1. Vascular structure Thorax and Abdomen Almas Khan Radiology Technologist Khorfakhan Hospital

2. Vascular structure Thorax and Abdomen Talk plan:-  Vascular system and Circulations  Co relation with Anatomical landmark  Common Indications.

3. Components of circulatory system Circulatory system Cardiovascular Lymphatic system Cardio Vascular Lymph (heart) (vessels) Lymph vessels Lymphatic nodules Pulmonary Systemic ( lung) ( body) The circulatory system consists of cardiovascular and lymphatic components. The cardiovascular portion includes heart, blood, and vessels that Transport the blood.

5. Blood vessels Arteries: carry blood away from the heart Arterioles – smallest arteries, carrying blood to tissue. Veins: carry blood back to the heart Venules – smallest vein, returning blood from tissue. Capillaries: microscopic blood vessels.

6. Aorta Four segments of Aorta 1)Aortic bulb ( root ) 2)Ascending aorta 3)Ascending arch 4)Descending aorta. Branches of Arch of Aorta :- 1) Brachiocephalic artery 2 ) Left common carotid artery 3) Left subclavian artery

7. Vascular structure Head and neck

8. Thoracic Aorta and major branches The thoracic aorta begins at the level of vertebra T5 and continue through to the diaphragm at the level of T12. Initially traveling within the mediastinum to the left of vertebral column, as it passes through the thoracic region.

9. Thoracic aorta branches : Visceral branches : Supply blood primarily to visceral organs of thorax Bronchial artery Esophageal artery Pericardial artery Mediastinal artery Parietal (somatic ) branches : blood to the muscles of thoracic cavity and vertebral column Intercostal artery Superior phrenic artery.

10. Thoracic aorta branches : Each bronchial artery supplies systemic blood to the lung and visceral pleura. Each pericardial artery supplies blood to the pericardium. Esophageal artery provides blood to the esophagus Mediastinal artery provides blood to the mediastinum. Each intercostal artery provides blood to the muscles of the thoracic cavity and vertebral column. Superior phrenic artery provides blood to the superior surface of the diaphram.

12. Abdominal Aorta and Major branches After crossing through the diaphragm at the aortic hiatus, the thoracic aorta is called abdominal aorta. It formally ends at the level of L4 vertebra. It bifurcates to form the common iliac arteries. Abdomen aorta gives rise to several important branches.

13. Celiac trunk:- Also called celiac artery a major branch of abdomen aorta, gives rise to the gastric artery, splenic artery, and common hepatic artery that forms the hepatic artery to the liver The right artery to the stomach, cystic artery to the gall bladder. CHA: common hepatic artery; CT: celiac trunk; GDA: gastroduodenal artery; LGA: left gastric artery; LHA: left hepatic artery; RHA: right hepatic artery; SA: splenic artery; SMA: superior mesenteric artery

14. Abdomen aorta Branches….. Left gastric artery : Branch of celiac trunk ; supply blood to stomach. Splenic artery : Branch of celiac trunk ; supply blood to the spleen. Common hepatic artery (CHA) : Br of celiac trunk that forms the hepatic artery, right gastric artery and cystic artery. Hepatic artery proper : Br of CHA ; supplies systemic blood to the liver. Right gastric artery : Br of CHA ; supplies blood to the stomach. Cystic artery : Br of CHA ; supplies blood to the gall bladder.

16. Superior mesenteric artery : Br of abdominal aorta ; suppilies blood to the small intestine (duodenum, jejunum, ileum), pancreases and a majority of the large intestine. Inferior meseneteric artery: supplies blood to the distal segment of the large intestine and rectum. Inferior phrenic artery : supplies blood to the inferior surface of diaphragm.

17. Adrenal artery: Br of abdominal aorta ; supplies blood to the adrenal (suprarenal ) glands. Renal artery : Branches approximately 2.5 cm inferior to the superior mesenteric arteries and supplies a kidney. The right renal artery is longer than the left since the aorta lies to the left of vertebral column.

18. Gonadal artery : Supplies blood to the gonads,or reproductive organs. Lumbar arteries : Supply blood to the lumbar region, the abdomen wall, and the spinal cord. The aorta divided at the level of vertebra L4 into left and right Common iliac artery. But continues as a small vessels, the median sacral artery in to sacrum.

20. The common iliac arteries provides blood to the pelvic region and lower limbs They split into external and internal iliac arteries. Internal iliac arteries: Supplies blood to the urinary bladder, wall of pelvis, external genitalia, medial portion of the femoral region. External iliac artery: It leaves the body cavity and become a femoral artery, supplies blood to lower limbs

21. Thoracic vein The right atrium receives all of the systemic venous return. The major veins the chest are the superior vena cava, azygos and pulmonary artery. Most of blood flow into either superior vena cava or inferior vena cava. Superior vena cava : Large systemic vein, blood from most areas superior to the diaphragm, empties in to right atrium.

22. Azygos vein : return blood from posterior thoracic wall to superior vena cava. The superior and inferior pulmonary veins return oxygenated blood from the lungs to the left atrium. Inferior vena cava return blood from the abdomen and lower limbs to the right atrium.

23. Abdominal veins Inferior vena cava : parallel the abdominal aorta. Receives blood from abdominal veins. This veins include the right and left common iliacs, internal iliacs external iliacs, renal veins and hepatic portal systems. Superior and inferior mesenteric veins return blood from the small and large intestine through the hepatic portal vein. Liver drains to each hepatic vein and directly in inferior vena cava.

24. Tributaries Of The Inferior Vena Cava Right suprarenal vein Right gonadal vein Hepatic veins Inferior vena cava External iliac vein Inferior phrenic vein Renal veins Lumbar veins Left ascending lumbar vein Left gonadal vein Common iliac vein Internal iliac vein Left suprarenal vein

25. Major Branches Of The Abdominal Aorta Adrenal gland Celiac trunk Kidney Abdominal aorta Diaphragm Suprarenal artery Renal artery Superior mesenteric artery Gonadal artery Inferior mesenteric artery Common iliac artery

26. Hepatic portal system : Contains substance absorbed by the stomach and intestines Delivers these compounds to the liver for Storage Metabolic conversion Excretion Nutrients from the digestive tract enter the hepatic portal vein

27. Tributaries of the Hepatic Portal Vein Inferior mesenteric vein: drains part of large intestine Splenic vein: drains spleen, part of stomach, and pancreas Superior mesenteric vein: drains part of stomach, small intestine, and part of large intestine Left and right gastric veins: drains part of stomach Cystic vein: drains gallbladder

28. Veins Of The Hepatic Portal System Hepatic veins Liver Spleen Gastric veins Inferior vena cava Splenic vein Inferior mesenteric vein Superior mesenteric vein Large intestine Hepatic portal vein Small intestine Rectum

29. The Hepatic Portal System A specialized part of the vascular circuit Picks up digested nutrients Delivers nutrients to the liver for processing

32. CT Angiogram CT Angiography is a medical exam that combines a CT scan with an injection of a contrast material to produce pictures of blood vessels and tissue in a part of body. CT Angiography to helps diagnose a narrowing or obstruction of the arteries, an aneurysm, deep vein thrombosis, pulmonary embolism, or other vascular condition.

33. MDCT angiography findings of the most common aortic diseases: 1. Congenital disorders 2. Inflammatory pathology 3. Aortic aneurysm 4. Complications of aortic aneurysm - Rupture - Impeding rupture 5. Acute aortic syndrome - Aortic dissection - Intramural hematoma - Penetrating atherosclerotic ulcer 6. Traumatic injuries 7. Postsurgical complications

34. Locator position for Angiograms Example of the regions of interest (ROIs) drawn on the aorta (arrow) to obtain the CT values. ROI 1: Arch of aorta at Th 7 level, ROI 2: abdominal aorta at L 1 level, and ROI 3: S 1 level.

35. CT Pulmonary Angiogram (CTA) localize the pulmonary trunk, which is just at or below the level of the bifurcation of the trachea (white lines). The resulting axial CT localization image is shown on the right. An elliptical ROI is placed in the right pulmonary artery to measure the time for contrast to reach this area from the injection site.

36. CT Pulmonary Angiogram (CTA) A picture of a heart model that displays the right atrium (RA) that receives deoxygenated blood from the superior vena cava (SVC). The blood then flows to the right ventricle (RV)) and to the pulmonary trunk (PT). These structures are also seen on the coronal CT image on the right. Also labeled are the aorta (A) and left ventricle (LV).

37. CT Pulmonary Angiogram (CTA) These two axial CT images show profound pulmonary emboli. On the left the embolus almost completely blocks the right pulmonary artery (yellow arrow). Right image show an extensive saddle embolus forming in both pulmonary arteries and becoming extensive. Both of these types of pulmonary emboli are life threatening and require immediate medical attention. Left- axial CT image demonstrate the anatomical presentations of the pulmonary trunk when normal in size, caliber, and pressure (yellow arrow), and on the right an example of a large widened pulmonary trunk (pink arrow) due to pulmonary hypertension.

38. MIP- and VRT-images: steno-obstructive disease Calcifications Aneurysms

39. CT Angiography Aorta bolus tracking time CT Pulmonary study timing Post Inj delay : 7sec Post threshold : Automatic minimum Scan start time : 12 seconds HU :120 /150 Locator : Just below the bifurcation CT Abdomen bolus tracking timing Post Inj delay : 12 Arterial : 18 to 20 seconds Portal venous phase : 70 sec Equilibrium : 120 sec CT KUB with Contrast Scan to start 5 to 10 mts from the start of Inj Post Inj delay : 8 sec Post threshold : 5 sec Scan start time : 15 sec HU : 120/150 Locator : Arch of aorta

40. Case Studies of Radiology Department Khorfakhan Hospital

44. CONCLUSION  We are able to understand how the circulation of blood is organized in the thorax and Abdomen.  Helps to identify vessels after injection of contrast.  A good understanding of anatomy is essential while performing angiography. Normal and abnormal distribution of circulatory system  Co relation with Anatomical landmark helps to identify vascular structures of Thorax and Abdomen precisely.

45. Thanks for the motivation and guidance provided by our Radiologists with out which we would not have achieved good results. Congrats and expecting continued best support from all my colleagues.

46. Thank you