Radio Anatomy of Lungs and Heart

RADIOANATOMY OF LUNGS AND HEART

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

IMAGING MODALITIES

Plain X-Ray CT Scan MRI Ultrasound Nuclear Medicine

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

RADIOANATOMY OF LUNGS

POSTEROANTERIOR VIEW OF CHEST

LATERAL VIEW

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

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

• 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

TRANSVERSE FISSURE

Runs from the anterior border of the lung along the fourth costal cartilage to the oblique fissure

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

OBLIQUE FISSURES

LUNG PARENCHYMA

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

RIGHT UPPER LOBE

RIGHT MIDDLE LOBE

RIGHT LOWER LOBE

LEFT UPPER LOBE WITH LINGULA

LEFT UPPER LOBE

LEFT LOWER LOBE

BRONCHOPULMONARY SEGMENTS

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

SEGMENTS OF THE RIGHT UPPER LOBE

1. Apical 2. Posterior 3. Anterior

SEGMENTS OF RIGHT MIDDLE LOBE

1. Lateral 2. Medial

SEGMENTS OF THE RIGHT LOWER LOBE

1. Superior 2. Medial-basal 3. Anterior-basal 4. Lateral-basal 5. Posterior-basal

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

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

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

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

TRACHEA AND BRONCHI

•Angle of Carina (angle between the two main stem bronchi

•Should be less than 60 degrees

BRONCHOGRAPHY

1. Apical segmental bronchus

2. Posterior segmental bronchus (RUL)

1+2 – apicoposterior segmental bronchus (LUL)

3. Anterior segmental bronchus (RUL)

3. Anterior segmental bronchus – RUL and LUL

6. Superior segmental bronchus (LLL)

Li – Lingular segmental bronchus (LUL)

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

CORONAL RECONSTRUCTION OF LUNGS AND TRACHEA

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

HILA

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

Lower margin of the left hilum is at the level of upper margin of right hilum

PULMONARY VASCULATURE

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

PULMONARY VASCULATURE

No vessels in 3.0 cm from apices

No vessels in 1.5 cm from pleura

TRANSVERSE FISSURE

Runs from the anterior border of the lung along the fourth costal cartilage to the oblique fissure

RADIOANATOMY OF HEART AND GREAT

VESSELS

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

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

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

PLAIN X-RAY OF HEART AND GREAT VESSELS

CHEST X-RAY - PA VIEW

RIGHT – Superior Vena Cava and Right Atrium LEFT – Arch of Aorta, Pulmonary Artery, Left Atrial

Appendage and Left Ventricle

CHEST X-RAY –LATERAL VIEW

Anterior border – right ventricle and outflow tract Posterior superior – left atrium Posterior inferior – left ventricle

POSTEROANTERIOR VIEW LATERAL VIEW

CT SCAN OF HEART AND GREAT VESSELS

Superior vena cava

Brachiocephalic trunk

Left Common carotid artery

Left Subclavian artery

Trachea

Esophagus

Azygous vein

Superior vena cava Left Brachiocephalic Vein crossing over to the right to join the right Braciocephalic vein to form the SVC

Arch of aorta

Aortic sac

Superior vena cava

Descending aorta

Pulmonary trunk

Right pulmonary artery

Pulmonary trunk

Left pulmonary artery

Left atrium

Right atrium

Aortic sac Pulmonary trunk

Descending aorta

FOUR CHAMBER VIEW

CORONARY CIRCULATION

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

CORONARY CIRCULATION

Left coronary artery arises from left aortic sinus Branches – left anterior descending and left

circumflex artery

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

CONVENTIONAL CORONARY ANGIOGRAPHY

CONVENTIONAL ANGIOGRAPHY

CT CORONARY ANGIOGRAPHY WITH 2D AND 3D RECONSTRUCTIONS

LEFT CIRCUMFLEX AND POSTERIOR DESCENDING ARTERIES

BRANCHES OF LEFT CORONARY ARTERY ON 3D RECONSTRUCTION

AORTA

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

BRANCHES OF ASCENDING AORTA

Arise near the aortic root Right coronary artery Left coronary artery

BRANCHES OF THE ARCH OF THE AORTA

Brachiocephalic artery Right subclavian Right common carotid artery

Left common carotid artery Left subclavian artery

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

AORTA ON PLAIN X-RAY

AORTA ON ANGIOGRAM

Ascending Aorta with its branches

BRANCHES OF AORTIC ARCH

BRANCHES OF THE BRACHIOCEPHALIC

ARTERY

LEFT COMMON CAROTID ARTERY

SUBCLAVIAN ARTERIES

BRANCHES OF SUBCLAVIAN ARTERIES

AORTA AND AORTIC VALVE ON CT SCAN

BRACHIOCEPHALIC VEIN

Right and left Internal jugular veins join with the right and left subclavian veins respectively to form the brachiocephalic vein

LEFT BRACHIOCEPHALIC VEIN CROSSES TO JOIN RIGHT BRACHIOCEPHALIC VEIN TO FORM THE SUPERIOR VENA CAVA

SUPERIOR VENA CAVA

Azygos Vein draining into the SVC

SVC draining in the Right Atrium

PULMONARY ARTERIES

PULMONARY VEINS