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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
