Radiology

CardioPulmonary Module

Dr. Mary G. Cormier

Professor of Radiology
Georgetown Medical School
 Outline
• Historical perspective
• Making images
• Basic anatomy
– CXR
– CT
• Examples of disease
– lung
– pleura
– heart/pericardium
 HISTORICAL PERSPECTIVE
Wilhelm Konrad Roentgen

Radiology officially
traces its beginning
to Wilhelm Konrad
Roentgen’s
discovery (and
naming) of x-rays,
1895
 HISTORICAL PERSPECTIVE
• physics professor at
University of
Wurzburg, in Germany
• discovered “a new
kind of ray”
accidentally while
experimenting with
Crooke electrical tubes
• “x” was the
mathematical symbol
for an unknown
WILHELM KONRAD ROENTGEN
 Making X-RAYS

• Electrons from (-)anode are

accelerated to (+)cathode in
vacuum tube
• Electrons’ direction altered
by the (+)nucleus
• X-RAYs are thereby emitted
in all directions
• X-RAYS escape through a
filtered window
X-rays
MAKING IMAGES
 X-RAYS

• Electromagnetic radiation of a short

wavelength (high energy)
• Penetrate materials to a certain degree
• Conventional radiology is based on
– irradiating the measured object
– measuring the intensity of the X-rays which
have been attenuated by the object
Making a chest radiograph
Creating a PA CXR
Creating a lateral CXR
Making a CT image
Making a CT image
Multiplanar capability
 Multiplanar CT images

axial coronal sagittal

Normal Anatomy
CXR
CT Chest
 Normal CXR

frontal view side view

Normal frontal CXR
trachea

Pulmonary arteries

heart

Pleural
diaphragm
angles
 Normal bones

clavicle Spinous process

Coracoid process

ribs

vertebrae
Normal “moguls”

Aortic arch

Pulmonary trunk

Left atrium/
Right atrium appendage

Left ventricle
 Normal Lateral CXR

scapulae
trachea
sternum

Vertebrae
heart

diaphragm
Axial slice
Normal axial CT anatomy
 Normal axial CT anatomy

16 15
1 8 9

14
2 10
7

13
5 11 12
3 4
Normal axial CT anatomy
 Normal axial CT anatomy

71 16
18
1 15
9
6
12 10
141

13 14 111 12 13
Normal axial CT anatomy
Normal cardiac valves (axial CT)

•aortic valve with right (R), left (L), and

noncoronary (N) cusps
•pulmonary valve with right (R), left (L), and
anterior (A) cusps
 Normal coronary arteries (axial CT)

Left main (LM) coronary artery at the level of the ostium, arises from the left
Valsalva sinus, courses posterior to the right ventricular outflow tract (RVOT),
and bifurcates into the left anterior descending (LAD) and the left circumflex
(LCX) branches
Middle segment of the right coronary artery (RCA) and distal segments of the
left anterior descending and left circumflex branches. The latter is seen in the
left atrioventricular groove, in close proximity to the great cardiac vein (GCV).
 Normal azygos vein

right paratracheal
prominence caused by the
azygos vein (arrow)

widening is due to
the azygos vein
(arrow)
azygos vein arches
forward to join the
SVC (arrow)

azygos vein (arrow)

 Examples of disease

• Lung
–pneumonia
–tumor
–pulmonary embolism
pneumonia
pneumonia
baseline
 RUL pneumonia

baseline RUL pneumonia

 RUL pneumonia

baseline RUL pneumonia

tuberculosis (cavitary)
tumor
lung carcinoma
lung carcinoma

PET scan
uterus cancer, spread to lungs

2007 2008
colon cancer, spread to lungs

2006 2008
possible early neoplasm
pulmonary embolism
Pulmonary embolism

Axial: clot in right and

left pulmonary arteries
(arrows)

Coronal: clot in right

pulmonary artery extending
into upper and lower
branches (arrow)
Normal Pleura
normal pleura
Pleural outlines

Minor fissure

Major fissures
Pleural fissures (LEFT)

LUL

LLL
Pleural fissures (RIGHT)

RUL

RML RLL
Normal pleura
 Examples of disease

• Pleura
–pneumothorax
–pleural effusion
–pleural infection (empyema)
–other
pneumothorax
pneumothorax
Complete L pneumothorax
L apical pneumothorax
Pleural effusion
Large pleural effusion
Layering pleural effusion
Layering pleural effusion
Pleural infection (empyema)
 empyema

empyema Chest tube drainage

 Pleural micronodules (sarcoidosis)

CT scan demonstrates small nodules in the

Normal pleura
lungs and along the minor (arrowhead) and
major (arrow) fissures representing
sarcoidosis
 Examples of disease

• Heart/Pericardium
– Enlarged cardiac silhouette
– Pulmonary edema
– Pericardial effusion
 enlarged “cardiac silhouette”

Normal heart size Enlarged cardiac silhouette

pulmonary edema
alveolar edema
 pulmonary edema

baseline 1 day later

 pulmonary edema

0000 hrs 0800 hrs

pericardial effusion
pericardial effusion
 Review
• Historical perspective
• Making images
• Basic anatomy
– CXR
– CT
• Examples of disease
– lung
– pleura
– heart/pericardium
The End