lecture 5 - thoracic imaging cross sectional imaging slides

7/31/2019 Lecture 5 - Thoracic Imaging Cross Sectional Imaging Slides

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Thoracic Imaging: Gross

ec ona mag ng o e es


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De artment of Radiolo

Vancouver General Hospital

Dr. Savvas Nicolaou

Director of ER/Trauma Radiology

[email protected]


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Objectives

Be able to identify the following mediastinal structures on Chest CT:

Esophagus

Trachea and bifurcation into right and left main bronchi

Pulmonary trunk and right and left pulmonary arteries

Thoracic aorta

Ascending

Arch

Descending

Sinus of valsava


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Objectives

Be able to identif the followin mediastinal structures on Chest CT:

Major branches of aorta

Brachiocephalic artery

Left common carotid artery

Left subclavian artery

Left and right subclavian and internal jugular veins

Left and right brachiocephalic veins

Superior and inferior vena cavae


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y v w


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LOOKING AT MEDIASTINUMLOOKING AT MEDIASTINUM

The mediastinum is the space betweenthe spine at the back, the sternum at the

front, and the lungs at the sides

It is divided into the superior and inferior

anterior, middle and posterior


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The Mediastinum


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Radiological DIVISIONSRadiological DIVISIONS OF THEOF THE

MEDIASTINUMMEDIASTINUM

Anterior

Middle

Posterior


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RADIOLOGY

THORACIC IMAGING

-


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RADIOLOGY

THORACIC IMAGING

Thymic massThymic mass in anteriorin anterior

-


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Anatomy Review

Esophagus


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Esophagus


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Anatomy Review

Trachea and bifurcation into right and left main bronchi At spinal level T4-T5


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Anatomy Review

Pulmonary trunk and right and left pulmonary arteries


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Anatomy Review

Thoracic aorta

Ascending, transvserse Arch

Descending,

Sinus of valsalva (aka aortic sinuses)


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Anatomy Review

Major branches of aorta:

Brachiocephalic artery

Left common carotid artery


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Anatomy Review

Left and right subclavian and internal jugular veins

Left and right brachiocephalic veins


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Anatomy Review


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Axial (transverse) mediastinal structures: Gross vs CT

3

12

34

1

24

5

5

1. Esophagus

2. Trachea

. rac ocep a c r ery urca on n o g ommon aro r ery anRight Subclavian Artery)

4. Left Common Carotid Arter

5. Left Subclavian Artery


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6 9 6

7

9

6. Right Subclavian Vein

7. Right Internal Jugular Vein

8. Left Internal Jugular Vein

9. Left Subclavian Vein


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Full size axial CT with contrast

7

8

1

23 4

5

6

.

2. Trachea

3. Brachiocephalic Artery

.

6. Right Subclavian Vein

7. Right Internal Jugular Vein

Artery and Right Subclavian Artery)

4. Left Common Carotid Artery

.

9. Left Subclavian Vein


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3

4

4

1 12

1. Esophagus 3. Brachiocephalic Artery

. rac ea . e ommon aro r ery


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56

6

5


6. Right Brachiocephalic Vein

7. Left Brachiocephalic Vein


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7

64

1

25

1. Esophagus

2. Trachea







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3

4 4

12

12

3

1. Esophagus 4. Aortic Arch

.

3. Superior Vena Cava


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4

3

1

. sop agus

2. Trachea


. or c rc


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3 3

4 4

12

12

1. Esophagus 3. Bifurcation into Left Main Bronchus

. .


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7

5

7

5

66

5. Ascending Aorta 7. Superior Vena Cava

6. Descending Thoracic Aorta


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5

73

4

2 6

1. Esophagus 5. Ascending Aorta

.

3. Bifurcation into Left Main Bronchus

4. Pulmonary Trunk

.



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12

1 2

1. Right Main Bronchus 2. Left Main Bronchus


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4

4

3

5

3

5

3. Esophagus4. Pulmonary Trunk

5. Right Pulmonary Artery


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78

76

99

6. Left Pulmonary Artery7. Superior Vena Cava

8. Ascending Aorta9. Descending Thoracic Aorta


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8

4

7

6

1

2

5

39

1. Right Main Bronchus

2. Left Main Bronchus

6. Left Pulmonary Artery


. sop agus

4. Pulmonary Trunk


. scen ng or a



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3

3

1 2

1 2

1. Esophagus

2. Descending Thoracic Aorta3. Sinus of Valsalva (Aortic Sinus)*

*Note the location of the aortic sinuses ust distal to the aortic valve


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3

12

.


3. Sinus of Valsalva (Aortic Sinus) -directly distal to aortic valve outlined-


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21

3

1

(4)

1. Esophagus


3. Inferior Vena Cava

(4. Liver)


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3

1

2

(4)

1. Esophagus



(4. Liver)


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Imaging of Lungs on Axial CT

Normal lung shows central, branching pulmonary arteries andbronchi

Bronchus is a thin-walled, white circle with central air (black),,

More peripherally, numerous small "dots" and a few branching

Major fissures (pleura) are visualized most frequently as

On high resolution CT: they may appear as lines or dense


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2

13

3

5

5

6

12

4 6

1. Right Major (oblique) fissure

.

3. Right Upper Lobe

4. Right Lower lobe1

2

35

.

6. Left lower lobe


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Cross Sectional CT Ima in of Lun s

3

4

57

3

4

5

7

1 2

6 8 68

1. Right Major (oblique) fissure

. e t ma or o que ssure

3. Right minor (horizontal) fissure

4. Right Upper Lobe

. g t ower o e

7. Left Upper lobe

8. Left lower lobe

5. g t e o e


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Coronal

Saggital

Transverse


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Coronal mediastinal structures: Gross vs CT

11

5

2

4

3 2

4

1. Trachea 4. Aortic Sinus

2. Pulmonary Trunk3. Ascending Aorta



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7 8 7 8

6

(9)

(10)10

.

7. Right Brachiocephalic Vein8. Left Brachiocephalic Vein

.

(10. Left Ventricle)

F ll i l CT i h


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Full size coronal CT with contrast

1

5

6

7 8

4

3

(9)

(10)

1. Trachea

2. Pulmonary Trunk



.

4. Aortic Sinus


.

(9. Right Atrium)

(10. Left Ventricle)


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1

4

1

3

3

4

2

1. Trachea 3. Aortic Arch

2. Pulmonary Trunk 4. Brachiocephalic Artery



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55

67 6 7

8

8

9

9

.


.


F ll i l CT ith t t


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1

4

5

3

6 7

8

1. Trachea2. Pulmonary Trunk


.



.




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1 1

2

3

3

. sop agus

2. Trachea

. or c rc


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Coronal mediastinal structures:

44

56

56






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12

3

4

5

6

1. Esophagus 5. Right Pulmonary Artery

.

3. Aortic Arch


.



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1

2

1

2

3

4

4

1. Esophagus

2. Trachea





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5

5

7 7

6

6

5. Descending Thoracic Aorta 7. Left Pulmonary Artery




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1

2

3

5

7

46

1. Esophagus 5. Descending Thoracic Aorta

.



.




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22

1. Eso ha us 2. Descendin Thoracic Aorta



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1

2

1. Esophagus 2. Descending Thoracic Aorta

Coronal CT Imaging of Lungs


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Coronal CT Imaging of Lungs

23

4 7

1

23

7

81

6 8

1. Right Major (oblique) fissure2. Left major (oblique) fissure

3. Ri ht minor horizontal fissure

5. Right Middle lobe6. Right Lower lobe

7. Left U er lobe

4. Right Upper Lobe 8. Left lower lobe

Sagittal mediastinal structures: Gross vs CT


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2

4

54

5

3

1

2

3

1


.


.


Full size sagittal CT with contrast


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5

2 3

1

.

2. Aortic Arch


.




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1

1

32

3

2

1. Trachea


3. Ascending Aorta



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(5)(5)

4 4

(6)

(6)

4. Left Brachiocephalic Vein (6. Left Atrium)

.

Full size sagittal CT with contrast


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(5)

14

2

(6)

.


3. Ascending Aorta

.

(5. Brachiocephalic Artery)

(6. Left Atrium)


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Arrow indicatesArrow indicatesmalpositionedmalpositionedtube.tube.

Normally, the ETNormally, the ET

tube should betube should beat least overat least over

of carina.of carina.

TRAUMATIC AORTIC DISSECTIONTRAUMATIC AORTIC DISSECTION


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TRAUMATIC AORTIC DISSECTIONTRAUMATIC AORTIC DISSECTION


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Traumaticaortic

aneurysm

Aort ic Angiogram


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lecture 5 - thoracic imaging cross sectional imaging slides

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