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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
RADIOANATOMY OF ! To know the pulmonary vasculature

LUNGS AND HEART ! To know the chambers of the heart

! To know the great vessels

IMAGING MODALITIES CHEST RADIOGRAPHS - VIEWS REQUIRED


! Plain X-Ray
! Most commonly done
1. Posteroanterior view
! CT Scan
2. Lateral view
! MRI
! Others
! Ultrasound
1. Lordotic view – to look at the apical segment
! Nuclear Medicine
2. Right anterior oblique view
3. Left anterior oblique view
4. Anteroposterior view
5. Decubitus view

POSTEROANTERIOR VIEW OF CHEST

RADIOANATOMY OF LUNGS
LATERAL VIEW 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

OBLIQUE FISSURES OBLIQUE FISSURES


Indicated by a line
that runs from the
spinous process of
T2 vertebra around • Indicated by a line
the thorax to the that runs from the
sixth costochondral
junction spinous process of T2
Similar on both sides vertebra around the
4. Right Oblique thorax to the sixth
Fissure costochondral
10. Left Oblique junction
Fissure
• Similar on both
sides

TRANSVERSE FISSURE FISSURES


Oblique Fissure - Indicated by
Runs from the a line that runs from the
anterior border spinous process of T2 vertebra
of the lung around the thorax to the sixth
along the fourth costochondral junction
costal cartilage
to the oblique
fissure 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. 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

RIGHT MIDDLE LOBE RIGHT LOWER LOBE


LEFT UPPER LOBE WITH LINGULA LEFT UPPER LOBE

LEFT LOWER LOBE BRONCHOPULMONARY SEGMENTS

BRONCHOPULMONARY SEGMENTS SEGMENTS OF THE RIGHT UPPER LOBE


! Each segment is pyramidal in shape with the
apex facing the root of the lung and the base on 1. Apical
the pleural surface 2. Posterior
! Each segment is supplied by its own segmental 3. Anterior
bronchi
SEGMENTS OF RIGHT MIDDLE LOBE SEGMENTS OF THE RIGHT LOWER LOBE
1. Lateral 1. Superior
2. Medial 2. Medial-basal
3. Anterior-basal
4. Lateral-basal
5. Posterior-basal

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

SEGMENTS OF THE LEFT LOWER LOBE


1. Superior
2. Anteromedial basal (merger of "anterior basal" and 1. Cardiac Bronchus
"medial basal") (normal variation)
2. Right Middle Lobe
3. Posterior basal 3. Right Main Bronchus
4. Anterior basal 4. Right Oblique Fissure
5. Right Lower Lobe
5. Lateral basal 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 AND BRONCHI
! Trachea – begins at the level of C6 vertebra and
extends to the carina at the level of T4-T5 •Angle of Carina
! Right bronchus – 2.5 cm in length and straight – (angle between the
more prone to infection two main stem
! Left bronchus – 5 cm in length and slightly bronchi
slanting – protected due to obliquity
•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)
Right middle
4. Lateral segmental bronchus (RML)
lobe segmental
5. Medial segmental bronchus (RML) bronchi

3. Anterior segmental bronchus – RUL and LUL Li – lingular bronchus


7. Medial basal segmental bronchus
6. Superior segmental bronchus (LLL)
Lower lobe
8. Anterior basal segmental bronchus
Li – Lingular segmental bronchus (LUL) segmental
9.Lateral basal segmental bronchus bronchi
10. Posterior segmental bronchus
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
HILA
! Left Lung

! Left Main Bronchus


STRUCTURES PRESENT IN THE HILUM
! This is where the root is attached to the lung
! It contains
1. Mainstem bronchus Lower margin
2. Pulmonary vessels (one artery and two veins) of the left
3. Bronchial vessels hilum is at the
4. Lymph vessels level of upper
5. Nerves – entering and leaving the lungs 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
PULMONARY VASCULATURE
! No vessels in 1.5 cm from pleura

PULMONARY VASCULATURE TRANSVERSE FISSURE


Runs from the
No vessels in 3.0 cm anterior border
from apices of the lung
along the fourth
costal cartilage
to the oblique
No vessels in 1.5 cm fissure
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 chambers – right atrium,


! Heart is a four chambered organ located in the thoracic right ventricle, left atrium,
cavity left ventricle
! Heart is located in the middle mediastinum ! Great vessels – SVC, IVC and

! Pumps blood to various parts of the body for nutritional pulmonary arteries ,
and respiratory requirements
pulmonary veins and aorta
! 4 valves – tricuspid,
pulmonary, bicuspid and
aortic

PLAIN X-RAY OF HEART AND GREAT


CHEST X-RAY - PA VIEW
VESSELS

! 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

Left Common
Superior vena Brachiocephalic carotid artery
cava trunk

CT SCAN OF HEART AND GREAT


VESSELS

Trachea
Esophagus Left Subclavian
artery

Superior vena cava Left Brachiocephalic Vein crossing over Arch of aorta
to the right to join the right
Braciocephalic vein to form the SVC

Azygous
vein
Pulmonary
Aortic sac trunk

Superior vena
cava

Descending aorta

Aortic sac Pulmonary


Right pulmonary Pulmonary trunk trunk
artery

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


CORONARY CIRCULATION ! Terminates by anastomosing with left coronary artery
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
CONVENTIONAL CORONARY
! Right marginal vein
ANGIOGRAPHY
! Anterior cardiac vein and venae cordis minimae

! Most of these drain in the coronary sinus which opens


directly into the right atrium

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 ! Brachiocephalic artery
1. Right coronary artery 1. Right subclavian
2. Left coronary artery 2. Right common carotid artery
! Left common carotid artery
! Left subclavian artery

BRANCHES OF THORACIC AORTA AORTA ON PLAIN X-RAY


! 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 ANGIOGRAM

Ascending Aorta
with its
branches
BRANCHES OF AORTIC ARCH

LEFT COMMON CAROTID ARTERY

BRANCHES OF THE
BRACHIOCEPHALIC
ARTERY

SUBCLAVIAN BRANCHES OF SUBCLAVIAN


ARTERIES
ARTERIES
AORTA AND AORTIC VALVE ON CT
SCAN
BRACHIOCEPHALIC VEIN

Right and left


Internal jugular LEFT
veins join with the BRACHIOCEPHALIC
right and left VEIN CROSSES TO
JOIN RIGHT
subclavian veins BRACHIOCEPHALIC
respectively to VEIN TO FORM THE
form the SUPERIOR VENA
brachiocephalic CAVA
vein

SUPERIOR VENA
CAVA
Azygos Vein
draining into
the SVC

PULMONARY ARTERIES

SVC draining
in the Right
Atrium

PULMONARY
VEINS