chest

„Selected Chapters from theCross-Sectional Anatomy

of the Human Body”

Chest anatomyAndrás Jakab MD, Levente István Lánczi MD

Bony structure of the chest

Thoracic vertebrae (12) Ribs (12 pairs) (clinical relation: cervical rib!) Sternum

Sternal angle (T4) Jugular notch Xyphoid process

Scapula

Ribs – Costae

Sternum

The whole chest – breathing

Muscles of the trunk – superficial back muscles

Spinohumeral muscles Levator scapulae m. Trapezius m. Rhomboideus m. Latissimus dorsi m.

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

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

Intercostal mm. External intercostal mm. Internal intercostal mm.

Pectoralmm.

SA

LDTrRh

ESM

Th7

DAo

AAoPT

PVL

SVC

PVR

BrL

BrR

BS

ESMTVS

LD

AO

PM

QL

Circulatory system

Brachiocephalic trunk Right common carotid a. Right vertebral a. Right subclavian a.

Left common carotid a. Left subclavian a.

Left vertebral a.

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

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

Ascending aortaLeft atrium

Right auricle

Interventricular septum muscular part

Interventricular septum membranous part

Aortic valve

Atrioventricular valvesleft (mitral)

right (tricuspidal)

Papillary mm.

Apex

Interventricular septum muscular part

Left ventricleRight ventricle

Posterior intervenrticular sulcus

Anterior intervenrticular sulcus

Papillary mm.

chordae tendineae

trabeculae carneae

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.

Respiratory system

Trachea, bronchi

Cricoid cartilage – C7 Trachea T5: bifurcation of trachea Principal bronchi

Right: wider, steeper Lobar bronchi Segmental bronchi Bronchioli

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

Superior lobe

Middle lobe

Inferior lobe

Oblique fissure

Horizontal

fissure

Lobar bronchi

Pulmonal a. and v.

Lymphatic nodes

nerves

Hilum of lung

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

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

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


Aortic arch Superior vena cava Lung Vertebrae, ribs,

muscles


Descending and ascending aorta

Superior vena cava Vertebrae, ribs,

muscles

Azygos vein

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!

Grat vessels demonstrated on

IMAIOS

Trachea demonstrated on IMAIOS

Oespophgaus demonstrated on

IMAIOS

Heart chambers on axial CT scans

ao

ao

Cardiac MRI

Coronarography demonstrated on

IMAIOS

Segments of the lung

Apical segment

Posterior segment

Anterior segment

Lateral segment

Medial segment

Superior segment

Posterior

basal

segment

Lateral basal

segment

Anterior basal

segment



Anterior segment

Superior lingular

segment

Superior segment

Lateral basal

segment

Posterior

basal

segment

Anterior basal

segment

Inferior

lingular

segment

JOBB BAL

Apical segment

Posterior segment

Anterior segment

Lateral segment

Medial segment

Superior segment

Posterior

basal

segment

Lateral basal

segment

Anterior basal

segment



Anterior segment

Superior lingular

segment

Superior segment

Lateral basal

segment

Posterior

basal

segment

Anterior basal

segment

Inferior

lingular

segment

JOBB BAL

Apical segment

Posterior segment

Anterior segment

Lateral segment

Medial segment

Superior segment

Posterior

basal

segment

Lateral basal

segment

Anterior basal

segment



Anterior segment

Superior lingular

segment

Superior segment

Lateral basal

segment

Posterior

basal

segment

Anterior basal

segment

Inferior

lingular

segment

JOBB BAL

Apical segment

Posterior segment

Anterior segment

Lateral segment

Medial segment

Superior segment

Posterior

basal

segment

Lateral basal

segment

Anterior basal

segment



Anterior segment

Superior lingular

segment

Superior segment

Lateral basal

segment

Posterior

basal

segment

Anterior basal

segment

Inferior

lingular

segment

JOBB BAL

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


Esetbemutatás 81 year old male Dyspnoea, dysphagia, stridor Earlier: lung carcinoma surgery, coronary artery

bypass CXR, CT: right lung consolidation, bulky

oesophagus, gas pockets


Dg: bronchooesophageal fistule Contrast swallow


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

Esetbemutatás

39 éves férfi, motorbaleset http://www.eurorad.org/case.php?id=6939 Aorta ruptura

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

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

Mellkas és szív anatómiája –

kiegészítések, források

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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Case & Chapter Reading ModesCase & Chapter Reading Modes

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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

IMAIOS

chest

Education

Transcript of chest