orientation: viewing heart in axial ct and mri - zill...
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ORIENTATION: VIEWING HEARTIN AXIAL CT AND MRI
Orientation of heartin axial CTand MRI
20 MINUTE ANATOMY VIDEOS
No sinner is ever saved after the first twenty minutes of a sermon - Mark Twain
RV
RALV
LA
4 CHAMBERED HEART
5 CHAMBERED HEART?
INVERTED Y SHAPE?
ORIENTATION: THORACIC CONTENTS ANTERIOR VIEW
R L
EsophagusTrachea
Subclavian V.
Left Int. Jugular V.
AORTA
PulmonaryTrunk
Structuresat Rootof Lung
diaphragm
R. Brachiocephalic V.
Sup. Vena Cava
POSTERIOR VIEWINCLUDINGTRACHEA,ESOPHAGUS
3) PulmonaryVeins
1) Arch of Aorta
2) PulmonaryArteries
2a) Trachea(bifurcation)
Esophagus,Thoracic duct
IVCdiaphragm
L R
Ordersimilarto root ofLung
HEART IS ON LEFT: REASON: ROTATED SO LEFT ATRIUM IS IN MIDLINE
Left Atrium - receives Pulmonary Veins symmetrically from both sides
LeftPulmonaryVeins
Right PulmonaryVeinsRV
LA
Right Ventricle -anterior
POSTERIOR VIEW: KNOW SEQUENCE
PulmonaryVeins 3) Pulmonary
Veins
1) Arch of Aorta
2) PulmonaryArteries
SVC
IVC
ANTERIOR VIEWAT TOP (SUPERIORLY) - VEIN IN FRONT OF ARTERIES
Arch of Aorta
Left Brachiocephalic Vein
SVC
Right Brachiocephalic Vein
Left Common Carotid ALeft Subclavian A
Brachiocephalic Trunk
ANTERIORVIEW
Reason: Allvenous blooddrains to RightAtrium
RV
Arch of AortaAscending
Aorta PulmonaryTrunk - fromConusArteriosus
ANTERIOR VIEWPULMONARY TRUNK - arises from Right Ventricle;
crosses anterior to Ascending Aorta; then branches
PULMONARYTRUNKON LEFTIN AXIALSECTIONS
RV
RA
LV
LA
CONUS ARTERIOSUSEXTENDS TOWARDLEFT; THENPULMONARY TRUNKBIFURCATES
YConus Arteriosus
POSTERIOR VIEW: KNOW SEQUENCE
PulmonaryVeins 3) Pulmonary
Veins
1) Arch of Aorta
2) PulmonaryArteries
SVC
IVCL R
Diaphragm Inferior vena cava
Esophagus
Azygous vein Thoracic (descending) aorta
Muscles of ventricles
R L
START ATDIAPHRAGM
Inferior vena cava
Interventricular septum
Azygous vein
Esophagus
Thoracic (descending) aorta
Left ventricle
Right ventricle
2 CHAMBERED HEART - ventricles onlyR L
Thoracic (descending) aortaEsophagus
Left ventricle
Right ventricle
4 CHAMBERED HEART!
Left atrium
Right atrium
R L
Left ventricle
Left pulmonary veinThoracic (descending) aorta
Azygous vein
Right atrium
Right ventricle
Right pulmonary vein Left atrioventricular
orifice
Right atrioventricular orifice
Interventricular septum
4 CHAMBERED HEART!R L
LALeft atrium
Left pulmonary veinRight pulmonary vein Azygous veinEsophagus
Thoracic (descending) aorta5 CHAMBERED HEART?
Left atrium
Right atrium
Left ventricle
Right ventricle* - AORTA - arisingfrom Vestibule
R L
Left main bronchus
Superior vena cava Ascending aorta
Azygous vein
RIGHT VENTRICLE EXTENDS TO LEFT
Right ventricle
RV
R L
Left pulmonary artery
Right pulmonary
artery
Carina at tracheal bifurcation Thoracic (descending) aorta
Ascending aorta
Superior vena cava
PULMONARY TRUNK BRANCHES
YY
Right ventricle to Pulmonary Trunk
R L
Left brachiocephalic vein
TracheaEsophagus
Left common carotid
Right lung
Right brachiocephalic vein
Left subclavian artery
Brachiocephalic trunk
LEFT BRACHIOCEPHALIC VEIN CROSSES ANTERIORLY
R L
Summary - Orientation of heart in CT and MRI is complex; rarely appears to have 4 chambers.
1. Position and Orientation of heart - Heart is rotated and tilted so Right Ventricle is anterior and inferior; this makes functional sense; as a result, Left Atrium is located in midline and receives blood symmetrically from Pulmonary Veins (low pressure).
2. Sequence of Structures Inferior to Superior - Pulmonary Veins, Pulmonary artery, Arch of Aorta.
3. Pulmonary artery - arises from Conus arteriosus (Infundibulum) of Right Ventricle; ascends toward left and crosses anterior to Aorta; Pulmonary artery then bifurcates (appears Y shaped in axial CT and MRI).
4. Aorta - arises from Left Ventricle and first courses in middle of heart (Heart appears to have 5 chambers in axial CT and MRI at this level).
5. Order of Structures in Superior Mediastinum - Veins (R and L Brachiocephalic) are anterior to Arteries (Brachiocephalic, L Common Carotid, L Subclavian) arising from Arch of Aorta.
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