RADIOANATOMY OF

LUNGS AND HEART

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Objectives
 To know the modalities used to study the
heart and lungs
 To identify the lungs and their lobes and

segments on Chest radiograph

 To identify the trachea, carina and right and

left main stem bronchi and their branches

 To know the pulmonary vasculature

 To know the chambers of the heart

 To know the great vessels

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Imaging Modalities
 Plain X-Ray
 CT Scan

 MRI

 Ultrasound

 Nuclear Medicine

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Chest radiographs - Views Required
 Most commonly done
1.Posteroanterior view
2.Lateral view
 Others

1.Lordotic view – to look at the apical segment

2.Right anterior oblique view
3.Left anterior oblique view
4.Anteroposterior view
 Decubitus view

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 Radioanatomy of lungs
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Posteroanterior View Of Chest

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Lateral View

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 LUNGS
 Two lungs situated in the thoracic cavity
1.Right
2.Left
 Separated from each other by middle
mediastinum containing the heart and great
vessels
 Lobes
1.3 lobes in the right separated by major and minor
fissures
2.2 lobes in the left separated by major fissure

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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
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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
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sides
Transverse Fissure
Runs from the
anterior
border of the
lung along the
fourth costal
cartilage to
the oblique
fissure

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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
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Oblique Fissures

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Lung Parenchyma

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Lobes of the Lungs
 Right

1.Upper
2.Middle
3.Lower
 Left

1.Upper
2.Lower
Lingula is counterpart of the right middle lobe
but is incorporated in the upper lobe

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Right Upper Lobe

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Right Middle Lobe

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Right Lower Lobe

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Left Upper Lobe with Lingula

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Left Upper Lobe

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Left Lower Lobe

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Bronchopulmonary Segments

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Bronchopulmonary Segments
 Each segment is pyramidal in shape with the
apex facing the root of the lung and the base
on the pleural surface
 Each segment is supplied by its own

segmental bronchi

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Segments of the right upper lobe

1. Apical
2. Posterior
3. Anterior

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Segments of right middle lobe
1. Lateral
2. Medial

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Segments of the right lower lobe
1. Superior
2. Medial-basal
3. Anterior-basal
4. Lateral-basal
5. Posterior-basal

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Segments of the left upper lobe
 Superior lobe
1. Apico-posterior (merger of "apical" and
"posterior")
2. Anterior
 Lingula of superior lobe –
1. Inferior lingular
2. Superior lingular

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Segments of the left lower lobe
1. Superior
2. Anteromedial basal (merger of "anterior basal"
and "medial basal")
3. Posterior basal
4. Anterior basal
5. Lateral basal

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1. Cardiac Bronchus
(normal variation)
2. Right Middle Lobe
3. 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
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 Airways
 Trachea – begins at the level of C6 vertebra
and extends to the carina at the level of T4-T5
 Right bronchus – 2.5 cm in length and straight

– more prone to infection

 Left bronchus – 5 cm in length and slightly

slanting – protected due to obliquity

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Trachea and Bronchi

•Angle of Carina
(angle between
the two main
stem bronchi
•Should be less
than 60 degrees

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Bronchography

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1. Apical segmental 35
bronchus
2. Posterior segmental bronchus (RUL)
1+2 – apicoposterior segmental bronchus (LUL)
3. Anterior segmental bronchus (RUL) 36
3. Anterior segmental bronchus – RUL and LUL
6. Superior segmental bronchus (LLL)
Li – Lingular segmental bronchus (LUL)
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 Right middle
4. Lateral segmental bronchus (RML)
lobe segmental
5. Medial segmental bronchus (RML) bronchi
Li – lingular bronchus
7. Medial basal segmental bronchus
Lower lobe
8. Anterior basal segmental bronchus
segmental
9.Lateral basal segmental bronchus bronchi
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10. Posterior segmental bronchus
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Coronal Reconstruction of Lungs
and Trachea

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3D Coronal Reconstruction of
Lungs and Trachea  Right Main Bronchus

 Right Upper Lobe

Bronchus
 Right Lung

 Right Lower Lobe

Bronchus
 Trachea

 Left Lung

 Left Main Bronchus

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Hila

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Structures present in the Hilum
 This is where the root is attached to the lung
 It contains

1.Mainstem bronchus
2.Pulmonary vessels (one artery and two veins)
3.Bronchial vessels
4.Lymph vessels
5.Nerves – entering and leaving the lungs

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Lower margin
of the left
hilum is at the
level of upper
margin of
right hilum

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Pulmonary Vasculature

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PULMONARY VASCULATURE

 The vessels taper from center to the periphery

 More blood flow is seen in the vessels at the base

of the lung than those at the apex - this is due to

gravity
 No vessels in 3.0 cm from apices

 No vessels in 1.5 cm from pleura

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PULMONARY VASCULATURE

No vessels in 3.0 cm
from apices

No vessels in 1.5 cm
from pleura

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Transverse Fissure
Runs from the
anterior
border of the
lung along the
fourth costal
cartilage to
the oblique
fissure

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 Radioanatomy of Heart
and great vessels
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Pericardium and Pericardial Cavity

 Pericardium is a fibroserous sac which encloses the

heart and roots of great vessels
 Fibrous pericardium

 Serous pericardium – parietal and visceral layers

 Pericardial space – potential space between

parietal and visceral layers

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ANATOMY OF HEART

 Heart is a four chambered organ located in the

thoracic cavity
 Heart is located in the middle mediastinum

 Pumps blood to various parts of the body for

nutritional and respiratory requirements

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ANATOMY OF HEART

4 chambers – right atrium,

right ventricle, left atrium,
left ventricle
 Great vessels – SVC, IVC
and pulmonary arteries ,
pulmonary veins and aorta
 4 valves – tricuspid,
pulmonary, bicuspid and
aortic

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Plain X-Ray Of Heart And Great
Vessels

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 Chest X-Ray - PA VIEW

 RIGHT – Superior Vena Cava and Right Atrium

 LEFT – Arch of Aorta, Pulmonary Artery, Left Atrial
Appendage and Left Ventricle 60
Chest X-Ray –Lateral View

 Anterior border – right ventricle and outflow tract

 Posterior superior – left atrium
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 Posterior inferior – left ventricle
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POSTEROANTERIOR VIEW LATERAL
CT Scan Of Heart And Great Vessels

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 Left Common
Superior vena Brachiocephalic carotid artery
cava trunk

Trachea
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Esophagus Left Subclavian
artery
 Superior vena cava Left Brachiocephalic Vein crossing
over to the right to join the right
Braciocephalic vein to form the SVC

Azygous
vein

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Arch of aorta

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 Pulmonary
Aortic sac trunk

Superior vena
cava

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Descending aorta
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Right pulmonary Pulmonary trunk
artery

Left
pulmonary
artery

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 Aortic sac Pulmonary
trunk

Right
atrium

Left
atrium

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Descending aorta
Four chamber view

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Coronary Circulation

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Coronary Circulation

 Heart is supplied by two coronary arteries arising

from the ascending aorta
 Right coronary artery arises from the right aortic

sinus
 Branches – marginal and posterior descending

 Terminates by anastomosing with left coronary

artery

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Coronary Circulation

 Left coronary artery arises from left aortic sinus

 Branches – left anterior descending and left

circumflex artery

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Coronary Circulation

 Great, middle and small cardiac veins

 Posterior vein of left ventricle

 Oblique vein of left atrium

 Right marginal vein

 Anterior cardiac vein and venae cordis minimae

 Most of these drain in the coronary sinus which

opens directly into the right atrium

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Conventional Coronary Angiography

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CONVENTIONAL ANGIOGRAPHY

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CT Coronary Angiography with 2D
and 3D Reconstructions

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Left Circumflex and Posterior
Descending Arteries

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Branches of Left Coronary Artery
on 3D reconstruction

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Aorta

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Parts of the aorta
 Ascending aorta
 Arch of the aorta

 Descending aorta – thoracic aorta

 Thisis not a physical separation as all the

three portions are continuous with each other

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Branches of ascending aorta
 Arise near the aortic root
1.Right coronary artery
2.Left coronary artery

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Branches of the arch of the aorta
 Brachiocephalic artery
1.Right subclavian
2.Right common carotid artery
 Left common carotid artery
 Left subclavian artery

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Branches of thoracic aorta
 The aorta gives off several paired branches as
it descends in the thorax. These include the
 Bronchial arteries

 Esophageal arteries

 Posterior intercostal arteries

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Aorta on Plain X-Ray

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Aorta on Angiogram

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Ascending
Aorta with its
branches

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Branches of Aortic Arch

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Branches of the
Brachiocephalic
artery

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Left common carotid artery

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Subclavian
Arteries

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Branches of Subclavian
Arteries

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Aorta and Aortic Valve on CT Scan

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Brachiocephalic vein

Right and left

Internal jugular
veins join with
the right and left
subclavian veins
respectively to
form the
brachiocephalic
vein

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Left
brachiocephalic
vein crosses to
join right
brachiocephalic
vein to form the
superior vena
cava

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Superior Vena
Cava

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Azygos Vein
draining
into the
SVC

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SVC
draining in
the Right
Atrium

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Pulmonary Arteries

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Pulmonary
Veins

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