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
!

RADIOANATOMY OF LUNGS AND HEART

IMAGING MODALITIES
Plain X-Ray ! CT Scan ! MRI ! Ultrasound ! Nuclear Medicine
!

CHEST RADIOGRAPHS - VIEWS REQUIRED
!

Most commonly done
1. 2.

Posteroanterior view Lateral view

!

Others
Lordotic view – to look at the apical segment Right anterior oblique view 3. Left anterior oblique view 4. Anteroposterior view 5. Decubitus view
1. 2.

POSTEROANTERIOR VIEW OF CHEST

RADIOANATOMY OF LUNGS

LATERAL VIEW
! 1. 2. !

LUNGS
Two lungs situated in the thoracic cavity
Right Left

Separated from each other by middle mediastinum containing the heart and great vessels ! Lobes
3 lobes in the right separated by major and minor fissures 2. 2 lobes in the left separated by major fissure
1.

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

• 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

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
!

RIGHT UPPER LOBE

Right
1. 2. 3.

Upper Middle Lower

!

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

RIGHT MIDDLE LOBE

RIGHT LOWER LOBE

LEFT UPPER LOBE WITH LINGULA

LEFT UPPER LOBE

LEFT LOWER LOBE

BRONCHOPULMONARY SEGMENTS

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
!

SEGMENTS OF THE RIGHT UPPER LOBE
1. 2. 3.

Apical Posterior Anterior

SEGMENTS OF RIGHT MIDDLE LOBE
1. 2.

SEGMENTS OF THE RIGHT LOWER LOBE
1. 2. 3. 4. 5.

Lateral Medial

Superior Medial-basal Anterior-basal Lateral-basal Posterior-basal

SEGMENTS OF THE LEFT UPPER LOBE
!

Superior lobe
1. 2.

Apico-posterior (merger of "apical" and "posterior") Anterior Inferior lingular Superior lingular

!

Lingula of superior lobe –
1. 2.

SEGMENTS OF THE LEFT LOWER LOBE
1. 2. 3. 4. 5.

Superior Anteromedial basal (merger of "anterior basal" and "medial basal") Posterior basal Anterior basal Lateral basal

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

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
!

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

BRONCHOGRAPHY

2. Posterior segmental bronchus (RUL) 1+2 – apicoposterior segmental bronchus (LUL) 1. Apical segmental bronchus 3. Anterior segmental bronchus (RUL)

4. Lateral segmental bronchus (RML) 5. Medial segmental bronchus (RML)

Right middle lobe segmental bronchi

3. Anterior segmental bronchus – RUL and LUL 6. Superior segmental bronchus (LLL) Li – Lingular segmental bronchus (LUL)

Li – lingular bronchus 7. Medial basal segmental bronchus 8. Anterior basal segmental bronchus 9.Lateral basal segmental bronchus 10. Posterior segmental bronchus Lower lobe segmental bronchi

CORONAL RECONSTRUCTION OF LUNGS AND TRACHEA

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
!

HILA

STRUCTURES PRESENT IN THE HILUM
! !

This is where the root is attached to the lung It contains
1. 2. 3.

Mainstem bronchus

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

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

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
! !

PULMONARY VASCULATURE

PULMONARY VASCULATURE
No vessels in 3.0 cm from apices

TRANSVERSE FISSURE
Runs from the anterior border of the lung along the fourth costal cartilage to the oblique fissure

No vessels in 1.5 cm from pleura

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
!

RADIOANATOMY OF HEART
AND GREAT VESSELS

ANATOMY OF HEART

ANATOMY OF HEART
!4

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
!

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

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

! ! !

Anterior border – right ventricle and outflow tract Posterior superior – left atrium Posterior inferior – left ventricle

POSTEROANTERIOR VIEW

LATERAL VIEW

Superior vena cava

Brachiocephalic trunk

Left Common carotid artery

CT SCAN OF HEART AND GREAT VESSELS

Trachea 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

Arch of aorta

Azygous vein

Aortic sac

Pulmonary trunk

Superior vena cava

Descending aorta

Right pulmonary artery

Pulmonary trunk

Aortic sac

Pulmonary trunk

Right atrium

Left pulmonary artery
Left atrium

Descending aorta

FOUR CHAMBER VIEW

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
!

CORONARY CIRCULATION

CORONARY CIRCULATION
! !

Left coronary artery arises from left aortic sinus Branches – left anterior descending and left circumflex artery

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
! !

CONVENTIONAL CORONARY ANGIOGRAPHY

CONVENTIONAL ANGIOGRAPHY

LEFT CIRCUMFLEX AND POSTERIOR DESCENDING ARTERIES

CT CORONARY ANGIOGRAPHY WITH 2D AND 3D RECONSTRUCTIONS

BRANCHES OF LEFT CORONARY ARTERY ON 3D RECONSTRUCTION

PARTS OF THE AORTA
Ascending aorta Arch of the aorta ! Descending aorta – thoracic aorta
! !

AORTA

!

This is not a physical separation as all the three portions are continuous with each other

BRANCHES OF ASCENDING AORTA
!

BRANCHES OF THE ARCH OF THE AORTA
!

Arise near the aortic root
1. 2.

Brachiocephalic artery
1. 2.

Right coronary artery Left coronary artery
!

Right subclavian Right common carotid artery

Left common carotid artery ! Left subclavian artery

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
!

AORTA ON PLAIN X-RAY

AORTA ON ANGIOGRAM

Ascending Aorta with its branches

BRANCHES OF AORTIC ARCH

LEFT COMMON CAROTID ARTERY

BRANCHES OF THE BRACHIOCEPHALIC
ARTERY

SUBCLAVIAN ARTERIES

BRANCHES OF SUBCLAVIAN ARTERIES

AORTA AND AORTIC VALVE ON CT SCAN

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

LEFT

BRACHIOCEPHALIC VEIN CROSSES TO JOIN RIGHT BRACHIOCEPHALIC VEIN TO FORM THE SUPERIOR VENA CAVA

SUPERIOR VENA CAVA

Azygos Vein draining into the SVC

PULMONARY ARTERIES

SVC draining in the Right Atrium

PULMONARY VEINS

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