chest imaging and anatomy

8/23/2019 Chest Imaging and Anatomy

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Chest Imaging And Anatomy Overview Imaging Methods : ain ocus

Others: Computed Tomography, MRI, Ultrasound, Nuclear

Medicine

Approach to CXR

Densities

Anatomy and approach

Technical Factors

Other Imaging Methods

CXR-Will be discussed later

Computed Tomography

MRI Ultrasound

Mainly for procedures

Computed Tomography

protocols/techniques

depending on clinicalhistory

Helical/spiral versus high

Contrast

Renal failure

Allergy


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Computed Tomography

Main further investigation for

most CXR abnormality (eg

nodule/mass) or to exclude

disease with normal CXR

Main investigation for certain

scenar os , ssec on,trauma)


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MRI

Multiple planes

No radiation

Common Indication

Pancoast tumour Brachial plexus

Cardiac

Vascular (aorta)

Usually targeted

examination (unlike

CT)

Coronal


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Nuclear Medicine

Variety of tests: functional rather than anatomic V/Q specific to chest imaging

Others: bone scan, gallium, WBC etc.

Ultrasound

Limited use in thorax (non cardiac) due to air in lungs

Assess pleural effusions

Mainly used for procedures

Chest Radiographs

PA (posterior to anterior) and Lateral (left) Minimizes magnification of heart (heart closest to film)

Portable (nearly always AP) Supine or Erect

Specialized Views Lordotic

Lateral decubitus (for effusions, pneumothorax)


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Chest Radiograph: Approach and

Normal Anatomy

THERE IS NO ONE APPROACH: BE

SYSTEMATIC

Bone and Soft Tissue including abdomen

Heart

Mediastinum-aorta, trachea

Hila

Lungs

Pleura

Normal Anatomy

Bone-CT Reconstruction

PA View

Rib IntercostalSpace

VertebralColumn

Bone Anatomy

Sternum

Rib


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Heart Size Normal is


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Cardiac Anatomy: Right Sided ChambersCardiac Anatomy: Left Sided

Chambers

SVC Aortic Arch

Right Descending

Pulmonary Artery

Left Descending

Pulmonary Ater

Lungs posteriorly

should get darker as

you go down more

inferiorlyRetrosternal

Airspace

Scapula

IVC

um

Pulmonary

Vessels


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Airway Anatomy

Trachea

Cartilage

Membranous posteriorly

Carina

Bifurcation

Bronchus

Left and right

Lobar (RUL,RML,LUL,LLL)

egmenta e t, r g t

Trachea

R +L Main

Carina

Bronchi

Lung Anatomy

Lobes are separated by fissures

Right

Upper Lobe

Middle Lobe

Lower Lobe

Left

Upper Lobe (includes lingula)

Lower Lobe


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Pleura and Fissures

Pleura

u ricates an prevents riction uring respiration

Potential Space Dont see unless abnormal

Parietal pleura: Lines chest wall, mediastinal and

diaphragmatic surfaces

Visceral pleura: Lines lungs, fissures

Parietal Pleura

Visceral pleura

Diaphragms

Normal: Sharp costophrenic sulcus


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Which is right and left diaphragm?

Approach to Chest Radiograph:

Technical Factors

Patient Identification (name and date)

Markers (Left vs right)

Assess for rotation (clavicles vs spinous process)

Penetration (thoracic spine should be visible)

Degree of Inpiration: 6th anterior or 10th posterior

Clavicles

S inous Process

Vertebral Body

Visible

6

7

Counting anterior

ribs

10

11

Counting posterior ribs


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Inspiration/Expiration Images

xp rat on

Heart size appear larger

Mediastinum is wider

Pulmonary vasculature indistinct

4th Anterior

8th Posterior

Expiration Image

Inspiration: Same PatientExpiration

chest imaging and anatomy

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