APPROACH TO

CHEST CT-
SCAN
Eliana Muis
OBJECTIVE
Understand the basic principles of a CT-
scan
Identify important and relevant anatomy
on a CT-scan
Provide an approach to reading a chest
CT-scan
Review the chest CT-scans of commonly
encountered radiological presentations
BASIC
PRINCIPLES OF
A CT-SCAN
IDENTIFICATION
Look at the identity of the patient, date
and time, also the name of place/hospital
Always try to correlate your imaging to
clinical findings
PLANES OF IMAGING &
GETTING ORIENTED

CT scans are viewed from below

RECOGNIZING DIFFERENT
MEDIUMS
Air black
Fluid grey
Soft tissues various shades of grey
Bone dense white
Blood white
Contrast dense white
TYPES OF CT IMAGING
AVAILABLE
Standart
Contrast can be given to highlight certain
structures and improve diagnostic accuracy
specifically to look at mediastinal vasculature and soft
tissue, and chronic pleural diseases
Other type of CT images include:
High resolution
Very thin cuts
Excellent spatial resolution
Good for detection of intertitial lung disease
Low radiation dose
IDENTIFYING
RELEVANT
CHEST
ANATOMY
ANATOMY
BRONCHOPULMONARY
SEGMENTS
3D PICTURES
BRONCHOPULMONARY
SEGMENTS
3D PICTURES
THORACIC
LYMPH NODES
3 WINDOWS OF CT
soft tissue
bone
lung
MEDIASTINAL ANATOMY
1. Coracoid
2. Right clavicle
3. Right common
carotid
4. Thyroid
5. Internal jugular
vein
6. Left clavicle
7. Left subclavian
vein
8. Left humeral
head
9. Scapular spine
10.Spinous process
IMPORTANT ANATOMICAL
LANDMARKS
1. Right humeral
head
2. Esophagus
3. Trachea
4. Left subclavian
vein
5. Scapular spine
6. Glenohumeral
joint
ANATOMICAL LANDMARKS

1. Esophagus
2. Rib
3. Trachea
4. Superior vena
cava
5. Brachiocephali
c artery
6. Left common
carotid artery
7. Aorta
8. Scapula
9. Spinal canal
MORE ANATOMICAL
LANDMARKS
1. Right
pulmonary
artery
2. Right lung
3. Superior vena
cava
4. Thoracic
ascending
aorta
5. Pulmonary
trunk
6. Left pulmonary
vein
7. Left pulmonary
artery
8. Scapula
MORE ANATOMICAL
LANDMARKS

1. Right atrium
2. Aortic root
3. Right
ventricle
4. Left atrium
5. Thoracic
descending
aorta
SAGITTAL
RECONSTRUCTION
1. Superior lobe of the
right lung
2. Right middle lob
3. Inferior lobe
4. Black arrow = minor
fissure
5. Red arrow = major
fissure
CORONAL
RECONSTRUCTION
1. Trachea
2. Left main bronchus
3. Right main bronchus
4. Apical segmental
bronchus
5. Right lower lobe
bronchus
6. Red arrow = major
fissure
APPROACH TO
READING THE
CHEST CT
STEP 1: IDENTIFY THE LEVEL
USING ANATOMICAL LANDMARKS
Sternoclavicular joint T1
Sternal angle of Louis, second rib, aortic arch
T4
Carina of the trachea T5
Bifurcation of pulmonary trunk T5/T6
Inferior pulmonary veins enter L atrium T7/T8
EXAMPLE: CT SCAN AT T4

Sternal angle of Louis, second rib, aortic

arch
EXAMPLE: CT SCAN AT
T5/T6

Carina of the trachea, Bifurcation of pulmonary trunk

EXAMPLE: CT SCAN AT
T7/T8

Inferior pulmonary veins enter left atrium

STEP 2: SYSTEMATIC
ASSESMENT
A air
B bone
C cardiac & great vessels
D digestive
E extras
S soft tissue
EXAMPLE
 STEP 1: DETERMINE THE
LEVEL

T5/T6
Trachea has
bifurcated
Pulmonary
artery is
bifurcating
 STEP 2: SYSTEMATIC
ASSESMENT

Air
Airway patent
No
nodules/masses,
calcification,
consolidation, or
fluid
 STEP 2: SYSTEMATIC
ASSESMENT

Bones
No fracture (ribs,
vertebrae, scapulae)
Novisible bony
metastatic disease
 STEP 2: SYSTEMATIC
ASSESMENT
Cardiac & great
vessels
Normal appearing
anatomy (SVC,
ascending &
descending
thoracic aorta,
pulmonary trunk)
No clots in
pulmonary
vasculature
 STEP 2: SYSTEMATIC
ASSESMENT

Digestive
Esophagus patent,
no surrounding
masses
 STEP 2: SYSTEMATIC
ASSESMENT

Extras
No thoracostomy
tubes, NG, foreign
bodies, etc visibles
 STEP 2: SYSTEMATIC
ASSESMENT

Soft tissue
No abnormalities
of musculature or
fat
COMMONLY
ENCOUNTERED
RADIOLOGICAL
PRESENTATIONS
COMMON PRESENTATIONS
Pneumothorax
Pleural effusion
Pulmonary metastation
PE
Clavicular fractures
LEFT PNEUMOTHORAX WITH
COLLAPSE
OF LUNG
Pneumothorax
BILATERAL PLEURAL EFFUSIONS

SOFT TISSUE WINDOW

Red arrows = pleural
effusion
PULMONARY METASTASES
Red arrow = lung
nodules
PULMONARY EMBOLISM
Arrow = filling
defect
CLAVICULAR FRACTURE
BONE WINDOW
SUMMARY
Always ensure it is the right patient
Always be systematic in your approach
Orient yourself
Use landmarks to identify the level
Remember your ABCDES
THANK YOU