thorax david s. hartman, m.d. department of radiology

Thorax

David S. Hartman, M.D.Department of Radiology

Learning Objectives:

Identify all objects indicated by

arrows on the radiolgical images

in this presentation

Cases in MDL

\\hersheymed.net\files\MMS\Public\education\radiology\lab-thorax-8-2007.pps

Cases can be viewed by any computer in the institution

PA and Lateral Chest

Radiograph

Heart Chambers

Most anterior

Most posterior

Right boarder

Left boarder

Right ventricle

Left atrium

Right atrium

Left atrium/ ventricle

Most superior Left atrium

Heart from the Front

Left atrium

Left ventricle

Pulmonary artery

Aorta

RightAtrium

RightVentricle

204

RightAtrium

Right ventricle

Left atriumVentricle

201

RightAtrium

Left AtriumVent-ricle

Aortic arch

Main pulmonary artery

Left atrium, ventricle

Trachea

Clavicles

Cardiophrenic angles

Costophrenic angles

Hilum (pleural: hila)

1. Root of the lung

2. Pulmonary artery

3. Upper lobe pul vein

4. Bronchus

5. (Lymph nodes)

Right hilum

Left hilum

Right ventricle

Left atrium

Left ventricle

Cardiophrenic angle

Costophrenic angle

LeftDiaphragm

219

Right ventricle

Left atrium left ventricle

Diaphragm

Cardiophrenic angle

Costophrenic angles

Trachea

Thoracic spine

Pulmonary

Arteriogram

Pulmonary Arteries

1. Main PA (pulmonary trunk) off right ventricle (anterior)

2. Right main PA longer than left main PA and runs horizontaly superior to left atrium

3. Left main PA is short and runs over left main stem bronchus

Right main PA

RA

RV LV

Main PA(trunk)

Left main PA

194

Aorta

LA

Catheter

in main PA

Right main pulmonary artery

Left inferior

pulmonary

artery

Arch Aortogram

Ascending aorta

Aortic arch

Descending aorta

Brachiocephalic art

Left common carotid art

Left subclavian art

225Aortic Arch

R L

Aortic arch

Brachiocephalic art

Left common carotid art

Left subclavian artery

Arch Aortogram

CT of the Heart and Mediastinum

(axial images)

Axial section

LeftRight

View as though facing the patient

LeftRight

By convention we look from below

Posterior

Anterior

Axial CT image with contrast

Liver

Heart

Lung

Right

Sternum

Scapula

SpineRibs

Vascular Arch

Vascular Arch

Vascular Arch

Vascular Arch

3 Vascular Arches

1. Aorta

2. Left pulmonary

artery

3. Azygos vein

Pulmonary artery,vein

Left main bronchus

Right main bronchus

Arch Structure below arch

The brachocephalic vein runs anterior to the

branches of the aorta

195

Frontal of the brachiocephalic vein and aortic arch

Aortic arch

Brachiocephalic artery

Left common carotid artery

Right brachio-cephalic vein

Left brachio-cephalic vein

Superior vena cava

Trachea

195

The trachea is just ventral to the esophagus

Trachea

Brachiocephalic artery

Left common carotid artery

Left subclavian artery

Esophagus

196Branches of the aorta

195

Origin of the great vessels above the aortic arch

Right

Origin of the great vessels above the aortic arch

Right

Left brachio-cephalic vein

Right brachio-cephalic vein

Brachiocephalic artery

Left common carotid artery

Left subclavian artery

Tracheal area

Esophagus

The azygos arch

passes over the

right main-stem

bronchus

RIGHTDIAPHRAGM

Superior vena cava

Right atrium

Right ventricle

Inferior vena cava

208

Superior vena cava

Azygos arch

Right bronchus

Right main pulmonary art

Right pulmonary veins

Right atrium

Azygos vein

208

195

Level of the aortic arch

Level of the aortic arch

Aortic arch

Superior vena cava

Trachea

Azygos arch

Esophagus

Vertebra

Level of the aortic arch

The left pulmonary

artery passes

over the left

main-stem bronchus

Aortic arch

Left main pulmonary art

Left atrium

Left ventricleLEFT

DIAPHRAGM

219

Aorta

Left main pulmonary artery

Left mainstem bronchus

Left pulmonary veins

Left atrium

219

Level below the aortic arch (top of the left pulmonary artery

SVC

PULMONARY ARTERY

ASCENDINGAORTA

201

Level below the aortic arch (top of the left pulmonary artery

Level below the aortic arch (top of the left pulmonary artery

Ascending aorta

Main pulmonary artery

Superior vena cava

Right pul art

Right bronchus

Left bronchus

Top of left pulmonary artery

Descending aorta

Azygos vein

BACK WALLOF BRONCHUS

Pulmonary artery

AscendingAorta

201

Top of the right atrium

Level at the root of the aorta and main pulmonary artery

Ascending aorta

Main pulmonary artery

Right atrium

Rt pulmonary artery

Right bronchus

Left bronchus

Lt lower lobe PA

Descending aorta

Azygos veinBack of the

left bronchus

The pulmonary trunk

is anterior to

the aorta root

The arota arises

from “center”

of heart

Heart from the Front

RightAtrium

RightVentricle

204

Aorta

Pulmonary artery

Left ventricle

Left atrium

RightAtrium

Right ventricle

Left Ventricle

201

Level at the top of the ventricles

Level at the top of the ventricles

Right ventricle

Right atrium

Ascending aorta

Left ventricle

Left atrium

Descending aorta

Azygos vein

Level at the top of the ventricles

Heart Chambers

Most anterior

Most posterior

Right boarder

Left boarder

Right ventricle

Left atrium

Right atrium

Left atrium/ ventricle

Most superior Left atrium

Right ventricle

Right atrium

Left ventricle

Left atrium

Pulmonary veins

Descending aorta

Azygos vein

230Level through all 4 heart chambers

RightAtrium

Right ventricle

Left Ventricle

201

Level through all 4 heart chambers

Right ventricle

Right atrium

Left ventricle

Left atrium

Aorta

Azygos vein

RightAtrium

Right ventricle

Left Ventricle

201

Level at the bottom of the heart (below left atrium)

Level at the bottom of the heart (below left atrium)

Right ventricle

Inferior vena cava

Left ventricle

Aorta

Azygos vein

Level at the bottom of the heart (below left atrium)

Follow a drop of bloodfrom the left arm

to the head

X

TO THE LEFT BRACIOCEPHALIC VEIN

X

INTO THE SVC

X

SVC

X

SVC

X

SVC

X

SVC

X

SVC

X

SVC

X

SVC

X

SVC

X

TOP OF THE RA

X

RA

X

RA

X

INTO THE RV

X

RV

X

RV

X

RV

X

RV

X

RV

X

RV

X

RV

X

RV OUTFLOW

X

RV OUTFLOW

X

RV INTO MAIN PA

X

MAIN PA

X

RT AND LT PA’S

X

X

RT AND LT PA’S

X

FROM LUNG TO LA

X

LA

X

LV

XXX

LV TO OUTFLOW

X

INTO ASCENDING AORTA

X

ASCENDING AORTA

X

ASCENDING AORTA

X

ASCENDING AORTA

X

INTO AORTIC ARCH

X

AORTIC ARCH

X

AORTIC ARCH

X

INTO BRACHIOCEPHALIC ARTERY

XX

INTO THE CAROTIDS

Thorax

David S. Hartman, M.D.Department of Radiology