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 !
RADIOANATOMY OF LUNGS AND HEART
IMAGING MODALITIES Plain X-Ray ! CT Scan ! MRI ! Ultrasound ! Nuclear Medicine !
CHEST RADIOGRAPHS - VIEWS REQUIRED !
!
Most commonly done 1.
Posteroanterior view
2.
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
LUNGS !
Two lungs situated in the thoracic cavity 1. 2.
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
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
TRANSVERSE FISSURE
• 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
FISSURES Runs from the anterior border of the lung along the fourth costal cartilage to the oblique fissure
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.
Upper
2.
Middle Lower
3. !
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
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 the pleural surface ! Each segment is supplied by its own segmental bronchi !
1.
Apical
2.
Posterior Anterior
3.
SEGMENTS OF RIGHT MIDDLE LOBE 1. 2.
SEGMENTS OF THE RIGHT LOWER LOBE
Lateral Medial
1. 2. 3. 4. 5.
Superior Medial-basal Anterior-basal Lateral-basal 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. 2.
Inferior lingular Superior lingular
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)
3. Anterior segmental bronchus – RUL and LUL
Li – lingular bronchus
6. Superior segmental bronchus (LLL)
7. Medial basal segmental bronchus
Li – Lingular segmental bronchus (LUL)
8. Anterior basal segmental bronchus 9.Lateral basal segmental bronchus 10. Posterior segmental bronchus
Right middle lobe segmental bronchi
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.
Lower margin of the left hilum is at the level of upper margin of right hilum
Mainstem bronchus
Pulmonary vessels (one artery and two veins) Bronchial vessels 4. Lymph vessels 5. Nerves – entering and leaving the lungs 2. 3.
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
No vessels in 1.5 cm from pleura
TRANSVERSE FISSURE Runs from the anterior border of the lung along the fourth costal cartilage to the oblique fissure
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, right ventricle, left atrium, left ventricle ! Great vessels – SVC, IVC and pulmonary arteries , pulmonary veins and aorta ! 4 valves – tricuspid, pulmonary, bicuspid and aortic
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 !
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
Superior vena cava
LATERAL VIEW
Brachiocephalic trunk
Left Common carotid artery
CT SCAN OF HEART AND GREAT VESSELS
Trachea Esophagus
Superior vena cava
Azygous vein
Left Brachiocephalic Vein crossing over to the right to join the right Braciocephalic vein to form the SVC
Left Subclavian artery
Arch of aorta
Aortic sac
Pulmonary trunk
Superior vena cava
Descending aorta
Right pulmonary artery
Aortic sac
Pulmonary trunk
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 !
Arise near the aortic root
BRANCHES OF THE ARCH OF THE AORTA !
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 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
SUPERIOR VENA CAVA
LEFT
BRACHIOCEPHALIC VEIN CROSSES TO JOIN RIGHT BRACHIOCEPHALIC VEIN TO FORM THE SUPERIOR VENA CAVA
Azygos Vein draining into the SVC
PULMONARY ARTERIES
SVC draining in the Right Atrium
PULMONARY VEINS
RADIOANATOMY OF LUNGS AND HEART
IMAGING MODALITIES Plain X-Ray ! CT Scan ! MRI ! Ultrasound ! Nuclear Medicine !
CHEST RADIOGRAPHS - VIEWS REQUIRED !
!
Most commonly done 1.
Posteroanterior view
2.
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
LUNGS !
Two lungs situated in the thoracic cavity 1. 2.
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
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
TRANSVERSE FISSURE
• 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
FISSURES Runs from the anterior border of the lung along the fourth costal cartilage to the oblique fissure
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.
Upper
2.
Middle Lower
3. !
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
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 the pleural surface ! Each segment is supplied by its own segmental bronchi !
1.
Apical
2.
Posterior Anterior
3.
SEGMENTS OF RIGHT MIDDLE LOBE 1. 2.
SEGMENTS OF THE RIGHT LOWER LOBE
Lateral Medial
1. 2. 3. 4. 5.
Superior Medial-basal Anterior-basal Lateral-basal 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. 2.
Inferior lingular Superior lingular
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)
3. Anterior segmental bronchus – RUL and LUL
Li – lingular bronchus
6. Superior segmental bronchus (LLL)
7. Medial basal segmental bronchus
Li – Lingular segmental bronchus (LUL)
8. Anterior basal segmental bronchus 9.Lateral basal segmental bronchus 10. Posterior segmental bronchus
Right middle lobe segmental bronchi
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.
Lower margin of the left hilum is at the level of upper margin of right hilum
Mainstem bronchus
Pulmonary vessels (one artery and two veins) Bronchial vessels 4. Lymph vessels 5. Nerves – entering and leaving the lungs 2. 3.
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
No vessels in 1.5 cm from pleura
TRANSVERSE FISSURE Runs from the anterior border of the lung along the fourth costal cartilage to the oblique fissure
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, right ventricle, left atrium, left ventricle ! Great vessels – SVC, IVC and pulmonary arteries , pulmonary veins and aorta ! 4 valves – tricuspid, pulmonary, bicuspid and aortic
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 !
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
Superior vena cava
LATERAL VIEW
Brachiocephalic trunk
Left Common carotid artery
CT SCAN OF HEART AND GREAT VESSELS
Trachea Esophagus
Superior vena cava
Azygous vein
Left Brachiocephalic Vein crossing over to the right to join the right Braciocephalic vein to form the SVC
Left Subclavian artery
Arch of aorta
Aortic sac
Pulmonary trunk
Superior vena cava
Descending aorta
Right pulmonary artery
Aortic sac
Pulmonary trunk
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 !
Arise near the aortic root
BRANCHES OF THE ARCH OF THE AORTA !
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 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
SUPERIOR VENA CAVA
LEFT
BRACHIOCEPHALIC VEIN CROSSES TO JOIN RIGHT BRACHIOCEPHALIC VEIN TO FORM THE SUPERIOR VENA CAVA
Azygos Vein draining into the SVC
PULMONARY ARTERIES
SVC draining in the Right Atrium
PULMONARY VEINS
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