radio anatomy of lungs and heart
TRANSCRIPT
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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 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
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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
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 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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• 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
OBLIQUE FISSURES
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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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FISSURES
Transverse Fissure - 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
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OBLIQUE FISSURES
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LUNG PARENCHYMA
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LOBES OF THE LUNGS
Right Upper Middle Lower
Left Upper 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 bronchus
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2. Posterior segmental bronchus (RUL)
1+2 – apicoposterior segmental bronchus (LUL)
3. Anterior segmental bronchus (RUL)
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3. Anterior segmental bronchus – RUL and LUL
6. Superior segmental bronchus (LLL)
Li – Lingular segmental bronchus (LUL)
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4. Lateral segmental bronchus (RML)
5. Medial segmental bronchus (RML)
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
Right middle lobe segmental bronchi
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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
Mainstem bronchus Pulmonary vessels (one artery and two veins) Bronchial vessels Lymph vessels 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
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CHEST X-RAY –LATERAL VIEW
Anterior border – right ventricle and outflow tract Posterior superior – left atrium Posterior inferior – left ventricle
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POSTEROANTERIOR VIEW LATERAL VIEW
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CT SCAN OF HEART AND GREAT VESSELS
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Superior vena cava
Brachiocephalic trunk
Left Common carotid artery
Left Subclavian artery
Trachea
Esophagus
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Azygous vein
Superior vena cava Left Brachiocephalic Vein crossing over to the right to join the right Braciocephalic vein to form the SVC
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Arch of aorta
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Aortic sac
Superior vena cava
Descending aorta
Pulmonary trunk
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Right pulmonary artery
Pulmonary trunk
Left pulmonary artery
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Left atrium
Right atrium
Aortic sac Pulmonary trunk
Descending aorta
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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
This is 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 Right coronary artery Left coronary artery
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BRANCHES OF THE ARCH OF THE AORTA
Brachiocephalic artery Right subclavian 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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