Department of Radiology Thorax David S. Hartman, M.D. Department of Radiology

Identify all objects indicated by arrows on the radiolgical images Learning Objectives: Identify all objects indicated by arrows on the radiolgical images in this presentation

Cases can be viewed by any computer in the institution Cases in MDL \\hersheymed.net\files\MMS\Public\education\radiology\lab-thorax-8-2007.pps Cases can be viewed by any computer in the institution

PA and Lateral Chest Radiograph

Heart Chambers Most anterior Most posterior Right boarder Left boarder Right ventricle Left atrium Right atrium Left atrium/ ventricle Most superior Left atrium

Heart from the Front Left atrium Left ventricle Pulmonary artery Aorta Right Atrium Right Ventricle 204

Right Atrium Left atrium Ventricle Right ventricle 201

Right Atrium Left Atrium Vent- ricle

Aortic arch Main pulmonary artery Left atrium, ventricle

Trachea Clavicles Cardiophrenic angles Costophrenic angles

Hilum (pleural: hila) Root of the lung Pulmonary artery Upper lobe pul vein Bronchus (Lymph nodes)

Right hilum Left hilum

Right ventricle Left atrium Left ventricle Cardiophrenic angle Costophrenic angle Left Diaphragm 219

Right ventricle Left atrium left ventricle Diaphragm Cardiophrenic angle Costophrenic angles

Trachea Thoracic spine

Pulmonary Arteriogram

Pulmonary Arteries Main PA (pulmonary trunk) off right ventricle (anterior) Right main PA longer than left main PA and runs horizontaly superior to left atrium Left main PA is short and runs over left main stem bronchus

Right main PA Left main PA Main PA (trunk) Aorta RA RV LV LA RA RV LV 194

Left inferior pulmonary artery Right main pulmonary artery Left inferior pulmonary artery Catheter in main PA

Arch Aortogram

Left common carotid art Ascending aorta Aortic arch Descending aorta Brachiocephalic art Left common carotid art Left subclavian art Aortic Arch 225

Arch Aortogram Aortic arch Brachiocephalic art Left common carotid art Left subclavian artery R L

CT of the Heart and Mediastinum (axial images)

View as though facing the patient Axial section Right Left

Axial CT image with contrast By convention we look from below Anterior Heart Liver Right Left Lung Posterior By convention we look from below

Right Sternum Scapula Spine Ribs

Vascular Arch

Vascular Arch

Vascular Arch

Vascular Arch

3 Vascular Arches Arch Structure below arch Aorta Left pulmonary artery 3. Azygos vein Pulmonary artery, vein Left main bronchus Right main bronchus

The brachocephalic vein runs anterior to the branches of the aorta

Frontal of the brachiocephalic vein and aortic arch 195

Brachiocephalic artery Left common carotid artery Aortic arch Brachiocephalic artery Left common carotid artery Right brachio-cephalic vein Left brachio-cephalic vein Superior vena cava Trachea 195

The trachea is just ventral to the esophagus

Brachiocephalic artery Left common carotid artery Trachea Brachiocephalic artery Left common carotid artery Left subclavian artery Esophagus Branches of the aorta 196

Origin of the great vessels above the aortic arch 195

Origin of the great vessels above the aortic arch Right

Left brachio-cephalic vein Right brachio-cephalic vein Brachiocephalic artery Left common carotid artery Left subclavian artery Tracheal area Esophagus Right

The azygos arch passes over the right main-stem bronchus

Superior vena cava Right atrium Right ventricle Inferior vena cava DIAPHRAGM 208

Right main pulmonary art Right pulmonary veins Right atrium Superior vena cava Azygos arch Right bronchus Right main pulmonary art Right pulmonary veins Right atrium Azygos vein 208

Level of the aortic arch 195

Level of the aortic arch

Aortic arch Superior vena cava Trachea Azygos arch Esophagus Vertebra Level of the aortic arch

The left pulmonary artery passes over the left main-stem bronchus

Left main pulmonary art Left atrium Left ventricle Aortic arch Left main pulmonary art Left atrium Left ventricle LEFT DIAPHRAGM 219

Left main pulmonary artery Left mainstem bronchus Left pulmonary veins Aorta Left main pulmonary artery Left mainstem bronchus Left pulmonary veins Left atrium 219

Level below the aortic arch (top of the left pulmonary artery SVC ASCENDING AORTA PULMONARY ARTERY 201

Level below the aortic arch (top of the left pulmonary artery

Top of left pulmonary artery Descending aorta Azygos vein Ascending aorta Main pulmonary artery Superior vena cava Right pul art Right bronchus Left bronchus Top of left pulmonary artery Descending aorta Azygos vein BACK WALL OF BRONCHUS

Level at the root of the aorta and main pulmonary artery Top of the right atrium Ascending Aorta Pulmonary artery 201

Ascending aorta Main pulmonary artery Right atrium Rt pulmonary artery Right bronchus Left bronchus Lt lower lobe PA Descending aorta Azygos vein Back of the left bronchus

The pulmonary trunk is anterior to the aorta root

The arota arises from “center” of heart

Heart from the Front Left atrium Aorta Pulmonary artery Left ventricle Right Atrium Aorta Pulmonary artery Right Ventricle Left ventricle 204

Level at the top of the ventricles Right Atrium Left Ventricle Right ventricle 201

Level at the top of the ventricles

Right ventricle Right atrium Ascending aorta Left ventricle Left atrium Descending aorta Azygos vein Level at the top of the ventricles

Heart Chambers Most anterior Most posterior Right boarder Left boarder Right ventricle Left atrium Right atrium Left atrium/ ventricle Most superior Left atrium

Level through all 4 heart chambers Right ventricle Right atrium Left ventricle Left atrium Pulmonary veins Descending aorta Azygos vein Level through all 4 heart chambers 230

Level through all 4 heart chambers Right Atrium Left Ventricle Right ventricle 201

Right ventricle Right atrium Left ventricle Left atrium Aorta Azygos vein

Level at the bottom of the heart (below left atrium) Right Atrium Left Ventricle Right ventricle 201

Level at the bottom of the heart (below left atrium)

Right ventricle Inferior vena cava Left ventricle Aorta Azygos vein Level at the bottom of the heart (below left atrium)

Follow a drop of blood from the left arm to the head

TO THE LEFT BRACIOCEPHALIC VEIN X MS 211 CT 7 NORMAL CHEST CT

INTO THE SVC X

SVC X

SVC X

SVC X

SVC X

SVC X

SVC X

SVC X

SVC X

TOP OF THE RA X

RA X

RA X

INTO THE RV X

RV X

RV X

RV X

RV X

RV X

RV X

RV X

RV OUTFLOW X

RV OUTFLOW X

RV INTO MAIN PA X

MAIN PA X

RT AND LT PA’S X

RT AND LT PA’S X X

FROM LUNG TO LA X

LA X

LV X

LV TO OUTFLOW X X X

INTO ASCENDING AORTA X

ASCENDING AORTA X

ASCENDING AORTA X

ASCENDING AORTA X

INTO AORTIC ARCH X

AORTIC ARCH X

AORTIC ARCH X

INTO BRACHIOCEPHALIC ARTERY X

INTO THE CAROTIDS X X

Department of Radiology Thorax David S. Hartman, M.D. Department of Radiology