Radio Anatomy Of Lungs And Heart

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OBJECTIVES 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 0

IMAGING MODALITIES Plain X-Ray 0 CT Scan 0 MRI 0 Ultrasound 0 Nuclear Medicine 0

CHEST RADIOGRAPHS - VIEWS REQUIRED 0

Most commonly done  

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Posteroanterior view Lateral view

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

Separated from each other by middle mediastinum containing the heart and great vessels 0 Lobes 0

 

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   

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Upper Middle Lower

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 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 0

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

Apical Posterior Anterior

SEGMENTS OF RIGHT MIDDLE LOBE 1. 2.

Lateral Medial

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

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

SEGMENTS OF THE LEFT UPPER LOBE 0

Superior lobe 1. 2.

0

Apico-posterior (merger of "apical" and "posterior") Anterior

Lingula of superior lobe ± 1. 2.

Inferior lingular Superior lingular

SEGMENTS OF THE LEFT LOWER LOBE 1. 2. b. 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 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 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 0

TRACHEA AND BRONCHI ²Angle of Carina (angle between the two main stem bronchi ²Should be less than 60 degrees

BRONCHOGRAPHY

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CORONAL RECONSTRUCTION OF LUNGS AND TRACHEA

bD CORONAL RECONSTRUCTION OF LUNGS AND TRACHEA 0 Right Main Bronchus Right Upper Lobe Bronchus 0 Right Lung 0 Right Lower Lobe Bronchus 0 Trachea 0 Left Lung 0 Left Main Bronchus 0

HILA

STRUCTURES PRESENT IN THE HILUM This is where the root is attached to the lung 0 It contains 0

    

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 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 0

PULMONARY VASCULATURE ,$  -

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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 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 0

ANATOMY OF HEART

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 0

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

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

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CT SCAN OF HEART AND GREAT VESSELS

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FOUR CHAMBER VIEW

CORONARY CIRCULATION

CORONARY CIRCULATION 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 0

CORONARY CIRCULATION Left coronary artery arises from left aortic sinus 0 Branches ± left anterior descending and left circumflex artery 0

CORONARY CIRCULATION 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 0

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 Ascending aorta 0 Arch of the aorta 0 Descending aorta ± thoracic aorta 0

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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

Left common carotid artery 0 Left subclavian artery 0

BRANCHES OF THORACIC AORTA 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 0

AORTA ON PLAIN X-RAY

AORTA ON ANGIOGRAM

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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

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SUPERIOR VENA CAVA

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PULMONARY ARTERIES

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