis.

49.如果你看到一个成年人有多处溶骨性病变，可以考虑为转移性疾病和多发性骨髓瘤。在转移性骨病变患者中原发肿瘤多考虑为肺癌、前列腺癌、乳腺癌、肾癌、甲状腺癌和结直肠癌。

If you see multiple lytic bone lesions in an adult, think of metastatic disease versus multiple myeloma. Primary tumors to consider in a patient with metastatic bone lesions are lung, prostate, breast, kidney, thyroid, and colorectal.

50.  经典骨样骨瘤患者会出现夜间疼痛并可通过服用阿司匹林缓解。

 Patients with an osteoid osteoma classically present with pain at night relieved by aspirin.