Objectives To outline basic pulmonary pleural and chest wall anatomy as delineated by the CXR and CT To emphasise normal structures and interfaces Lungs airways fissures pleura Interface with mediastinum and diaphragm ID: 1047868
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1. Radiological anatomy of the chest wall, lungs and pleura
2. ObjectivesTo outline basic pulmonary, pleural and chest wall anatomy as delineated by the CXR and CTTo emphasise normal structures and interfacesLungs, airways, fissures, pleuraInterface with mediastinum and diaphragm
3. Normal CXR
4.
5. Normal CXRMediastinumLungsPleural spaceBonesSoft tissues
6. The normal CXRAortic archMain pulmonary arteryLeft atrial appendageLeft ventricleRight atriumSVCR diaphragmL diaphragmHorizontal fissure
7. Anatomy
8. Anatomy
9. What structures make up the cardiomediastinal contours of the CXR?AirwaysHeartGreat vessels
10. R mediastinal border – right atrium
11. R mediastinal border – ascending aorta
12. R mediastinal border – superior vena cava
13. L mediastinal border – left ventricle
14. L mediastinal border – left atrium (appendage)
15. L mediastinal border – main pulmonary artery
16. L mediastinal border – aortic arch
17. L mediastinal border – descending aorta
18. Mediastinal anatomy axial planeSVCTracheaAortic arch321
19. Mediastinal anatomy axial planeRight atriumLeft atriumLeft atrial appendageDescending aorta1234
20. Mediastinal anatomy axial planeRight ventricleLeft ventricle21
21. Lungs – lobar anatomy
22. Lungs – lobar anatomyRight middle lobe abuts right atriumRight lower lobe abuts right diaphragm
23. Lungs – lobar anatomyLingula abuts left heart borderLeft lower lobe abuts left diaphragm and descending thoracic aorta
24. FissuresLobes separated by fissures (2 layers of visceral pleura)Fissures help delineate the lobes on CXR and CT and show in which lobe pathology is likely to be
25. Horizontal fissure - CXR
26. Horizontal fissure - CT
27. Fissures well seen on CT- left oblique fissure (extends from level of T4 to anterior costophrenic recess)
28. Right oblique fissure- slightly more anterior than left
29. Right horizontal fissure- divides upper and middle lobes
30. Tracheobronchial tree
31. Tracheobronchial tree132TracheaLeft main bronchusRight main bronchus
32. Tracheobronchial tree132CarinaBifurcation of main bronchiAngle 60 – 90 degrees
33. Tracheobronchial treeRightUpper lobe bronchusBronchus intermediusMiddle lobe bronchusLower lobe bronchus
34. Tracheobronchial treeRightUpper lobe bronchusBronchus intermediusMiddle lobe bronchusLower lobe bronchus
35. Tracheobronchial treeRightUpper lobe bronchusBronchus intermediusMiddle lobe bronchusLower lobe bronchus
36. Tracheobronchial treeLeftUpper lobe bronchusLower lobe bronchus
37. Tracheobronchial treeLeftUpper lobe bronchusLower lobe bronchus
38. Bronchial tree
39. Lobar bronchi divide into segmentsRight upper lobeApical segmentPosterior segmentAnterior segmentRight middle lobe4 Medial segment5 Lateral segmentRight lung, lateral view
40. Lobar airways divide into segmentsRight lower lobeApical segmentMedial basalAnterior basalLateral basalPosterior basalRight lung, lateral view
41. Lobar bronchi divide into segments Left upper lobe1&2 Apicoposterior segmentAnteriorSuperior lingular segmentInferior lingular segment4Left lung, lateral view
42. Lobar bronchi divide into segments Left lower lobe4Left lung, lateral view6 Apical segment7 Medial basal segment8 Anterior basal segment9 Lateral basal segment10 Posterior basal segment
43. Hilar regionsPulmonary arteries and veinsLeft higher than right
44. Hilar regions
45. Hilar regions1234567Rt pulmonary arteryLt pulmonary arteryLeft atriumR superior pulmonary veinR inferior pulmonary veinL inferior pulmonary veinL superior pulmonary vein
46. Pleural spaces - not seen unless abnormalLeft pleural effusion
47. Pleural spaces - not seen unless abnormalLeft pneumothorax
48. Pleural spaces - not seen unless abnormalLeft meothelioma
49. Chest wall
50. Arterial supply chest wall
51. Chest wallSerratus anteriorExternal intercostalInternal intercostalInnermost intercostalLungPleural cavityVisceral pleuraParietal pleuraIntercostal veinIntercostal arteryIntercostal nerve
52. Bones – rib fractures
53. Bones – rib metastasis
54. Bones – rib notching in coarctation of aorta
55. Bones – rib notching in coarctation of aorta
56. Quiz