Radiological Anatomy of Thoraxksumsc.com/download_center/1st/3. Respiratory Block... ·...
Transcript of Radiological Anatomy of Thoraxksumsc.com/download_center/1st/3. Respiratory Block... ·...
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Radiological Anatomy of Thorax
Dr. Jamila Elmedany &Prof. Saeed Abuel Makarem
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• Achestx-raymaybeusedtodiagnoseandplantreatmentforvariousconditions,including:• Diseases/Fracturesofthebonesofthechest(ribs,sternum,clavicleandthevertebrae)
• Lungdisorders• Heartdisorders
Chestradiographsarealsousedtoscreenforjob-relatedlungdisease inindustriessuchasminingwhereworkersareexposedtodust.
IndicationsforChestx-Ray
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Posteroanterior(PA)view:• Thex-raysenterthroughthe
posterioraspectofthechest,andexitoutoftheanterioraspectwheretheyaredetectedbyanx-rayfilm.
• PAviewgivesagoodassessmentoftheCardiacSize.
• Itavoidsmagnificationoftheheartasthefilmisclosetotheanteriorchestwall.
• Itisidentifiedbythepresenceofthefundal gasbubbleandtheabsenceofthescapulaeinthelungfields.
• Different views of the chest can be obtained by changing the relative position ofthe body and the direction of the x-ray beams.
• The most common views are Posteroanterior (PA), Anteroposterior (AP), lateral (L) & Decubitus.
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Anteroposterior(AP)view:• Thex-raysenterthroughtheanterioraspectandexitthrough
theposterioraspectofthechest.• APchestx-raysaredonewhereitisdifficultforthepatientto
obtainanormalchestx-ray,suchaswhenthepatientcannotgetoutofbed.
• Lateralview• Indicatedonlyforfurtherinterpretation• Decubitus:lyingattheside
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Posteroanteriorradiograph the following structures must be examined: ØSuperficial soft tissues: ØNipples in both sexes and the Breast in (females) are seen superimposed on the lung fields.ØBones of thoracic cage.ØDiaphragm .Ø Lungs and Bronchi.ØHeart & Great Vessels.
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Bones• TheThoracicVertebraeareimperfectlyseen.
• TheCostotransverse jointsandeachRib shouldbeexaminedinorderfromabovedownwardandcomparedtotheirfellowsoftheoppositeside.
• TheCostalCartilagesarenotusuallyseen,butifcalcified,theywillbevisible.
• TheClavicles areseenclearlycrossingtheupperpartofeachlungfield.
• ThemedialbordersoftheScapulaemayoverlaptheperipheryofeachlungfield.
C
SR
V
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Diaphragm• Thediaphragmshows
Dome-shapedshadowsoneachside.
• Therightdomeisslightlyhigherthantheleftdome.
• Beneaththerightdomeisthehomogeneous,denseshadowoftheliver.
• Beneaththeleftdomeagasbubblemaybeseeninthefundusofthestomach. Gas bubble
in the fundus of stomach
RD
LD
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Costo-diaphragmatic(costo-phrenic)Angles
• Theyareatthesiteswherethediaphragmmeetsthethoracicwall.
• Theanglesbecomebluntorobscuredincaseofpresenceofpleuralfluidorfibrosis
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Trachea
• Theradiotranslucent,air-filledshadowofthetracheaisseeninthemidlineoftheneckasadarkarea.
• Itissuperimposedonthelowercervicalandupperthoracicvertebrae.
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Trachealshift• Trachealaircolumnisseen
shiftedtorightonX-raychest PA view.
• Itindicates:• Alossofvolumeoftherightupperlobeofthelung,eitherduetocollapseorfibrosis.
• OR• Amassivepleuraleffusionontheleftside.(Butinthisxray,nopleuraleffusion is seenontheleft)
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Lungs
• LungRoots:Relativelydenseshadowscausedbythepresenceoftheblood-filledpulmonaryandbronchialvessels,thelargebronchi,andthelymphnodes.
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• Thelungfields,byvirtueoftheairtheycontain,readilypermitthepassageofx-rays.Forthisreason,thelungsaremoretranslucentonfullinspirationthanonexpiration.
• Thepulmonarybloodvessels areseenasaseriesofsmall,round,whiteshadowsradiatingfromthelungroot.
• Thelargebronchi,alsocastsimilarroundshadows.Thesmallerbronchiarenotseen
BPV
H
H
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Bronchography• Bronchographyisaspecialstudyofthebronchialtreebymeansoftheintroductionofcontrastmediumintoaparticularbronchusorbronchi,usuallyunderfluoroscopiccontrol.Thecontrastmediaarenonirritatingandsufficientlyradiopaque toallowgoodvisualizationofthebronchi.Aftertheradiographicexaminationiscompleted,thepatientisaskedtocoughandexpectoratethecontrastmedium. Posteroanterior Bronchogram
T
B
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Mediastinum• Theshadowis
producedbythevariousstructureswithinthemediastinum,superimposedoneontheother
• Notetheoutlineoftheheartandgreatvessels.
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• TheRightBorderfromabovedownwardconsistsof:
• Rightbrachiocephalicvein,Superiorvenacava,Rightatrium,andsometimestheInferiorvenacava.
• TheLeftBorderconsistsof:
• Aprominence,theAorticknuckle,causedbytheaorticarch;
• LeftmarginofthePulmonaryTrunk,theLeftAuricle,andtheLeftVentricle&apexofheart.
Superior vena cava
Right pulmonary artery
Right atrium
Apex of heart
Left ventricle
Left auricle
Left pulmonary artery
Aorticknuckle
Right brachiocephalic vein
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• Theinferiorborder(lowerborderoftheheart)blendswiththediaphragmandlivershadow.
• Notethecardiophrenicangles.
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Heart• TheTransverseDiameter oftheheartshouldnotexceedhalfthewidthofthethoraciccage.
• Ondeepinspiration,whenthediaphragmdescends,theverticallengthoftheheartincreasesandthetransversediameterisnarrowed.
• Ininfants,theheartisalwayswiderandmoreglobularinshapethaninadults.
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HEART
PA
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LV
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Aortic Arch
Intervertebral disc
Pulmonary archVertebralbody
Lateralradiographofthechest
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CoronaryAngiogram(anX-raywithradio-opaquecontrastinthecoronaryarteries)
Right coronary Left coronary
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ContrastVisualizationoftheEsophagus
Leftlateralradiographofthechestofanormaladultmanafterabariumswallow.
Esophagus
Otherbariumcontraststudies:Bariummeal:stomachBariumfollowthrough:smallintestineBariumenema:largeintestine
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