每日一题_2023.09.12

A 62-year-old woman with stage IV ovarian cancer presents with shortness of breath and chest pain. Diagnostic imaging indicates a fluid collection within the right pleural space. The physician prepares the patient for therapeutic thoracentesis, and she inserts the needle in the midaxillary line on the right side, in the lower margin of the ninth intercostal space. Which structure(s) does the physician aim to avoid by inserting the needle at this point?

一名患ⅳ期卵巢癌的62岁女性表现为呼吸急促和胸痛。诊断性影像学检查显示右侧胸膜腔内积液。医生为患者准备进行治疗性胸腔穿刺术，她将针插入右侧的腋中线，在第9肋间隙的下缘。医生在这一点插入针是为了避免哪些结构?

(A) Ninth intercostal nerve, artery, and vein 第九肋间神经、动脉和静脉

(B) Parietal pleura胸膜壁层

(C) Phrenic nerve膈神经

(D) Right pericardiophrenic artery and vein 右心膈动静脉

(E) Tenth intercostal nerve, artery, and vein 第10肋间神经、动脉和静脉

(F) Visceral pleura脏层胸膜

答案解析：

该患者表现为胸腔积液，即过量液体在胸膜腔内积聚。胸腔积液有多种病因，包括肺炎、充血性心力衰竭和癌症。治疗性胸腔穿刺术可缓解症状，改善呼吸功能。肋间静脉、动脉和神经在每根肋骨下表面的肋间沟中走行。当进行胸腔穿刺术时，穿刺针总是插入肋间的最下方，以避免这些结构沿着空间的上方运行。

正确答案：A