Radiographic Anatomy of the

Chest

Narinder Paul , MD
Tae Bong, MD
Bill Weiser, MD
Panayiotis Iracleous
 Clavicle

Rib

Intercostal
Space
Vertebral
Column

Heart

Diaphragm
 Airway Anatomy
• Trachea
– Cartilage
– Membranous posteriorly

• Carina
– Bifurcation

• Bronchus
– left and right
– Lobar (RUL,RML,RLL,LUL,LLL)
– Segmental (8 left, 10 right)

• Bronchioles
Trachea

R + L Main
Bronchi

Carina
 Lung Anatomy
• Lobes are separated by fissures
– Right
• Upper Lobe
• Middle Lobe
• Lower Lobe

– Left
• Upper Lobe (includes Lingula)
• Lower Lobe
ANT POST
Right Middle Lobe Pneumonia
 Pleura and Fissures
• Pleura: Lubricates and prevents
friction during respiration
• Parietal Pleura: Lines chest wall,
mediastinal and diaphragmatic
surfaces
• Visceral pleura: Lines lungs, fissures
• Pulmonary Ligaments
• Costophrenic recess
• Cardiophrenic recess
 PNEUMOTHORAX
E
D
G
E
O
F
C
O
L
L
A
P
S
E
D
L
U
N
G
SUPINE FILM PNEUMOTHORAX
 PNEUMOTHORAX CT
EDGE OF COLLAPSED LUNG
EMPYEMA
 Mediastinum
• Anatomic Classification
– Superior (above sternal angle)
– Anterior
– Middle (Heart and Pericardium)
– Posterior
 Mediastinum
• Heart and Pericardium
• Thyroid
• Thymus
• Lymph Nodes
• Nerves
• Vessels
• Esophagus
• Lymphatics (Thoracic Duct)
THYMUS

AORTA

CARINA
THYMUS

PULMONARY
ARTERY
Normal Anatomy
BONY THORAX
 Retrosternal
Trachea Space

Scapula
Sternum
Hila

Spine
Heart

IVC
Inspiration Expiration
TRACHEAL DEVIATION

GOITER
GOITER

TRACHEA
ENLARGED LYMPH
NODES
ENLARGED LYMPH
NODES
Cardiovascular Anatomy
 Cardiovascular Anatomy: Coronal

AA
SVC

RPA LAA

RA LV
Heart: MRI coronal
Cardiovascular Anatomy: Sagittal
Heart: MRI short axis oblique
The Pericardium
Normal azygos vein
 Azygos lobe

Aberrant azygos vein

 Azygos lobe

Aberrant azygos vein

 Pulmonary Arteries

Main PA
Rt PA Lt PA
 Pulmonary Arteries

ANT POST POST ANT

Right PA Epiarterial Bronchus Left PA Hyparterial Bronchus

 Cardiovascular Anatomy- Left Heart

RT
LT

RUL / ML
PV JOIN

Pulmonary Veins posterior view

 Cardiovascular Anatomy- Left Heart

PV
LA LA
PV
PV PV

LA = Lt Atrium Four main Pulmonary Veins

PV = Pulmonary vein
Cardiovascular Anatomy- Left Heart

IVS
RV
AV
LV
LA LA

MV

LA = Lt Atrium MV = Mitral Valve

LV = Lt Ventricle IVS = Intraventricular septum RV= Rt Ventricle
AV = Aortic valve
Cardiovascular Anatomy- Left Heart

IVS
RV
AV RA
LV
LA LA

MV
CLINICAL SCENARIO

BREATHLESSNESS
Common Emergencies: Cardiac
Failure

Normal Heart

Ratio cardiac: thoracic < 55 %

 Cardiac Failure: Stage 1,2.

Stage 1 = Equilibration of upper and lower lobe vessels

Stage 2 = Upper lobe venous diversion
Cardiac Failure: Stage 3

Interstitial Edema
Cardiac Failure: Stage 4

Pulmonary Edema
 Pulmonary Embolus

Pseudotumour

Atelectasis
Pulmonary Embolus

Infarcted lung
 Pulmonary Embolus

Avascular lung Central clot

 Pulmonary Embolus

Thrombus
Pulmonary Emboli: Computed
Tomography

Thrombus