Вы находитесь на странице: 1из 121

›   

   ›
OBJECTIVES
0 To know the modalities used to study the heart and
lungs
0 To identify the lungs and their lobes and segments
on Chest radiograph
0 To identify the trachea, carina and right and left
main stem bronchi and their branches
0 To know the pulmonary vasculature

0 To know the chambers of the heart

0 To know the great vessels


IMAGING MODALITIES

0 Plain X-Ray
0 CT Scan

0 MRI

0 Ultrasound

0 Nuclear Medicine
CHEST RADIOGRAPHS - VIEWS REQUIRED
0 Most commonly done
 Posteroanterior view
 Lateral view
0 Others
 Lordotic view ± to look at the apical segment
 Right anterior oblique view
 Left anterior oblique view
 Anteroposterior view
 Decubitus view
RADIOANATOMY OF LUNGS
POSTEROANTERIOR VIEW OF CHEST
LATERAL VIEW
LUNGS
0 Two lungs situated in the thoracic cavity
 Right
 Left
0 Separated from each other by middle mediastinum
containing the heart and great vessels
0 Lobes
 b lobes in the right separated by major and minor
fissures
 2 lobes in the left separated by major fissure
OBLIQUE FISSURES
Indicated by a line
that runs from the
spinous process of
T2 vertebra around
the thorax to the
sixth costochondral
junction
Similar on both sides
4. Right Oblique
Fissure
10. Left Oblique
Fissure
OBLIQUE FISSURES

² Indicated by a line
that runs from the
spinous process of
T2 vertebra around
the thorax to the sixth
costochondral
junction
² Similar on both
sides
TRANSVERSE FISSURE
Runs from the
anterior border
of the lung
along the fourth
costal cartilage
to the oblique
fissure
FISSURES
Oblique Fissure - Indicated by a
line that runs from the spinous
process of T2 vertebra around
the thorax to the sixth
costochondral junction

Transverse Fissure - Runs


from the anterior border of
the lung along the fourth
costal cartilage to the oblique
fissure
OBLIQUE FISSURES
LUNG PARENCHYMA
LOBES OF THE LUNGS
0 Right
 Upper
 Middle
 Lower
0 Left
 Upper
 Lower
Lingula is counterpart of the right middle lobe but is
incorporated in the upper lobe
RIGHT UPPER LOBE
RIGHT MIDDLE LOBE
RIGHT LOWER LOBE
LEFT UPPER LOBE WITH LINGULA
LEFT UPPER LOBE
LEFT LOWER LOBE
BRONCHOPULMONARY SEGMENTS
BRONCHOPULMONARY SEGMENTS
0 Each segment is pyramidal in shape with the apex
facing the root of the lung and the base on the
pleural surface
0 Each segment is supplied by its own segmental
bronchi
SEGMENTS OF THE RIGHT UPPER LOBE

1. Apical
2. Posterior
b. Anterior
SEGMENTS OF RIGHT MIDDLE LOBE
1. Lateral
2. Medial
SEGMENTS OF THE RIGHT LOWER LOBE
1. Superior
2. Medial-basal
b. Anterior-basal
4. Lateral-basal
5. Posterior-basal
SEGMENTS OF THE LEFT UPPER LOBE
0 Superior lobe
1. Apico-posterior (merger of "apical" and "posterior")
2. Anterior
0 Lingula of superior lobe ±
1. Inferior lingular
2. Superior lingular
SEGMENTS OF THE LEFT LOWER LOBE
1. Superior
2. Anteromedial basal (merger of "anterior basal" and
"medial basal")
b. Posterior basal
4. Anterior basal
5. Lateral basal
1. Cardiac Bronchus
(normal variation)
2. Right Middle Lobe
b. Right Main Bronchus
4. Right Oblique Fissure
5. Right Lower Lobe
6. Lingular lobe of the left
lung
7. Left Upper Lobe
8. Left Upper Lobe
Bronchus
9. Left Main Bronchus
10. Left Oblique Fissure
11. Left Lower Lobe
AIRWAYS
0 Trachea ± begins at the level of C6 vertebra and
extends to the carina at the level of T4-T5
0 Right bronchus ± 2.5 cm in length and straight ±
more prone to infection
0 Left bronchus ± 5 cm in length and slightly slanting
± protected due to obliquity
TRACHEA AND BRONCHI

²Angle of Carina
(angle between the
two main stem
bronchi
²Should be less
than 60 degrees
BRONCHOGRAPHY
9  
Ý  !›
"
9Ý#  !

"
$  !›
"
$  # ›
%

&  !

"

#
 !

"
›%%

!›
"

' %!›
" 

# 
( %

+
)  

*
 
9  
CORONAL RECONSTRUCTION OF LUNGS
AND TRACHEA
bD CORONAL RECONSTRUCTION OF
LUNGS AND TRACHEA 0 Right Main Bronchus

0 Right Upper Lobe


Bronchus
0 Right Lung

0 Right Lower Lobe


Bronchus
0 Trachea

0 Left Lung

0 Left Main Bronchus


HILA
STRUCTURES PRESENT IN THE HILUM
0 This is where the root is attached to the lung
0 It contains
 Mainstem bronchus
 Pulmonary vessels (one artery and two veins)
 Bronchial vessels
 Lymph vessels
 Nerves ± entering and leaving the lungs
Lower margin
of the left hilum
is at the level of
upper margin
of right hilum
PULMONARY VASCULATURE
PULMONARY VASCULATURE

0 The vessels taper from center to the periphery


0 More blood flow is seen in the vessels at the base of the
lung than those at the apex - this is due to gravity
0 No vessels in b.0 cm from apices

0 No vessels in 1.5 cm from pleura


PULMONARY VASCULATURE

,$ 
-

,9 '
-
TRANSVERSE FISSURE
Runs from the
anterior border
of the lung
along the fourth
costal cartilage
to the oblique
fissure
RADIOANATOMY OF HEART AND
GREAT VESSELS
PERICARDIUM AND PERICARDIAL CAVITY

0 Pericardium is a fibroserous sac which encloses the


heart and roots of great vessels
0 Fibrous pericardium

0 Serous pericardium ± parietal and visceral layers

0 Pericardial space ± potential space between parietal and


visceral layers
ANATOMY OF HEART

0 Heart is a four chambered organ located in the thoracic


cavity
0 Heart is located in the middle mediastinum

0 Pumps blood to various parts of the body for nutritional


and respiratory requirements
ANATOMY OF HEART

04 chambers ± right atrium,


right ventricle, left atrium, left
ventricle
0 Great vessels ± SVC, IVC and
pulmonary arteries , pulmonary
veins and aorta
0 4 valves ± tricuspid,
pulmonary, bicuspid and aortic
PLAIN X-RAY OF HEART AND GREAT
VESSELS
CHEST X-RAY - PA VIEW

 RIGHT ± Superior Vena Cava and Right Atrium


 LEFT ± Arch of Aorta, Pulmonary Artery, Left Atrial Appendage
and Left Ventricle
CHEST X-RAY ±LATERAL VIEW

0 Anterior border ± right ventricle and outflow tract


0 Posterior superior ± left atrium
0 Posterior inferior ± left ventricle
É    
   

CT SCAN OF HEART AND GREAT VESSELS

-0
, . %1
, /



- ,
1
,,
-.3,
4.,
- 30

21
,
-
1
 /


,,

%
›1 1
1 /


-
1
1
 1
/

›



-


%
FOUR CHAMBER VIEW
CORONARY CIRCULATION
CORONARY CIRCULATION

0 Heart is supplied by two coronary arteries arising from


the ascending aorta
0 Right coronary artery arises from the right aortic sinus

0 Branches ± marginal and posterior descending

0 Terminates by anastomosing with left coronary artery


CORONARY CIRCULATION

0 Left coronary artery arises from left aortic sinus


0 Branches ± left anterior descending and left circumflex
artery
CORONARY CIRCULATION

0 Great, middle and small cardiac veins


0 Posterior vein of left ventricle

0 Oblique vein of left atrium

0 Right marginal vein

0 Anterior cardiac vein and venae cordis minimae

0 Most of these drain in the coronary sinus which opens


directly into the right atrium
CONVENTIONAL CORONARY ANGIOGRAPHY
CONVENTIONAL ANGIOGRAPHY
CT CORONARY ANGIOGRAPHY WITH 2D
AND bD RECONSTRUCTIONS
LEFT CIRCUMFLEX AND POSTERIOR
DESCENDING ARTERIES
BRANCHES OF LEFT CORONARY ARTERY
ON bD RECONSTRUCTION
AORTA
PARTS OF THE AORTA
0 Ascending aorta
0 Arch of the aorta

0 Descending aorta ± thoracic aorta

0 This is not a physical separation as all the three


portions are continuous with each other
BRANCHES OF ASCENDING AORTA
0 Arise near the aortic root
 Right coronary artery
 Left coronary artery
BRANCHES OF THE ARCH OF THE AORTA
0 Brachiocephalic artery
 Right subclavian
 Right common carotid artery
0 Left common carotid artery
0 Left subclavian artery
BRANCHES OF THORACIC AORTA
0 The aorta gives off several paired branches as it
descends in the thorax. These include the
0 Bronchial arteries

0 Esophageal arteries

0 Posterior intercostal arteries


AORTA ON PLAIN X-RAY
AORTA ON ANGIOGRAM
% 
+
BRANCHES OF AORTIC ARCH
BRANCHES OF THE
BRACHIOCEPHALIC
ARTERY
LEFT COMMON CAROTID ARTERY
SUBCLAVIAN
ARTERIES
BRANCHES OF SUBCLAVIAN
ARTERIES
AORTA AND AORTIC VALVE ON CT SCAN
BRACHIOCEPHALIC VEIN

›%-
4
,4+
%-
, ,
,1-

,

 
.› 00 
0
3 0›   5
› 
.› 00 
0
3  › 
›› 3 0 3
SUPERIOR VENA
CAVA
213
%
 30
30%
›

PULMONARY ARTERIES

 ›
3

Оценить