M-1
CHEST
RADIOLOGY
Francis H. Neuffer, MD
USC-SOM
1
OBJECTIVES
 Understand chest X-ray anatomy
 Relate catheters and medical devices
to anatomy
 Identify landmarks at standard CT section levels
 Correlate common pathology to anatomy
2
NORMAL CHEST
X-RAY
PA
LATERAL
3
NORMAL HEART
BORDERS
4
LEFT 4TH RIB
POSTERIOR AND ANTERIOR PORTIONS
POSTERIOR
4
ANTERIOR
4TH
5
BRONCHOGRAM—CONTRAST OUTLINING AIRWAY
TRACHEA
LT. MAIN BRONCHUS
RT. MAIN BRONCHUS
CARINA
6
ENDOTRACHEAL TUBE IN
POST OPERATIVE PATIENT
NORMAL CHEST ANATOMY
LATERAL CHEST XRAY
Diaphragm-AP view
AORTIC ARCH
LT.
TRACHEA
HORIZONTAL
FISSURE
Diaphragm- Lateral view
OBLIQUE FISSURE
LT.
RT. HEMIDIAPHRAGM
RT.
LT. HEMIDIAPHRAGM
LT.
COLON GAS
8
FISSURES DIVIDE
LUNGS INTO LOBES
RIGHT lung has:
UPPER
HORIZONTAL
FISSURE
MIDDLE
lobes
LOWER
LEFT lung has:
UPPER
lobes
LOWER
9
Lt
NUCLEAR MEDICINE
LUNG SCANS
10
MR
ARTERIOGRAM
11
PULMONARY ARTERIOGRAM
CATHETER
LT. BRACHIOCEPHALIC
VEIN
LT. PULMONARY ARTERY
LT. UPPER LOBE
VESSELS
RT. UPPER LOBE
VESSELS
RT. MIDDLE LOBE
VESSELS
RT.
PULMONARY
ARTERY
MAIN
PULMONARY
ARTERY
RT. LOWER LOBE
VESSELS
LT. LOWER LOBE
VESSELS
12
INT. JUG. VEIN
PULMONARY ARTERY
CATHETER
SVC
PA
RT. PUL .ART.
RA
SWAN CATHETER
RV
13
INT. JUG. VEIN
SUBCLAVIAN
VEIN
BRACHIOCEPHALIC VEIN
UPPER
EXTREMITY
VENOUS DRAINAGE
SVC
ELECTRODES
(NOTE CATHETERS)
14
INT. JUG. VEIN
BRACHIOCEPHALIC VEINS
SUBCLAVIAN
VEIN
UPPER
EXTREMITY
VENOUS DRAINAGE
SVC
ELECTRODES
(NOTE CATHETERS)
15
RT. COMMON CAROTID
LT. COMMON CAROTID
LT. SUBCLAVIAN
ARTERY
RT. PUL
ARTERY
LT. PUL
ARTERY
AORTA
LT ATRIUM
SUBTRACTION IMAGE
AORTA
MR CONTRAST ARTERIOGRAM
16
OBLIQUE
ESOPHAGUS
TRACHEA
OBLIQUE
SPINE
BARIUM FILLED
ESOPHAGUS
LEFT HEMIDIAPHRAGM
FUNDUS OF STOMACH
17
X-RAY MAMMOGRAPHY
PATIENT
POSITIONING FOR
MAMMOGRAPHY
Marker is always put on the axillary side of the breast
18
SCREENING MAMMOGRAPHY
VIEWS
MLO
FATTY TISSUE
CC
MUSCLE
CC VIEW
CRANIO - CAUDAL
GLANDULAR AND
FIBROUS TISSUE
MLO VIEW
MEDIO-LATERAL OBLIQUE
19
NORMAL HEART
20
Aorta
AORTA
Pulmonary
artery
PA
RA
RV
LV
Left
Ventricle
21
PACEMAKER
WITH
RT. ATRIAL AND RT. VENTRICULAR LEADS
RA
RV
22
TRICUSPID AND MITRAL VALVE
REPLACEMENT
ARROWS SHOW DIRECTION OF BLOOD FLOW THROUGH
VALVES FROM ATRIA TO VENTRICLES
T
T
M
M
Right to left
Posterior to anterior
23
POST OP VALVE
REPAIR
M- MITRAL
A- AORTIC
A
M
24
Pacemaker
Electrode
on skin
AORTIC AND PULMONARY
VALVE REPLACEMENT
P
A
Pacer in Rt.
Ventricle
25
CORONARY
ARTERY
ANATOMY
26
CORONARY
ARTERIES
RT.
LT.
LAD
CIRCUMFLEX
27
CORONARY
ARTERY STENTS
28
LAD
CORONARY
ARTERIOGRAM
CIRCUMFLEX
LEFT MAIN
ARTERIAL INJECTION
29
CHEST- POST – OP
CABG
ENDO TRACHEAL TUBE
CORNARY ARTERY BYPASS GRAFT
CATHETER ENTERS SKIN AT
LT SUBCLAVIAN VEIN
x
LT. BCV
RT SUBCLAVIAN VEIN
STERNAL WIRES
SVC
RT. PUL .ART.
PA
RA
CARDIAC
ELECTRODES
RV
LV
CATHETER PATH
SUBCLAVIAN VEIN
LT. BRACHIOCEPHALIC VEIN
SUPERIOR VENA CAVA
RIGHT ATRIUM
THROUGH TRICUSPID VALVE
RT VENTRICLE
PULMONARY ARTERY
RT PULMONARY ARTERY
30
SAPHENOUS VEIN
GRAFT TO RIGHT
CORONARY ARTERY
3D CT MODEL OF
CORONARY ARTERIES
31
LEFT INTERNAL
THORACIC (MAMMARY)
ARTERY GRAFT
APPLIED
SURGICAL
CLIPS
RADIOLOGY
7/2008
32
CT THORACIC ANATOMY
LOOK AT AN X-RAY AS IF THE
PATIENT IS LOOKING AT YOU.
LOOK AT A CT SCAN AS IF THE
PATIENT IS LYING ON THEIR BACK
AND YOU ARE LOOKING FROM
THEIR FEET TO THEIR HEAD.
Anterior projection
33
RT
SCAN LEVELS
GREAT VESSELS
AORTIC ARCH
PULMONARY/CARINA
ATRIA
VENTRICLES
CT CHEST ANATOMY
34
RT
GREAT VESSELS
RT
CT CHEST ANATOMY
35
CHEST-- CT
RT
BRACHIOCEPHALIC ARTERY
SVC
TRACHEA
LT. COMMON CAROTID ART.
LT. SUBCLAVIAN ART.
Great vessels
36
AORTIC ARCH
CT CHEST ANATOMY
37
CHEST -- CT
INTERNAL MAMMARY (THORACIC)
ARTERY AND VEIN
SVC
AORTIC ARCH
ESOPHAGUS
SCAPULA
Aortic arch
38
PULMONARY
&
CARINA
CT CHEST ANATOMY
39
CHEST -- CT
STERNUM
ASCENDING
AORTA
LT. PULMONARY
ARTERY
CARINA
DESCENDING
AORTA
PULMONARY
&
CARINA
40
CHEST - CT
LT. ATRIUM
ATRIA
ASCENDING AORTA
RT ATRIUM
LT ATRIUM
DESCENDING
AORTA
Atria
42
VENTRICLES
CT CHEST ANATOMY
43
CHEST -- CT
RT. VENTRICLE
SEPTUM
DOME OF DIAPHRAGM
LT. VENTRICLE
DESCENDING AORTA
Ventricles
44
CORONAL SLICES
STERNUM
COSTAL CARTILAGE
LIVER
45
CORONAL SLICES
PULMONARY OUTFLOW
RT. VENTRICLE
LT. VENTRICLE
LIVER
46
CORONAL SLICES
PULMONARY ARTERY
AORTA
RT. ATRIUM
LEFT VENTRICLE
47
CORONAL SLICES
SVC
RT. ATRIUM
48
CORONAL SLICES
RT. PULMONARY ARTERY
LT. ATRIUM
49
CORONAL SLICES
AORTA
CARINA
LT. PULMONARY ARTERY
LT. ATRIUM
DESCENDING AORTA
50
CORONAL SLICES
DESCENDING AORTA
LIVER
SPLEEN
51
WHO DREW THIS PICTURE ?
52
INTERESTING CASES
You will be assigned one of the following cases. I
will email your case to you. Please send the slide
back to me with your diagnosis typed in the space
provided within 2 days. I will then send you a the
correct diagnosis in a 4 slide ppt. You will be asked
to label and answer questions concerning your case.
You will have 3 days to return the completed ppt. to
me. If you have any questions please call me @
733-3298, or come by my office.(Basement of the
Library)
Penny Al-Emam RT, (R) (M)
Department of Radiology
Please note: You will be working on the case with a partner.
I want only 1 returned ppt. Do not copy the case so that I receive a
ppt. from each partner. Thanks.
53
CHEST CASE # 1
Patient with chest pain and cough.
Study the images. Add your
diagnosis and return to me .
Penelople.Al-Emam@uscmed.sc.edu
Diagnosis______________________
Students____________________
____________________________
Date_________
CHEST CASE # 2
56 year old female goes to ED
with cough and fever.
Review the radiographs and add your
Diagnosis. Return to me.
Penelope.Al-Emam@uscmed.sc.edu
Diagnosis :_______________
Student s ________________
______________
CHEST CASE # 3
4 week old infant taken to the ED because of a cough x 2 weeks.
Review the film.
Add your diagnosis in the space
given and return to me.
Penelope.Al-Emam@uscmed.sc.edu
Diagnosis____________________
Students___________________
___________________
Date___________
CHEST CASE # 4
Patient in Doctor’s office with peripheral edema.
Review the image-add your diagnosis
and send back to me.
Penelope.Al-Emam@uscmed.sc.edu
Diagnosis______________
Students_______________
________________
Date_____________
CHEST CASE # 5
Patient in the ICU with decreased O2 saturation over 12 hours
Review the image
Add your diagnosis
And return to me .
Penelope.Al-Emam@uscmed.sc.edu
Diagnosis :____________
Students__________________
__________________
Date____________
CHEST CASE # 6
35 year old male presents to the ED with SOB
Review the film.
Give your diagnosis and
return to me.
Penelope.Al-Emam@uscmed.sc.edu
Diagnosis:______________
Students_______________
_______________________
Date________________
CHEST CASE # 7
Patient in the ICU becomes SOB
Review the film.
Give your diagnosis and
return to me.
Penelope.Al-Emam@uscmed.sc.edu
Diagnosis:______________
Students_______________
_______________________
Date________________
CHEST CASE # 8
70 year old female goes to doctor with complaint of difficulty breathing.
Review the film.
Give your diagnosis and
return to me.
Penelope.Al-Emam@uscmed.sc.edu
Diagnosis:______________
Students_______________
Date________________
CHEST CASE #9
Automobile accident victim brought in to the ED by paramedics.
Review the film.
Give your diagnosis and
return to me.
Penelope.Al-Emam@uscmed.sc.edu
Diagnosis:______________
Students_______________________
_______________________
Date________________
CHEST CASE #10
A 33 year old male post 4-wheeler accident.
Review the film.
Give your diagnosis and
return to me.
Penelope.Al-Emam@uscmed.sc.edu
Diagnosis:______________
Students_______________
_______________________
Date________________
CHEST CASE #11
Mother brings child into the ED stating that the child has swallowed
something and is now drooling more that usual.
Review the film.
Give your diagnosis and
return to me.
Penelope.Al-Emam@uscmed.sc.edu
Diagnosis:_________
Students_________
Date_____________