This document provides an overview of topographic anatomy and its correlation with MRI/CT imaging. It begins with introductory sections on relevant anatomy. The majority of the document consists of clinical cases presented with accompanying MRI/CT images and diagnoses. Cases include a variety of pulmonary, cardiac, hepatic, pancreatic and splenic pathologies such as lung cancer, empyema, liver abscess, hepatocellular carcinoma, pancreatic cancer and splenic lymphoma. Each case provides brief patient history and physical exam findings along with labeled MRI/CT images and diagnoses. The document concludes with references.

1. Prof. Vilai Chentanez MD PhD
Tanat Tabtieang MD
Department of Anatomy
Faculty of Medicine, Chulalongkorn University
1

2. Topographic anatomy and
Correlation with MRI/CT
2

3. Section 12

4. Section 13

5. Section 15

6. Section 17

7. Section 18

8. Mitral valve
Tricuspid valve
Section 20

9. Section 21

10. Section 22

11. Clinical Correlation
11

12.  A 58-year-old man presents with a 2-week
history of progressive dyspnea on exertion,
neck swelling, decreased appetite, and
fatigue.
 There is no history of syncope or dysphagia.
 He smoked cigarettes until 5 years ago.
 The physical examination reveals superficial
vascular distention over the neck.
12

13. 13

14. 14

15.  Contrast enhanced axial CT thorax showing
the right lobe tumor together with
paratracheal lymphadenopathy. There is
tumor which has invaded into the superior
vena cava (arrow)
15

16.  Primary Lung Carcinoma
16

17.  Axial CT of the lung
showing a left
pulmonary nodule
(arrow) with
spiculated margins
indicating its
infiltrative malignant
nature.
17

18.  A 65-year-old man presents with history of
prolonged fever and left-sided chest pain
 He has past history of productive cough,
acute dyspnea and acute fever over a month
ago
 The physical examination reveals decrease
breath sound of left lung, increase tractile left
right lung.
18

19. 19

20. 20

21.  CT scan of thorax shows loculated pleural
effusion on left and contrast enhancement of
visceral pleura.
21

22.  Right Empyema Thoracis
22

23.  A 65-year-old man presents with progressive
dyspnea for over a year
 He has past history of colonic cancer S/P
radiotherapy 5 years ago
23

24. 24

25.  Oval or spherical
discrete nodules
 Solitary or multiple
 Well-defined, smooth
or irregular outlines
 Soft-tissue density
 Pulmonary vessels
leading to
metastases (“afferent
vessel sign”)
25

26.  Metastatic colonic adenocarcinoma
26

27.  A 30-year-old women presents at emergency
room with sudden severe retrosternal chest
pain after forceful vomiting
 Physical examination reveals dyspnea,
subcutaneous emphysema.
27

28. 28

29. 29

30.  Axial NECT
through the root
of the thoracic
inlet shows gas
(arrows)
insinuating
between the neck
vessels.
 T=trachea,
 A=common
carotid artery,
 V=jugular vein,
 E=esophagus.
30

31.  Pneumomediastinum
31

32.  A 48-year-old man presents with a history of
progressive dysphagia, hoarseness of voice,
weight loss and shortness of breath.
 He heavily smoked cigarettes until 1 years
ago.
 The physical examination reveals cachectic
appearance, supraclavicular lymph nodes
enlargement.
32

33. 33

34. 34

35.  Contrast enhanced axial CT images show a
large circumferential tumor in the esophagus
(arrows) with narrowing of the lumen at the
aortopulmonary (b) and subcarinal (c) level.
 The tumour compresses on the posterior
aspect of the trachea and carina with
narrowing of the right and left main bronchi
(arrowheads).
35

36.  Esophageal cancer
36

37. Topographic anatomy and
Correlation with MRI/CT
37

38. 38
T10

39. 39
T11

40. 40
T12

41. 41
T12-L1

42. 42
L1

43. 43
L2

44. 44
L2-3

45. 45
L3

46. 46
L4

47. 47
L4-5

48. Clinical Correlation
48

49.  A 45-year-old man presents with a 2-week
history of prolonged fever, loss of appetite,
RUQ abdominal pain
 The physical examination reveals tender
hepatomegaly
49

50. 50

51. 51

52.  Contrast enhanced
axial computed
tomography (CT)
shows a large left
lobe hepatic
abscess (arrows) as
a multiloculated
hypodense lesion
with septations.
52

53.  Pyogenic liver abscess
53

54.  A 55-year-old man presents with decreased
appetite, weight loss, and fatigue.
 History of heavy alcohol drinking
 The physical examination reveals jaundice
and abdominal distension
54

55. 55
Contrast enhance axial CT (left) arterial phase (right)
portal venous phase

56. 56

57.  Contrast enhanced axial
computed tomography
shows enhancement of
a small hepatocellular
carcinoma (arrows). It
shows increased
enhancement
(hypervascular) on the
arterial phase and
decreased enhancement
(compared with the rest
of the liver) on the
portal venous phase.
57

58.  Hepatocellular carcinoma
58

59.  axial enhanced CT in
the portal phase
demonstrates
 1. peripheral
nodularity of hepatic
parenchyma
 2. splenomegaly
 3. spontaneous shunt
between the left portal
(arrow) and
paraumbilical veins
(arrowhead)
59

60.  Contrast enhanced axial
computed tomography
showing multiple hepatic
metastases as
hypodense, poorly
enhancing lesions
(arrowheads). Note the
right pleural effusion
(asterisk) and ascites
(arrows). Mass lesion in
the right adrenal gland
(open arrow) represents
another site of
metastasis.
60

61.  A 55-year-old man presents with progressive
jaundice.
 He also has past history of anorexia, malaise
and significant weight loss
 The physical examination reveals jaundice.
 Laboratory results reveals direct
hyperbilirubinemia and high level of CA19-9.
61

62. 62

63. 63

64.  Contrast enhanced axial
computed tomography
(CT) shows a hypodense
tumour in pancreatic
head (arrow). The rest of
the pancreas appears
normal (open arrows).
Note the presence of
biliary stent (arrowhead)
which was inserted to
relieve common bile
duct obstruction by the
tumour. However, the
gallbladder (asterisk)
remains distended.
64

65.  Pancreatic cancer
65

66.  T2-weighted MRI
image: a
hyperintense
nodule is seen in
the distal
pancreatic body
66

67.  A 50-year-old man presents with abdominal
discomfort.
 He also has past history of anemia, malaise
and weight loss
 The physical examination reveals
splenomegaly.
67

68. 68

69. 69

70.  Contrast-enhanced
CT in the equilibrium
phase showed a
huge hypovascular
and heterogeneous
mass.
70

71.  Splenic lymphoma
71

72.  Ellis H, Logan BM, Dixon AK. Human Sectional
Anatomy. 3rd Ed. Hodder Arnold, 2007.
 Moeller TB, Reif E. Pocket Atlas of Sectional
Anatomy: Volume II Thorax, Heart, Abdomen,
and Pelvis. 3rd Ed. Thieme, 2007.
 สิทธิพร แอกทอง, และคณะ. กายวิภาคของช่องอกและการประยุกต์ใช้ทางคลินิก.
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