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		<h1 class="catchCopy">救急現場でのCTは，「7つの原則」を意識せよ！</h1>
		

		<h1 class="copy">7つの原則から読む</h1>
		<h1 class="title">救急CTの解き方<span class="version"></span></h1>
		

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					著：楠井　隆（長浜赤十字病院 副院長）
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				<ul class="property"><li class="disc">A5判・464頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-3743-8</li><li class="disc">2014年7月2日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">画像診断を専門としない医師にとって悩ましいのが救急・時間外診療でのCT読影．救急現場のCTで, 見落とし・誤診を防ぐにはどうすればよいのか？　本書は「general radiologist（何でも屋放射線科医）」をもって任じる画像診断の達人が，救急CTを読み解くための「７つの原則」を徹底解説，読影のコツを余すところなく開陳した．救急・時間外診療に携わる医師，看護師，放射線技師必携の一冊．<br>☆図版5点，モノクロ写真362点</section><section class="preface">序文<br><br>　不動産の宣伝で「駅やスーパーが近い」というのは売りの一つである．便利だからで，日常的に利用することが想定されている．「病院が近い」というのもポイントとなるが，これは「いざというときに安心だから」である．すなわち日常的に通うのではなく例外的に必要になったとき利用することが想定されている．医療には予防もあり，日頃の健康管理が重要であることは言うまでもないが，「のど元過ぎれば熱さ忘れる」のが人の常で，「忘れた頃に（突然）やってくる災い」の一つである病気にいついかなるときでも対応してくれることを医療機関に望む人が多いのである．<br>　医療人は医療には予防，健診，慢性疾患の治療や管理，その他重要なことが多くあることを十分に認識しているが，自らを健康と認識する住民の多くは「いざというとき」の医療，すなわち救急医療の充実を最も強く期待している．その救急医療が崩壊の危機に瀕しているといわれる．それも特に一般的な診療時間外の問題が大きい．これは救急医療に対する要求が増大しているにもかかわらず医師をはじめ十分な人員や予算が確保できないことが最大の要因であると考えられる．<br>　理想は救急専門医を中心とするチームが交代勤務で24時間カバーすることである．しかし，わが国で特に診療時間外は，救急を専門としない（他の診療科を専門とする）医師が交替でカバーしているのが実情である．筆者も普段は患者を直接診察しない放射線科医でありながら救急の当直にも参加している．正直いって体力の面でも負担であるが，何より専門外のことを一人で処理しなければならないことの負担が著しい．<br>　画像診断を専門としない医師にとって，救急当直や時間外での画像診断が大きな負担となっていることは想像に難くない．本書は救急で多用されるCTに関して，いかに見落としや誤診を防ぐかとの観点から書いたものである．第1部では救急特有のポイントを7つ挙げ，第2部では見逃すと重大な結果を招く疾患について解説，第3部では主な受診動機ごとに解説した．最後に第4 部はクイズ形式で示唆に富む症例を示した．<br>　CTはMRと比しコントラストが不十分で造影CTが有用な場合が多い．一方，時間外の診療体制では造影CTに制限があったり，造影CT適応の判断に不慣れであったりするために非造影CTのみで済まされることも少なくない．救急疾患では非造影CTに所見があることが多いため，造影CTなら容易に診断できる疾患の非造影CTでの所見について特に力点を置いて解説した．<br>本書が救急や時間外診療を担当する医師，さらには放射線技師，看護師など多くのスタッフの一助となれば幸いである．<br><br>平成26年7月吉日<br>楠井　隆</section><section class="indexes">第1部　救急・時間外CT7原則<br>1　出血，血管，血流に注目せよ<br>　図解1 非造影CTで，血栓，血腫とも血管内の血液より高吸収<br>　図解2 脳卒中の場合<br>　図解3 大動脈解離の場合<br>　図解4 活動性の出血<br>　図解5 肺塞栓の場合<br>　図解6 腸管の絞扼と造影効果<br>2　時間軸を考慮せよ<br>　図解1 急性疾患の経過<br>　図解2 出血に関して<br>　図解3 外傷初期診療の流れ<br>　図解4 外傷CTの見方<br>3　空気・ガスの分布を読め<br>　図解1 気脳症<br>　図解2 気胸・縦隔気腫・皮下気腫<br>　図解3 縦隔気腫<br>　図解4 腹腔内遊離ガス像<br>　図解5 軟部の気体<br>　図解6 脈管の中の気体<br>　図解7 紛らわしい正常像<br>　図解8 肺の含気と肺気腫について<br>4　脂肪内の変化に気を配れ<br>　図解1 観察ウィンドウ<br>　図解2 皮下の変化<br>　図解3-1 脂肪濃度上昇がキーとなる疾患：胆囊炎，憩室炎など<br>　図解3-2 脂肪濃度上昇がキーとなる疾患：液体漏出<br>　図解3-3 脂肪濃度上昇がキーとなる疾患：外傷<br>　図解3-4 脂肪濃度上昇がキーとなる疾患：血管病変<br>　図解3-5 脂肪濃度上昇がキーとなる疾患：その他<br>5　大きくなった構造に着目し，その原因を考察せよ<br>　図解1-1〜3　腔の拡張<br>　図解2 心拡大<br>　図解3-1〜3　実質臓器の腫大<br>　図解4 壁肥厚<br>6　画像所見と臨床像の不一致に注意せよ<br>　図解1-1〜4　検討の流れの例<br>7　一つの画像を複数回読め<br>　図解1-1,2　救急での偶発発見病変例<br>　図解2-1,2　偶発発見腫瘍と対応<br>　図解3-1,2　最後にもう一度ここをチェック<br>第2部　見落としが重大な結果につながることが多い疾患<br>1　内因性くも膜下出血<br>　図解1-1,2　基本の画像<br>　図解2-1,2　横断像で動脈瘤のみえる位置<br>　図解3-1,2　少量くも膜下出血の例<br>　図解4 動脈瘤破裂以外の内因性くも膜下出血の原因<br>　図解5 内因性と外傷性の鑑別<br>2　脳ヘルニアとそのリスク<br>　図解1 重篤例<br>　図解2 外傷例<br>　図解3 被殻出血例<br>3　大動脈解離<br>　図解1-1〜3　基本の画像<br>　図解2 急性期の問題：破裂，虚血<br>　図解3 慢性期の問題：径の拡大と再解離<br>4　大動脈瘤破裂<br>　図解1 基本の画像<br>　図解2 嚢状大動脈瘤と造影剤血管外漏出<br>　図解3 破裂に伴う大動脈壁の変化，胸部大動脈瘤破裂<br>　図解4-1,2　切迫破裂の考え方<br>5　その他の内因性の出血<br>　図解1 喀　血<br>　図解2 吐　血<br>　図解3 下　血<br>　図解4 婦人科的出血<br>　図解5 尿路出血<br>　図解6 腫瘍出血<br>　図解7 その他の出血<br>6　肺塞栓<br>　図解1-1 基本の画像：大きくない肺塞栓<br>　図解1-2 基本の画像：下肢深部静脈血栓症<br>　図解2 非造影CTでの所見<br>7　その他の急性血管閉塞<br>　図解1 急性心筋梗塞・急性冠動脈症候群<br>　図解2 急性上腸間膜動脈閉塞<br>　図解3 腎梗塞・脾梗塞など<br>　図解4 内臓動脈解離<br>　図解5 下肢動脈急性閉塞<br>　図解6 上大静脈症候群<br>　図解7 門脈系閉塞<br>8　絞扼性イレウス<br>　図解1 基本の画像<br>　図解2-1 主な絞扼の機序：腸管・間膜が小孔を通過／腸重積<br>　図解2-2 主な絞扼の機序：捻転<br>　図解3-1 索状物による絞扼<br>　図解3-2 内ヘルニア・閉鎖孔ヘルニア<br>　図解3-3 捻　転<br>　図解3-4 腸重積<br>　図解3-5 外ヘルニア<br>　図解3-6 クローズドループ<br>9　急性虫垂炎<br>　図解1-1 軽症例<br>　図解1-2 穿孔例<br>　図解1-3 汎腹膜炎<br>　図解1-4 鑑別診断時の正常虫垂<br>　図解1-5 さまざまな正常虫垂<br>10　消化管穿孔<br>　図解1 基本の画像<br>　図解2-1,2　上部消化管穿孔<br>　図解3-1,2　下部消化管穿孔<br>11　咽頭周囲膿瘍，急性喉頭蓋炎<br>　図解1 解剖の要点<br>　図解2 扁桃周囲炎<br>　図解3 咽後膿瘍<br>　図解4 喉頭蓋炎<br>　図解5 その他<br>12　気胸，縦隔気腫，皮下気腫<br>　図解1-1,2　気　胸<br>　図解1-3 気胸の原因<br>　図解2-1,2　縦隔気腫<br>第3部　シナリオごとの着目点<br>1　外　傷<br>Ⅰ 頭部外傷<br>　図解1-1 頭蓋内出血：急性硬膜外血腫<br>　図解1-2 頭蓋内出血：硬膜下血腫<br>　図解1-3 頭蓋内出血：外傷性くも膜下血腫<br>　図解1-4 頭蓋内出血：脳内出血・挫傷性出血<br>　図解1-5 頭蓋内出血：種々の出血の混在<br>　図解2 小児の急性硬膜下血腫<br>　図解3-1,2　慢性硬膜下血腫<br>　図解4 頭蓋骨骨折<br>　図解5 頭蓋底の孔<br>　図解6 側頭骨正常解剖<br>　図解7 側頭骨骨折<br>　図解8-1 顔面骨骨折：前頭骨骨折，鼻篩骨骨折<br>　図解8-2 顔面骨骨折：頬骨骨折<br>　図解8-3 顔面骨骨折：鼻骨・鼻中隔骨折<br>　図解8-4 顔面骨骨折：眼窩骨折<br>　図解8-5 顔面骨骨折：下顎骨折<br>　図解9 歯科的外傷<br>II 頸部外傷<br>　図解1 気道損傷<br>　図解2 頸部の軟部損傷<br>　図解3 頸部刺創<br>III 胸部外傷<br>　図解1 肺損傷<br>　図解2 外傷性心損傷<br>　図解3-1,2　胸部大動脈損傷<br>　図解4 横隔膜損傷<br>　図解5 肋骨・胸骨骨折<br>　図解6 胸壁動揺<br>IV 腹部外傷<br>　図解1-1,2　腎損傷<br>　図解2-1 尿路損傷<br>　図解2-2 膀胱損傷<br>　図解3-1,2　肝損傷<br>　図解4-1,2　脾損傷<br>　図解5-1,2　膵損傷<br>　図解6-1,2　消化管および腸間膜損傷<br>　図解7-1〜6　骨盤骨折<br>　図解8-1〜4　脊椎骨折<br>　図解9-1,2　環軸椎骨折<br>　図解10 脊椎分離症<br>　図解11 脆弱性による圧迫骨折<br>　図解12-1,2　四肢骨折<br>　図解13 筋損傷<br>　図解14 外傷性副腎出血<br>　図解15-1〜4　刺　創<br>2　脳卒中<br>I 脳出血<br>　図解1-1 脳出血：皮核出血・視床出血<br>　図解1-2 脳出血：脳幹出血<br>　図解1-3 脳出血：小脳出血・皮質下出血<br>　図解1-4 脳出血：血管奇形<br>　図解1-5 脳出血：動脈瘤<br>II-1　脳梗塞<br>　図解2-1 脳梗塞：基本の画像<br>　図解2-2,3　脳 梗塞：早期虚血サイン<br>　図解2-4 脳梗塞：小梗塞<br>　図解2-5 脳梗塞：静脈性梗塞<br>II-2 脳梗塞：脳幹および小脳の梗塞<br>　図解1 脳梗塞：脳幹・小脳梗塞<br>III 鑑別診断<br>　図解1 陳旧性梗塞<br>　図解2 ②脳腫瘍　③石灰化<br>3 発熱と発熱を伴う病態<br>Ⅰ 頭頸部疾患による発熱<br>　図解1-1,2　髄膜炎<br>　図解2 脳膿瘍と脳室炎<br>　図解3 副鼻腔炎<br>　図解4 中耳炎・乳突洞炎<br>　図解5-1 口腔疾患に伴う発熱<br>　図解5-2 歯根尖周囲膿瘍<br>　図解6-1 リンパ節炎<br>　図解6-2 リンパ節炎（結核性）<br>　図解7 川崎病<br>II 軀幹部疾患による発熱<br>　図解1-1 肺胞性肺炎<br>　図解1-2 気管支肺炎<br>　図解1-3 間質性肺炎<br>　図解1-4 肺膿瘍<br>　図解1-5 粟粒結核<br>　図解1-6 過敏性肺炎<br>　図解2 膿　胸<br>　図解3 急性肝炎・肝周囲炎<br>　図解4 肝膿瘍<br>　図解5-1,2　胆囊炎<br>　図解6-1 胆管炎<br>　図解6-2 胆道系のガス<br>　図解7-1 腎盂腎炎<br>　図解7-2 腎膿瘍<br>　図解8 感染性腸炎<br>　図解9 クローン病<br>　図解10-1,2　腹膜炎<br>　図解10-3 腹膜炎・臍炎<br>　図解11 卵管卵巣炎<br>III その他の原因による発熱<br>　図解1 椎間板炎<br>　図解2 関節炎<br>　図解3 褥　瘡<br>　図解4-1,2　蜂窩織炎<br>　図解5 術後創感染<br>　図解6-1,2　術後縫合不全<br>　図解7-1,2　悪性リンパ腫<br>4　頭痛とその他の頭頸部の症状<br>　図解1-1 頭痛：脳腫瘍<br>　図解1-2 頭痛：低髄圧症候群<br>　図解1-3 頭痛：副鼻腔炎<br>　図解1-4 頭痛：中耳炎<br>　図解2 めまい・嘔気・嘔吐<br>　図解3 痙攣<br>　図解4-1 頸部痛<br>　図解4-2 頸部痛・頸部腫脹<br>　図解5-1 嚥下痛と嚥下困難<br>　図解5-2 嚥下困難<br>　図解6-1,2　異物誤嚥・誤飲<br>5　胸痛とその他の胸部の症状<br>　図解1-1,2　胸痛：冠動脈CTAとtriple rule out<br>　図解1-3 胸痛：肺炎・胸膜炎<br>　図解1-4 胸痛：肋骨・肋軟骨疾患<br>　図解2-1 呼吸困難・低酸素血症<br>　図解2-2 呼吸困難・低酸素血症：肺野<br>　図解2-3 呼吸困難・低酸素血症：気道<br>　図解2-4 呼吸困難・低酸素血症：心不全<br>　図解3 その他<br>　図解4 喀　血<br>6　腹痛とその他の腹部の症状<br>　図解1 胃潰瘍<br>　図解2 胃潰瘍穿孔，出血<br>　図解3 十二指腸潰瘍<br>　図解4 十二指腸潰瘍穿孔<br>　図解5 胆石発作<br>　図解6 総胆管結石<br>　図解7-1〜5　急性膵炎<br>　図解7-6 自己免疫性膵炎<br>　図解8-1,2　尿路結石<br>　図解9-1,2　イレウス<br>　図解10 虚血性腸炎<br>　図解11 その他の腸炎<br>　図解12 憩室炎<br>　図解13 腹膜垂炎<br>　図解14 排卵出血<br>　図解15 卵巣軸捻転<br>　図解16 卵巣嚢腫破裂<br>　図解17 異所性妊娠<br>　図解18 その他の腹部の症状<br>　図解19 急性腰痛・腰背部痛<br>第4部　示唆に富む症例<br>　症例1 家人の目前で突然倒れたという高齢者<br>　症例2 自宅で倒れていた60代女性<br>　症例3 朝食後，突然倒れた高齢男性<br>　症例4 通常みないような造影剤の分布<br>　症例5 発熱を主訴に来院した高齢者<br>　症例6 血痰で来院した高齢女性<br>　症例7 腹部激痛の高齢男性透析患者<br>　症例8 突然の腹痛で来院した女性<br>　症例9 摂食不良と発熱で来院した1歳女児<br>　症例10 全身倦怠感を主訴に来院した高齢女性<br>　症例11 頭部外傷の60代男性<br>　症例12 交通事故で受傷の60代女性<br>　症例13 労災事故症例<br>　症例14 高速道路での交通事故症例<br>　症例15 末期胃・左腎重複癌患者</section></article>
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