Radiological Anatomy of Thorax

Dr. Jamila Elmedany &Prof. Saeed Abuel Makarem

• Achestx-raymaybeusedtodiagnoseandplantreatmentforvariousconditions,including:• Diseases/Fracturesofthebonesofthechest(ribs,sternum,clavicleandthevertebrae)

• Lungdisorders• Heartdisorders

Chestradiographsarealsousedtoscreenforjob-relatedlungdisease inindustriessuchasminingwhereworkersareexposedtodust.

IndicationsforChestx-Ray

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.

Anteroposterior(AP)view:• Thex-raysenterthroughtheanterioraspectandexitthrough

theposterioraspectofthechest.• APchestx-raysaredonewhereitisdifficultforthepatientto

obtainanormalchestx-ray,suchaswhenthepatientcannotgetoutofbed.

• Lateralview• Indicatedonlyforfurtherinterpretation• Decubitus:lyingattheside

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.

Bones• TheThoracicVertebraeareimperfectlyseen.

• TheCostotransverse jointsandeachRib shouldbeexaminedinorderfromabovedownwardandcomparedtotheirfellowsoftheoppositeside.

• TheCostalCartilagesarenotusuallyseen,butifcalcified,theywillbevisible.

• TheClavicles areseenclearlycrossingtheupperpartofeachlungfield.

• ThemedialbordersoftheScapulaemayoverlaptheperipheryofeachlungfield.

C

SR

V

Diaphragm• Thediaphragmshows

Dome-shapedshadowsoneachside.

• Therightdomeisslightlyhigherthantheleftdome.

• Beneaththerightdomeisthehomogeneous,denseshadowoftheliver.

• Beneaththeleftdomeagasbubblemaybeseeninthefundusofthestomach. Gas bubble

in the fundus of stomach

RD

LD

Costo-diaphragmatic(costo-phrenic)Angles

• Theyareatthesiteswherethediaphragmmeetsthethoracicwall.

• Theanglesbecomebluntorobscuredincaseofpresenceofpleuralfluidorfibrosis

Trachea

• Theradiotranslucent,air-filledshadowofthetracheaisseeninthemidlineoftheneckasadarkarea.

• Itissuperimposedonthelowercervicalandupperthoracicvertebrae.

Trachealshift• Trachealaircolumnisseen

shiftedtorightonX-raychest PA view.

• Itindicates:• Alossofvolumeoftherightupperlobeofthelung,eitherduetocollapseorfibrosis.

• OR• Amassivepleuraleffusionontheleftside.(Butinthisxray,nopleuraleffusion is seenontheleft)

Lungs

• LungRoots:Relativelydenseshadowscausedbythepresenceoftheblood-filledpulmonaryandbronchialvessels,thelargebronchi,andthelymphnodes.

• Thelungfields,byvirtueoftheairtheycontain,readilypermitthepassageofx-rays.Forthisreason,thelungsaremoretranslucentonfullinspirationthanonexpiration.

• Thepulmonarybloodvessels areseenasaseriesofsmall,round,whiteshadowsradiatingfromthelungroot.

• Thelargebronchi,alsocastsimilarroundshadows.Thesmallerbronchiarenotseen

BPV

H

H

Bronchography• Bronchographyisaspecialstudyofthebronchialtreebymeansoftheintroductionofcontrastmediumintoaparticularbronchusorbronchi,usuallyunderfluoroscopiccontrol.Thecontrastmediaarenonirritatingandsufficientlyradiopaque toallowgoodvisualizationofthebronchi.Aftertheradiographicexaminationiscompleted,thepatientisaskedtocoughandexpectoratethecontrastmedium. Posteroanterior Bronchogram

T

B

Mediastinum• Theshadowis

producedbythevariousstructureswithinthemediastinum,superimposedoneontheother

• Notetheoutlineoftheheartandgreatvessels.

• 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

• Theinferiorborder(lowerborderoftheheart)blendswiththediaphragmandlivershadow.

• Notethecardiophrenicangles.

Heart• TheTransverseDiameter oftheheartshouldnotexceedhalfthewidthofthethoraciccage.

• Ondeepinspiration,whenthediaphragmdescends,theverticallengthoftheheartincreasesandthetransversediameterisnarrowed.

• Ininfants,theheartisalwayswiderandmoreglobularinshapethaninadults.

HEART

PA

LV

Aortic Arch

Intervertebral disc

Pulmonary archVertebralbody

Lateralradiographofthechest

CoronaryAngiogram(anX-raywithradio-opaquecontrastinthecoronaryarteries)

Right coronary Left coronary

ContrastVisualizationoftheEsophagus

Leftlateralradiographofthechestofanormaladultmanafterabariumswallow.

Esophagus

Otherbariumcontraststudies:Bariummeal:stomachBariumfollowthrough:smallintestineBariumenema:largeintestine

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