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
1. Posteroanterior view
2. Lateral view
! Others
1. Lordotic view – to look at the apical segment
2. Right anterior oblique view
3. Left anterior oblique view
4. Anteroposterior view
5. Decubitus view
RADIOANATOMY OF LUNGS
POSTEROANTERIOR VIEW OF CHEST
LATERAL VIEW LUNGS
! Two lungs situated in the thoracic cavity
1. Right
2. Left
! Separated from each other by middle mediastinum containing the heart and great vessels
! Lobes
1. 3 lobes in the right separated by major and minor fissures
2. 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
1. Upper
2. Middle
3. Lower
! Left
1. Upper
2. 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
1. Mainstem bronchus
2. Pulmonary vessels (one artery and two veins)
3. Bronchial vessels
4. Lymph vessels
5. 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
VESSELSCHEST 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
1. Right coronary artery
2. Left coronary artery
BRANCHES OF THE ARCH OF THE AORTA
! Brachiocephalic artery
1. Right subclavian
2. 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
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