Chest CT

Thoracic Apertures Superior Aperture Thoracic Inlet Formed by first thoracic vert. First pair of ribs w/ costal cartilage Manubrium Functions: Passage way for nerves, vessels and viscera from the neck into the thoracic cavity

THORACIC APERTURES Inferior Aperture Thoracic Outlet Much larger 12th. thoracic vert. 12th. pair of ribs and costal margins Xiphoid Sternal junction

Includes trachea, bronchi, great vessels, lymph nodes,and heart. Covers from the middle of the right to left lung, and to the sternum to the spinal column. Other important facts Carina is at the level of T5 Pulmonary artery carries deoxygenated blood and divides at T5-6 Pulmonary vein carries oxygenated blood Mediastinum

Includes trachea, bronchi, great vessels, lymph nodes,and heart.

Covers from the middle of the right to left lung, and to the sternum to the spinal column.

Other important facts

Carina is at the level of T5

Pulmonary artery carries deoxygenated blood and divides at T5-6

Pulmonary vein carries oxygenated blood

Bony Thorax Protects the lungs and aids in respiration Vertebrae (12) Sternum (1) Ribs (12) pairs Costal cartilages

Protects the lungs and aids in respiration

Vertebrae (12)

Sternum (1)

Ribs (12) pairs

Costal cartilages

Sternum (3) Components: Manubrium Body Xiphoid process Sternoclavicular joints Jugular notch Sternal angle (T4-T5)

(3) Components:

Manubrium

Body

Xiphoid process

Sternoclavicular joints

Jugular notch

Sternal angle (T4-T5)

Sternum Attachments

Ribs Form the lateral borders of the thoracic cage all (12) pairs articulate post. With T spine First (7) pairs are TRUE Lower (5) pairs FALSE

Form the lateral borders of the thoracic cage

all (12) pairs articulate post. With T spine

First (7) pairs are TRUE

Lower (5) pairs FALSE

Rib Images

Rib Articulations

Trachea Air is transported through the trachea. The cells that line the trachea have minuscule hair-like cilia, which collect any dust that you inhale, and prevent it from entering your lungs. It is then removed by coughing. To prevent food from entering your windpipe, it has a small flap of skin at the entrance (epiglottis). When you eat, this flap closes over your trachea to prevent food from entering.

Air is transported through the trachea. The cells that line the trachea have minuscule hair-like cilia, which collect any dust that you inhale, and prevent it from entering your lungs. It is then removed by coughing.

To prevent food from entering your windpipe, it has a small flap of skin at the entrance (epiglottis). When you eat, this flap closes over your trachea to prevent food from entering.

Pleura the lungs are surrounded by two serous membranes , the pleurae . The outer pleura ( parietal pleura ) covers and is attached to the chest wall . The inner pleura ( visceral pleura ) covers and is attached to the lung and other structures, i.e. blood vessels , bronchi and nerves . Between the two is a thin space known as the pleural space , which normally contains a small amount of pleural fluid .

the lungs are surrounded by two serous membranes , the pleurae . The outer pleura ( parietal pleura ) covers and is attached to the chest wall . The inner pleura ( visceral pleura ) covers and is attached to the lung and other structures, i.e. blood vessels , bronchi and nerves . Between the two is a thin space known as the pleural space , which normally contains a small amount of pleural fluid .

Bronchus Right and left Right is larger Right divides into (3) sections or secondary bronchi Left divides into (2) bronchi

Right and left

Right is larger

Right divides into (3) sections or secondary bronchi

Left divides into (2) bronchi

Bronchi

Secondary Bronchi

Lungs Right lung has 3 lobes Left lung has 2 lobes

Lung Anatomy

Lots of Anatomy

Lung and Chest

Esophagus Extends from pharynx to stomach. Anterior to spine & posterior to trachea Passes through the esophageal hiatus (opening)

Extends from pharynx to stomach.

Anterior to spine & posterior to trachea

Passes through the esophageal hiatus (opening)

Lymph Nodes Drain waste and tissue fluids from cells small oval bodies runs along and is part of circulatory system has no pumping mechanism nodes sit in lymph vessels rid toxins from the body immune system

Drain waste and tissue fluids from cells

small oval bodies

runs along and is part of circulatory system

has no pumping mechanism

nodes sit in lymph vessels

rid toxins from the body

immune system

Pulmonary veins and arteries Aorta Vena cava Subclavian artery Common carotid Brachiocephalic artery and veins Azygos artery and vein Great Vessels

Pulmonary veins and arteries

Aorta

Vena cava

Subclavian artery

Common carotid

Brachiocephalic artery and veins

Azygos artery and vein

Thorax Contents

Major Vessels

Anterior to the trachea and arteries To the right of the mediastinum SVC is formed by a union of both brachiocephalic arteries Major Vein - SVC - Large trunk vein - receives branches from all of the body above the diaphragm except the lungs - Lies behind sternum

Anterior to the trachea and arteries

To the right of the mediastinum

SVC is formed by a union of both brachiocephalic arteries

Major Vein - IVC - large trunk vein - enters from lower abdomen - enters right atrium

- large trunk vein

- enters from lower abdomen

- enters right atrium

Thoracic Veins

Major Artery - Aorta - Main trunk Begins at lt. ventricle passes behind sternum behind sternum – ascending aorta at sternal angle (left) at thoracic vert. becomes descending aorta

- Main trunk

Begins at lt. ventricle

passes behind sternum

behind sternum – ascending aorta

at sternal angle (left)

at thoracic vert. becomes descending aorta

Branch from Aortic Arch

SVC RT ATRIUM TRICUSPID VALVE RT VENTRICLE PLUMONARY VALVE BICUSPID PULMONARY ARTERY LUNGS PULMONARY VEIN LT ATRIUM MITRAL VALVE BICUSPID LT VENTRICLE AORTIC VALVE TRICUSPID ASCENDING AORTA Circulation of Blood in Heart

SVC

RT ATRIUM

TRICUSPID VALVE

RT VENTRICLE

PLUMONARY VALVE BICUSPID

PULMONARY ARTERY

LUNGS

PULMONARY VEIN

LT ATRIUM

MITRAL VALVE BICUSPID

LT VENTRICLE

AORTIC VALVE TRICUSPID

ASCENDING AORTA

Pulmonary Circulation LPA

Pulmonary Arteries & Veins

Coronal Reformat

Coronary Arteries Right Coronary (1) Left Anterior Descending (2) Left Circumflex (3) Superior Vena Cava (4) Inferior Vena Cava (5) Aorta (6) Pulmonary Artery (7) Pulmonary Vein (8)

Heart Anatomy Right Atrium (9) Right Ventricle (10) Left Atrium (11) Left Ventricle (12) Papillary Muscles (13) Chordae Tendineae (14) Tricuspid Valve (15) Mitral Valve (16) Pulmonary Valve (17) Aortic Valve ( NOT PICTURED)

Survey for metastatic disease Lung infiltrates Mediastinal and hilar masses Pleural disease Parenchyma disease Indications

Survey for metastatic disease

Lung infiltrates

Mediastinal and hilar masses

Pleural disease

Parenchyma disease

Patient is in the supine position and either feet or head first Arms over the head Scout from the thoracic inlet to adrenal glands on inspiration Assess patient to see if they and hold breath for need time Contrast indications Pumonary emboli Mediastinal and hilar masses Lung infiltrates ( differentiating infiltrate from lung cancer ) Lung nodules High resolution scans can be done supine and prone Screening exams are preformed at a low dose ( 10-20 mA ) Prep

Patient is in the supine position and either feet or head first

Arms over the head

Scout from the thoracic inlet to adrenal glands on inspiration

Assess patient to see if they and hold breath for need time

Contrast indications

Pumonary emboli

Mediastinal and hilar masses

Lung infiltrates ( differentiating infiltrate from lung cancer )

Lung nodules

High resolution scans can be done supine and prone

Screening exams are preformed at a low dose ( 10-20 mA )

Scout

Lung nodules Cancer Vascular disease Effusion and infiltration Trauma Pulmonary Parenchymal diseases Hilar Masses Protocol Parameters Single Slice 4 SLICE 16 SLICE PATIENT HEAD or FEET FIRST. SUPINE SAME SAME SCANNING AREA APEX TO ADRENAL GLANDS SAME SAME CONTRAST 100ML AT 2ML/SEC @ 45 SECOND DELAY SAME SAME DETECTOR COLLI NA 4X1MM OR 1.25MM 16X0.75 OR 16X1.25 DFOV DEPENDS ON PATIENT SAME SAME SLICE THICKNESS 5 MM SAME SAME ANGLE NONE SAME SAME TABLE FEED/ROT 6MM VARIES VARIES PITCH 1 OR 1.5 VARIES VARIES ROT TIME 1 SEC 0.5 SEC 0.5 SEC RECON STANDARD/LUNG SAME SAME WINDOW 450W/30L—1600W/600L SAME SAME

Lung nodules

Cancer

Vascular disease

Effusion and infiltration

Trauma

Pulmonary Parenchymal diseases

Hilar Masses

Contrast Studies Ionic Diatrizoate meglumine Non Ionic Iopamidol Barium Sulfate Used as a paste to evaluate the esophagus

Ionic

Diatrizoate meglumine

Non Ionic

Iopamidol

Barium Sulfate

Used as a paste to evaluate the esophagus

Neck/Chest 1 2 2 3 4 1- Jugular Vein 2- Thyroid Gland 3- Trachea 4- Common Carotid 5- Esophagus 5

Chest Apex 1 2 3 4 5 1- Rt.Subclavian Vein 2- Right common carotid artery 3- Lt. Common Carotid artery 4- Sternoclavicular Joint 5- Lt. Subclavian Artery 6- Lt brachiocephalic vein 6

Arteries off Arch 1 2 3 4 5 6 1- Superior Vena Cava 2- Brachiolcephalic Artery 3- Lt. Common Carotid Artery 4- Lt. Subclavian Artery 5- Esophagus 6- Trachea 7- Lt.Brachiolcephalic Vein 7

Zoom off Arch 1 2 3 4 5 6 1- Superior Vena Cava 2- Brachiocephalic Artery 3- Lt. Common Carotid Artery 4- Lt. Subclavian Artery 5- Esophagus 6- Trachea 7- Lt.Brachiolcephalic Vein 7

Arch 1 1- Trachea 2- SVC 3- Aortic Arch 4- Scapula 2 3 4

Chest 1 2 3 1- Ascending Aorta 2- Carina 3- Descending Aorta

Pulmonary Trunk 1 2 3 1- Pulmonary Trunk 2- Lt.Pulmonary artery 3- Rt.Pulmonary artery 4- Azygos Vein 4

Mid Heart 1 2 3 5 6 1-Rt.Ventricle 2- Rt.Atrium 3- Aortic Root 4-Lt. Atrium 5- Pulmonary Vein 6-Lt.Ventricle 4

Zoom Mid Heart 1 2 3 4 5 6 1-Rt.Ventricle 2- Rt.Atrium 3- Aortic Root 4-Lt. Atrium 5- Pulmonary Vein 6-Lt.Ventricle

Top Heart 1 2 3 4 5 6 7 1- MYOCARDIUM 2-LV 3-LA 4-RV 5-RA (WITH CONTRAST) 6-LVOT 7-PULMONARY VEIN

Two Chambers 1-RV 2- SEPTUM 3-LV 4-DESCENDING AORTA 1 2 3 4

Near end of Study 1- Liver 2- Descending aorta 3- Spleen 1 2 3

End adrenal gland 1 1- Adrenal Gland Scan until we have no more lungs, and are at the level of both adrenal glands

First Section

Final Section

Lung Windows 1 2 1- Pulmonary Vein 2- Pulmonary Vein

L. Window 1 2 1- Lung Nodule 2- Bronchial Tubes

Indications Diffuse pulmonary disease Bronchiectasis Asbestosis Air trapping Sarcoid and fibrosis As HRCT's aim is to assess a generalized lung disease, the test is conventionally performed by taking thin sections 10-40 mm apart. HRCT

Indications

Diffuse pulmonary disease

Bronchiectasis

Asbestosis

Air trapping

Sarcoid and fibrosis

As HRCT's aim is to assess a generalized lung disease, the test is conventionally performed by taking thin sections 10-40 mm apart.

Lung nodules Cancer Vascular disease Effusion and infiltration Trauma Pulmonary Parenchymal diseases Hilar Masses High Resolution Parameters Single Slice 4SLICE 16 SLICE PATIENT HEAD or FEET FIRST. SUPINE PRONE FOR ASBESTOSIS SAME SAME SCANNING AREA APEX TO ADRENAL GLANDS SAME SAME CONTRAST NONE SAME SAME DETECTOR COLLI NA 2X0.5MM OR .625MM 1MM DFOV SKIN TO SKIN SAME SAME SLICE THICKNESS 1 MM SAME SAME ANGLE NONE SAME SAME TABLE FEED/ROT 10 MM SAME SAME PITCH 1NA VARIES VARIES ROT TIME 1 SEC 0.5 SEC 0.5 SEC RECON HIGH RESOLUTION/LUNG SAME SAME WINDOW 1600W/600L SAME SAME

Lung nodules

Cancer

Vascular disease

Effusion and infiltration

Trauma

Pulmonary Parenchymal diseases

Hilar Masses

HRCT

Dynamic Ct Quickly being replaced by Helical/Spiral CT, Dynamic Scanning is accomplished with short interscan delays the scan takes maximum advantage of the tissue enhancement from a bolus administration of intravenous iodinated contrast. Delay times are as low as 4 seconds.

Quickly being replaced by Helical/Spiral CT, Dynamic Scanning is accomplished with short interscan delays the scan takes maximum advantage of the tissue enhancement from a bolus administration of intravenous iodinated contrast. Delay times are as low as 4 seconds.

Enlarged Thyroid A goiter is an enlargement of the thyroid, and is sometimes used as a term to refer to an enlarged thyroid. The thyroid becomes large enough so that it can be seen as enlarged on ultrasounds or x- rays, and may be enlarged enough to enlarge the neck area visibly.

A goiter is an enlargement of the thyroid, and is sometimes used as a term to refer to an enlarged thyroid. The thyroid becomes large enough so that it can be seen as enlarged on ultrasounds or x- rays, and may be enlarged enough to enlarge the neck area visibly.

Interstitial Diseases of the Lung Interstitial disease of the lungs are usually diffuse pathologic processes involving the interstitium , or framework, of the lungs. Examples include: Bronchiectasis Emphysema Asbestosis Sarcoidosis

Interstitial disease of the lungs are usually diffuse pathologic processes involving the interstitium , or framework, of the lungs. Examples include:

Bronchiectasis

Emphysema

Asbestosis

Sarcoidosis

Bronchiectasis Bronchiectasis is a disease that causes localized, irreversible dilatation of part of the bronchial tree

EMPHYSEMA

Asbestosis Asbestosis is a chronic inflammatory medical condition affecting the parenchymal tissue of the lungs . It occurs after long-term, heavy exposure to asbestos , e.g. in mining , and is therefore regarded as an occupational lung disease . Sufferers have severe dyspnea (shortness of breath) and are at an increased risk regarding several different types of lung cancer .

Asbestosis is a chronic inflammatory medical condition affecting the parenchymal tissue of the lungs . It occurs after long-term, heavy exposure to asbestos , e.g. in mining , and is therefore regarded as an occupational lung disease . Sufferers have severe dyspnea (shortness of breath) and are at an increased risk regarding several different types of lung cancer .

Sarcoidosis Sarcoidosis , also called sarcoid (from the Greek 'sark' and 'oid' meaning "flesh-like") or Besnier-Boeck disease , is an immune system disorder characterised by non- caseating granulomas (small inflammatory nodules) that most commonly arises in young adults. The cause of the disease is still unknown. Virtually any organ can be affected; however, granulomas most often appear in the lungs or the lymph nodes .

Sarcoidosis , also called sarcoid (from the Greek 'sark' and 'oid' meaning "flesh-like") or Besnier-Boeck disease , is an immune system disorder characterised by non- caseating granulomas (small inflammatory nodules) that most commonly arises in young adults. The cause of the disease is still unknown. Virtually any organ can be affected; however, granulomas most often appear in the lungs or the lymph nodes .

Pulmonary embolism (PE) is a blockage of the pulmonary artery (or one of its branches), usually when a venous thrombus (blood clot from a vein), becomes dislodged from its site of formation and embolizes to the arterial blood supply of one of the lungs. This process is termed thromboembolism . Pulmonary embolism

Pulmonary embolism (PE) is a blockage of the pulmonary artery (or one of its branches), usually when a venous thrombus (blood clot from a vein), becomes dislodged from its site of formation and embolizes to the arterial blood supply of one of the lungs. This process is termed thromboembolism .

MDCT (multi detector CT) scanners give the optimum resolution and image quality for this test Images are usually taken on a 0.625mm slice thickness, although 2mm is sufficient. 50 - 100 mls of contrast is given to the patient at a rate of 4 ml/s. The tracker/locator is placed at the level of the Pulmonary Arteries, which sit roughly at the level of the carina. Images are acquired with the maximum intensity of radio-opaque contrast in the Pulmonary Arteries. This is done using bolus tracking Procedure

MDCT (multi detector CT) scanners give the optimum resolution and image quality for this test

Images are usually taken on a 0.625mm slice thickness, although 2mm is sufficient.

50 - 100 mls of contrast is given to the patient at a rate of 4 ml/s.

The tracker/locator is placed at the level of the Pulmonary Arteries, which sit roughly at the level of the carina.

Images are acquired with the maximum intensity of radio-opaque contrast in the Pulmonary Arteries. This is done using bolus tracking

PE Scan

Lung Mass

Lung Tumor

Aortic Aneurysm General term for any swelling ( dilatation or aneurysm ) of the aorta , usually representing an underlying weakness in the wall of the aorta at that location. While the stretched vessel may occasionally cause discomfort, a greater concern is the risk of rupture, which causes severe pain; massive internal hemorrhage ; and, without prompt treatment, results in a quick death. IV CONTRAST is necessary for accurate demonstration of AA. The contrast helps outline the wall of the aorta and the CT numbers within the actual lumen of the aorta are different from the dissected portion due to differences in blood flow

General term for any swelling ( dilatation or aneurysm ) of the aorta , usually representing an underlying weakness in the wall of the aorta at that location. While the stretched vessel may occasionally cause discomfort, a greater concern is the risk of rupture, which causes severe pain; massive internal hemorrhage ; and, without prompt treatment, results in a quick death.

Coronary Artery Calcification

Reconstructions