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