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  1. 1. „ Selected Chapters from the Cross-Sectional Anatomy of the Human Body” Chest anatomy András Jakab MD, Levente István Lánczi MD
  2. 3. Bony structure of the chest <ul><li>Thoracic vertebrae (12) </li></ul><ul><li>Ribs (12 pairs) (clinical relation: cervical rib!) </li></ul><ul><li>Sternum </li></ul><ul><ul><li>Sternal angle (T4) </li></ul></ul><ul><ul><li>Jugular notch </li></ul></ul><ul><ul><li>Xyphoid process </li></ul></ul><ul><li>Scapula </li></ul>
  3. 4. Ribs – Costae
  4. 5. Sternum
  5. 6. The whole chest – breathing
  6. 7. Muscles of the trunk – superficial back muscles <ul><li>Spinohumeral muscles </li></ul><ul><ul><li>Levator scapulae m. </li></ul></ul><ul><ul><li>Trapezius m. </li></ul></ul><ul><ul><li>Rhomboideus m. </li></ul></ul><ul><ul><li>Latissimus dorsi m. </li></ul></ul>
  7. 8. Muscles of the trunk – deep (axial) back muscles <ul><ul><li>Splenius capitis & cervicis m </li></ul></ul><ul><ul><li>Transversospinal muscles </li></ul></ul><ul><ul><ul><li>Semispinalis mm. (capitis, cervicis, thoracis) </li></ul></ul></ul><ul><ul><ul><li>Multifidus m. </li></ul></ul></ul><ul><ul><ul><li>Interspinales mm. </li></ul></ul></ul><ul><ul><ul><li>Intertransversarii mm. </li></ul></ul></ul><ul><ul><li>Spinalis thoracis m. </li></ul></ul><ul><ul><li>Longissimus thoracis m. </li></ul></ul><ul><ul><li>Erector spinae m. </li></ul></ul><ul><ul><li>Nuchal ligament </li></ul></ul><ul><ul><li>Thoracolumbal fascia </li></ul></ul>
  8. 9. Breathing muscles <ul><li>Breathing muscles </li></ul><ul><ul><li>Intercostal mm. </li></ul></ul><ul><ul><li>Diaphragm </li></ul></ul><ul><li>Accesory breathing muscles </li></ul><ul><ul><li>Scaleni mm. </li></ul></ul><ul><ul><li>Sternocleidomastoid mm. </li></ul></ul><ul><ul><li>Levator costarum mm. </li></ul></ul><ul><ul><li>Serratus posterior superior m. </li></ul></ul><ul><ul><li>Thoracohumeral mm. </li></ul></ul><ul><ul><li>Abdominal mm. </li></ul></ul><ul><ul><li>Serratus posterior inferior m. </li></ul></ul><ul><ul><li>Transversus thoracis m. </li></ul></ul>belégzés kilégzés
  9. 10. <ul><li>Intercostal mm. </li></ul><ul><ul><li>External intercostal mm. </li></ul></ul><ul><ul><li>Internal intercostal mm. </li></ul></ul>
  10. 11. Pectoral mm. SA LD Tr Rh ESM Th7 DAo AAo PT PVL SVC PVR BrL BrR BS
  11. 12. ESM TVS LD AO PM QL
  12. 13. Circulatory system
  13. 15. <ul><li>Brachiocephalic trunk </li></ul><ul><ul><li>Right common carotid a. </li></ul></ul><ul><ul><li>Right vertebral a. </li></ul></ul><ul><ul><li>Right subclavian a. </li></ul></ul><ul><li>Left common carotid a. </li></ul><ul><li>Left subclavian a. </li></ul><ul><ul><li>Left vertebral a. </li></ul></ul>
  14. 17. Heart Right auricle Right atrium Right venrticle Right pulmonal a. Aortic arch Brachiocephalic trunk Left common carotid a. Left subclavian a. Arterial lig. (Botallo) Left pulmonal a. Pulmonal trunk Left auricle Apex Left ventricle Conus arteriosus
  15. 18. Apex Left ventricle Left pulmonal a. Superior v. cava Azygos v. Brachiocephalic vv. right left Aortic arch Right pulmonal a. Left pulmonal veins Right pulmonal vv. Right atrium Left atrium Inferior v. cava Left venrticle Left auricle
  16. 19. Ascending aorta Left atrium Right auricle Interventricular septum muscular part Interventricular septum membranous part Aortic valve Atrioventricular valves left (mitral) right (tricuspidal) Papillary mm. Apex
  17. 20. Interventricular septum muscular part Left ventricle Right ventricle Posterior intervenrticular sulcus Anterior intervenrticular sulcus Papillary mm. chordae tendineae trabeculae carneae
  18. 22. Veins Subclavian v. Internal jugular v. Right brachiocephalic v. Left brachiocephalic v. Superior v. cava Right pulmonal vv. Left pulmonal vv. Right atrium Left atrium Inferior v. cava Hepatic vv.
  19. 23. Respiratory system
  20. 24. Trachea, bronchi <ul><li>Cricoid cartilage – C7 </li></ul><ul><li>Trachea </li></ul><ul><li>T5: bifurcation of trachea </li></ul><ul><li>Principal bronchi </li></ul><ul><ul><li>Right: wider, steeper </li></ul></ul><ul><ul><li>Lobar bronchi </li></ul></ul><ul><ul><li>Segmental bronchi </li></ul></ul><ul><ul><li>Bronchioli </li></ul></ul>
  21. 26. Anatomy of the lung <ul><li>Airflow </li></ul><ul><li>Basis – Apex – Hilus </li></ul><ul><li>Lobes </li></ul><ul><ul><li>Left side: 2; right side: 3 </li></ul></ul><ul><li>Pulmonary segments (20) </li></ul><ul><ul><li>Left: 5-5; right: 3-2-5 </li></ul></ul><ul><li>Pleura </li></ul><ul><li>Diaphragm </li></ul>
  22. 27. Superior lobe Middle lobe Inferior lobe Oblique fissure Horizontal fissure
  23. 28. Lobar bronchi Pulmonal a. and v. Lymphatic nodes nerves Hilum of lung
  24. 29. 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
  25. 30. What can be seen on a PA radiograph of the chest? <ul><li>Thoracic cage bones </li></ul><ul><ul><li>Vertebrae </li></ul></ul><ul><ul><li>Ribs </li></ul></ul><ul><ul><li>Clavicle & scapule </li></ul></ul><ul><li>Heart </li></ul><ul><ul><li>Superior vena cava (1) </li></ul></ul><ul><ul><li>Right atrium (2) </li></ul></ul><ul><ul><li>Left ventricle (6) </li></ul></ul><ul><ul><li>Left atrium (auricle) (5) </li></ul></ul><ul><ul><li>Pulmonary trunk (4) </li></ul></ul><ul><ul><li>” Aortic button” (3) </li></ul></ul><ul><li>Airways </li></ul><ul><ul><li>Trachea </li></ul></ul><ul><ul><li>Right & left primary bronchi </li></ul></ul><ul><li>Diaphragm & recesses </li></ul>
  26. 31. What can be looked for on the axial scans? <ul><li>Brachiocephalic tr. </li></ul><ul><li>Left common carotid a. </li></ul><ul><li>Left subclavian a. </li></ul><ul><li>Right and left brachiocephalic vv. </li></ul><ul><li>Apex of the lung </li></ul><ul><li>Vertebrae, ribs, muscles </li></ul>
  27. 32. T3
  28. 33. What can be looked for on the axial scans? <ul><li>Aortic arch </li></ul><ul><li>Superior vena cava </li></ul><ul><li>Lung </li></ul><ul><li>Vertebrae, ribs, muscles </li></ul>
  29. 34. T4
  30. 35. What can be looked for on the axial scans? <ul><li>Descending and ascending aorta </li></ul><ul><li>Superior vena cava </li></ul><ul><li>Vertebrae, ribs, muscles </li></ul>
  31. 36. T5
  32. 37. Azygos vein
  33. 39. T6
  34. 41. T7
  35. 43. T8
  36. 44. Important landmarks on axial scans <ul><li>Bones – vertebrae, ribs, articulatio costovertebralis </li></ul><ul><li>Sternum </li></ul><ul><ul><li>Manubrium </li></ul></ul><ul><ul><li>Angulus – T4; 2nd rib </li></ul></ul><ul><ul><li>Body – T5-T10 </li></ul></ul><ul><li>Muscles: erector spinae, trapezius, intercostal, pectoral </li></ul><ul><li>Trachea </li></ul><ul><li>Oesophagus, thymus! </li></ul><ul><li>Vessels – aortic arch, superior vena cava </li></ul><ul><li>Pulmonary vessels, pleura </li></ul><ul><li>Heart, pericardium </li></ul><ul><li>Parenchyma of the lung; hilum of lung! </li></ul>
  37. 47. Grat vessels demonstrated on IMAIOS
  38. 48. Trachea demonstrated on IMAIOS
  39. 49. Oespophgaus demonstrated on IMAIOS
  40. 50. Heart chambers on axial CT scans
  41. 52. ao ao
  42. 57. Cardiac MRI
  43. 59. Coronarography demonstrated on IMAIOS
  44. 60. Segments of the lung
  45. 61. 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
  46. 62. JOBB BAL
  47. 63. 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
  48. 64. JOBB BAL
  49. 65. 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
  50. 66. JOBB BAL
  51. 67. 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
  52. 68. JOBB BAL
  53. 72. Clinical case <ul><li>74 year old male </li></ul><ul><li>Cough, low grade fewer recently; smoker </li></ul><ul><li>Chest X-ray, CT: rounded lesion on right side </li></ul><ul><li>http://www.eurorad.org/case.php?id=8653 </li></ul><ul><li>Diagnosis: rounded pneumonia </li></ul><ul><ul><li>Usual in children, SARS </li></ul></ul><ul><ul><li>Not easy to differentiate on images: TUMOR! </li></ul></ul><ul><ul><li>Biopsy, follow up can help </li></ul></ul>
  54. 73. Esetbemutatás <ul><li>81 year old male </li></ul><ul><li>Dyspnoea, dysphagia, stridor </li></ul><ul><li>Earlier: lung carcinoma surgery, coronary artery bypass </li></ul><ul><li>CXR, CT: right lung consolidation, bulky oesophagus, gas pockets </li></ul><ul><li>http://www.eurorad.org/case.php?id=8584 </li></ul><ul><li>Dg: bronchooesophageal fistule </li></ul><ul><ul><li>Contrast swallow </li></ul></ul>
  55. 75. Esetbemutatás <ul><li>Miliáris kórképek </li></ul><ul><li>http://www.eurorad.org/case.php?id=8255 </li></ul><ul><li>http://www.eurorad.org/case.php?id=4516 </li></ul><ul><li>http://www.eurorad.org/case.php?id=2180 </li></ul>
  56. 76. Esetbemutatás <ul><li>39 éves férfi, motorbaleset </li></ul><ul><li>http://www.eurorad.org/case.php?id=6939 </li></ul><ul><li>Aorta ruptura </li></ul>
  57. 77. Esetbemutatás <ul><li>A. pulmonaris aneurysma http://www.eurorad.org/case.php?id=8208 </li></ul><ul><li>V. subclavia thrombozis http://www.eurorad.org/case.php?id=8016 </li></ul><ul><li>Aortadisszekció Marfan-syndromában http://www.eurorad.org/case.php?id=7919 </li></ul>
  58. 78. Esetbemutatás <ul><li>TOS http://www.eurorad.org/case.php?id=8391 </li></ul><ul><li>Sertésinfluenza (H1N1) http://www.eurorad.org/case.php?id=8257 </li></ul><ul><li>PE http://www.eurorad.org/case.php?id=7735 </li></ul><ul><li>Tűznyelő pneumoniája http://www.eurorad.org/case.php?id=7197 </li></ul><ul><li>Pneumomediastium http://www.eurorad.org/case.php?id=5060 </li></ul>
  59. 79. Mellkas és szív anatómiája – kiegészítések, források
  60. 80. www.ChestRadiology.net A web-based, interactive tutorial and reference database in anatomy for chest imaging www.ChestRadiology.Net
  61. 81. MENU Case & Chapter Reading Modes www.ChestRadiology.Net
  62. 82. MENU The user may read the tutorial in two modes: Title by title… <ul><li>The anatomy tutorial includes chapters about: </li></ul><ul><li>Techniques </li></ul><ul><li>Standard exams </li></ul><ul><li>Projections </li></ul><ul><li>Airways </li></ul><ul><li>Lung parenchyma </li></ul><ul><li>Heart and vessels </li></ul><ul><li>Mediastinum </li></ul><ul><li>Diaphragm </li></ul><ul><li>Pleura </li></ul><ul><li>Pitfalls </li></ul><ul><li>Pathology </li></ul><ul><li>Normal values </li></ul>
  63. 83. MENU … by reading page by page like a book (you can page back and forward), or…
  64. 84. MENU … or by reading the entire chapter at once
  65. 85. MENU
  66. 86. MENU
  67. 87. IMAIOS

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