CT Chest and Abdomen for Beginners Arcot Chandrasekhar, M.D. Hema Chandrasekhar, M.D. Recommended way to use presentation: • Use it as a slide show. • Decide on one structure and follow the sequence, example aorta. • Next attempt to see its relationship to other structures. • Study it multiple times until you are comfortable in identifying each structure. • When in doubt, follow the structure above and below and it will become evident. Exercises: First go through the entire sequence. 1. Follow axillary vein to superior vena cava entering right atrium. 2. Follow iliac veins to inferior vena cava entering right atrium. 3. Follow splenic vein to portal vein. 4. Follow aorta originating from LV to bifurcation to common iliac arteries. 5. Follow esophagus to rectum. 6. Follow trachea to RUL bronchus. 7. Follow SVC to RA to RV to main pulmonary artery and branches. Focus on one structure and use the pg up/pg down option to follow it. At the level of Contrast is injected in the right antecubital vein. Follow the contrast in the next few slides. Trachea Contrast in axillary vein Thyroid cartilage Humerus Cervical spine Clavicle Scapula Pectoralis major AC joint Supraspinatus Thyroid Gland Thyroid gland First rib First rib Apex of lung Rt common carotid artery Rt subclavian artery Medial end of clavicle The subclavian vein joins the internal jugular vein to form the brachiocephalic vein behind the medial end of clavicle. Subclavian vein Right Left common carotid artery Left subclavian artery The brachiocephalic vein is also called the innominate vein. Sternum Because contrast was injected on the right side there is no visible contrast in left brachiocephalic vein. Left brachiocephalic vein Innominate vein Brachiocephalic artery Left A: Brachiocephalic artery B: Left common carotid artery C: Left subclavian artery A B C See how the left brachiocephalic vein is joining the right brachiocephalic vein to become the superior vena cava. Contrast in the right brachiocephalic vein has been diluted by blood from the left brachiocephalic vein as they combine to form the SVC. Arch Aortic ofarch aorta SVC Mediastinal fat Scapula Ascending aorta Main pulmonary artery Descending aorta Contrast in SVC is diluted by blood from the azygous vein. Esophagus Azygous vein Left pulmonary artery Carina Right pulmonary artery Main pulmonary artery RUL bronchus Left pulmonary artery Left main bronchus SVC Intermediate bronchus LUL division Ascending aorta Rt atrium Rt ventricle Pulmonary vein Lt atrium A: Aortic root RV RA A LV LA Aortic valve Rt ventricle Lt ventricle Interventricular septum Osteophyte IVC Liver Heart Stomach GE junction Esophagus Stomach Liver Spleen Lt lobe Rt lobe Fissure for ligamentum teres Fissure for ligamentum venosum Caudate lobe Diaphragm Caudate lobe Diaphragm Portal vein Lt adrenal Portal vein Rt adrenal Surgical clips in gallbladder fossa. Coeliac trunk Pancreas Splenic vein The splenic vein lies in the posterior pancreatic grove and joins the superior mesenteric vein to form the portal vein. Pancreas Duodenal bulb IVC Rt renal artery The right renal artery is retrocaval. Small cyst in the left kidney. Lt renal vein IVC Left renal vein emptying into the IVC. Transverse colon Ileum Kidney Kidney Right Descending colon Right Renal pelvis Ascending colon Right colon with fecal material. Abdominal aorta about to bifurcate. Psoas Rt common iliac artery IVC Lt common iliac artery L5 Arrows are pointing to the common iliac veins joining to form the IVC. Left Ilium Sacrum Arrows are pointing to the internal and external iliac veins joining to form the common iliac vein. Ilium Sacrum Rectosigmoid Sacroiliac joint Diverticula in recto sigmoid Rectosigmoid Arrows are pointing to air filled diverticulum and the second one is filled with residual barium from an old GI study. Gluteus Bladder Seminal vesicle Rectum Femoral artery Femoral vein Bladder Prostate Rectum Femoral head Acetabulum Feces in the rectum Pubic symphysis Ischiorectal fossa Shaft of penis Femur