chest
TRANSCRIPT
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„Selected Chapters from theCross-Sectional Anatomy
of the Human Body”
Chest anatomyAndrás Jakab MD, Levente István Lánczi MD
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Bony structure of the chest
Thoracic vertebrae (12) Ribs (12 pairs) (clinical relation: cervical rib!) Sternum
Sternal angle (T4) Jugular notch Xyphoid process
Scapula
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Ribs – Costae
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Sternum
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The whole chest – breathing
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Muscles of the trunk – superficial back muscles
Spinohumeral muscles Levator scapulae m. Trapezius m. Rhomboideus m. Latissimus dorsi m.
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Muscles of the trunk – deep (axial) back muscles Splenius capitis & cervicis m Transversospinal muscles
Semispinalis mm.(capitis, cervicis, thoracis)
Multifidus m. Interspinales mm. Intertransversarii mm.
Spinalis thoracis m. Longissimus thoracis m. Erector spinae m.
Nuchal ligament Thoracolumbal fascia
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Breathing muscles Breathing muscles
Intercostal mm. Diaphragm
Accesory breathing muscles Scaleni mm. Sternocleidomastoid mm. Levator costarum mm. Serratus posterior superior m. Thoracohumeral mm. Abdominal mm. Serratus posterior inferior m. Transversus thoracis m.
belégzés
kilégzés
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Intercostal mm. External intercostal mm. Internal intercostal mm.
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Pectoralmm.
SA
LDTrRh
ESM
Th7
DAo
AAoPT
PVL
SVC
PVR
BrL
BrR
BS
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ESMTVS
LD
AO
PM
QL
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Circulatory system
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Brachiocephalic trunk Right common carotid a. Right vertebral a. Right subclavian a.
Left common carotid a. Left subclavian a.
Left vertebral a.
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Heart
Right auricle
Right atrium
Right venrticle
Right pulmonal a.
Aortic arch
Brachiocephalic trunkLeft common carotid a.Left subclavian a.
Arterial lig. (Botallo)
Left pulmonal a.
Pulmonal trunk
Left auricle
Apex
Left ventricle
Conus arteriosus
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Apex
Left ventricle
Left pulmonal a.
Superior v. cava
Azygos v.
Brachiocephalic vv.rightleft
Aortic arch
Right pulmonal a.
Left pulmonal veins Right pulmonal vv.
Right atrium
Left atrium
Inferior v. cava
Left venrticle
Left auricle
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Ascending aortaLeft atrium
Right auricle
Interventricular septum muscular part
Interventricular septum membranous part
Aortic valve
Atrioventricular valvesleft (mitral)
right (tricuspidal)
Papillary mm.
Apex
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Interventricular septum muscular part
Left ventricleRight ventricle
Posterior intervenrticular sulcus
Anterior intervenrticular sulcus
Papillary mm.
chordae tendineae
trabeculae carneae
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Veins
Subclavian v.
Internal jugular v.
Right brachiocephalic v. Left brachiocephalic v.
Superior v. cava
Right pulmonal vv.
Left pulmonal vv.
Right atriumLeft atrium
Inferior v. cava Hepatic vv.
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Respiratory system
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Trachea, bronchi
Cricoid cartilage – C7 Trachea T5: bifurcation of trachea Principal bronchi
Right: wider, steeper Lobar bronchi Segmental bronchi Bronchioli
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Anatomy of the lung
Airflow Basis – Apex – Hilus Lobes
Left side: 2; right side: 3 Pulmonary segments (20)
Left: 5-5; right: 3-2-5 Pleura Diaphragm
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Superior lobe
Middle lobe
Inferior lobe
Oblique fissure
Horizontal
fissure
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Lobar bronchi
Pulmonal a. and v.
Lymphatic nodes
nerves
Hilum of lung
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Apical segment
Posterior segment
Anterior segment
Lateral segment
Medial segment
Superior segment
Posterior
basal
segment
Lateral basal
segment
Anterior basal
segment
+ Basal medial segment (cardial)
Apical posterior segment
Anterior segment
Superior lingular
segment
Superior segment
Lateral basal
segment
Posterior
basal
segment
Anterior basal
segment
Inferior
lingular
segment
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What can be seen on a PA radiograph of the chest?
Thoracic cage bones Vertebrae Ribs Clavicle & scapule
Heart Superior vena cava (1) Right atrium (2) Left ventricle (6) Left atrium (auricle) (5) Pulmonary trunk (4) ”Aortic button” (3)
Airways Trachea Right & left primary bronchi
Diaphragm & recesses
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What can be looked for on the axial scans?
Brachiocephalic tr. Left common carotid a. Left subclavian a. Right and left
brachiocephalic vv. Apex of the lung Vertebrae, ribs,
muscles
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T3
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What can be looked for on the axial scans?
Aortic arch Superior vena cava Lung Vertebrae, ribs,
muscles
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T4
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What can be looked for on the axial scans?
Descending and ascending aorta
Superior vena cava Vertebrae, ribs,
muscles
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T5
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Azygos vein
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T6
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T7
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T8
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Important landmarks on axial scans
Bones – vertebrae, ribs, articulatio costovertebralis Sternum
Manubrium Angulus – T4; 2nd rib Body – T5-T10
Muscles: erector spinae, trapezius, intercostal, pectoral Trachea Oesophagus, thymus! Vessels – aortic arch, superior vena cava Pulmonary vessels, pleura Heart, pericardium Parenchyma of the lung; hilum of lung!
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Grat vessels demonstrated on
IMAIOS
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Trachea demonstrated on IMAIOS
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Oespophgaus demonstrated on
IMAIOS
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Heart chambers on axial CT scans
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ao
ao
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Cardiac MRI
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Coronarography demonstrated on
IMAIOS
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Segments of the lung
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Apical segment
Posterior segment
Anterior segment
Lateral segment
Medial segment
Superior segment
Posterior
basal
segment
Lateral basal
segment
Anterior basal
segment
+ Basal medial segment (cardial)
Apical posterior segment
Anterior segment
Superior lingular
segment
Superior segment
Lateral basal
segment
Posterior
basal
segment
Anterior basal
segment
Inferior
lingular
segment
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JOBB BAL
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Apical segment
Posterior segment
Anterior segment
Lateral segment
Medial segment
Superior segment
Posterior
basal
segment
Lateral basal
segment
Anterior basal
segment
+ Basal medial segment (cardial)
Apical posterior segment
Anterior segment
Superior lingular
segment
Superior segment
Lateral basal
segment
Posterior
basal
segment
Anterior basal
segment
Inferior
lingular
segment
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JOBB BAL
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Apical segment
Posterior segment
Anterior segment
Lateral segment
Medial segment
Superior segment
Posterior
basal
segment
Lateral basal
segment
Anterior basal
segment
+ Basal medial segment (cardial)
Apical posterior segment
Anterior segment
Superior lingular
segment
Superior segment
Lateral basal
segment
Posterior
basal
segment
Anterior basal
segment
Inferior
lingular
segment
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JOBB BAL
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Apical segment
Posterior segment
Anterior segment
Lateral segment
Medial segment
Superior segment
Posterior
basal
segment
Lateral basal
segment
Anterior basal
segment
+ Basal medial segment (cardial)
Apical posterior segment
Anterior segment
Superior lingular
segment
Superior segment
Lateral basal
segment
Posterior
basal
segment
Anterior basal
segment
Inferior
lingular
segment
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JOBB BAL
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Clinical case 74 year old male Cough, low grade fewer recently; smoker Chest X-ray, CT: rounded lesion on right side
http://www.eurorad.org/case.php?id=8653
Diagnosis: rounded pneumonia Usual in children, SARS Not easy to differentiate on images: TUMOR! Biopsy, follow up can help
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Esetbemutatás 81 year old male Dyspnoea, dysphagia, stridor Earlier: lung carcinoma surgery, coronary artery
bypass CXR, CT: right lung consolidation, bulky
oesophagus, gas pockets
http://www.eurorad.org/case.php?id=8584
Dg: bronchooesophageal fistule Contrast swallow
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Esetbemutatás
Miliáris kórképek
http://www.eurorad.org/case.php?id=8255 http://www.eurorad.org/case.php?id=4516 http://www.eurorad.org/case.php?id=2180
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Esetbemutatás
39 éves férfi, motorbaleset http://www.eurorad.org/case.php?id=6939 Aorta ruptura
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Esetbemutatás
A. pulmonaris aneurysmahttp://www.eurorad.org/case.php?id=8208
V. subclavia thrombozis http://www.eurorad.org/case.php?id=8016
Aortadisszekció Marfan-syndromában http://www.eurorad.org/case.php?id=7919
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Esetbemutatás
TOShttp://www.eurorad.org/case.php?id=8391
Sertésinfluenza (H1N1)http://www.eurorad.org/case.php?id=8257
PEhttp://www.eurorad.org/case.php?id=7735
Tűznyelő pneumoniájahttp://www.eurorad.org/case.php?id=7197
Pneumomediastiumhttp://www.eurorad.org/case.php?id=5060
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Mellkas és szív anatómiája –
kiegészítések, források
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www.ChestRadiology.netwww.ChestRadiology.net
A web-based, interactive tutorial and reference A web-based, interactive tutorial and reference database in anatomy for chest imagingdatabase in anatomy for chest imaging
www.ChestRadiology.Net
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MENU
Case & Chapter Reading ModesCase & Chapter Reading Modes
www.ChestRadiology.Net
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MENU
The user may read the tutorial in two modes: Title by title…
The anatomy tutorial includes chapters about:
• Techniques• Standard exams• Projections• Airways• Lung parenchyma• Heart and vessels• Mediastinum• Diaphragm• Pleura• Pitfalls• Pathology• Normal values
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…by reading page by page like a book (you can page back and forward), or…
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…or by reading the entire chapter at once
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IMAIOS