Title: Respiratory Module Anatomy by Radiology
1Respiratory Module Anatomy by Radiology
- Welcome to this PowerPoint presentation on
anatomy seen radiologically. - There are normal and abnormal views of the nasal
cavity and sinuses, and of the thorax. - Plain X-ray, CT and MRI have been used.
- Study the images and answer the questions before
moving to answers on the next slide (your
learning and retention will be much better). - Always cross-reference and integrate with other
learning experiences and resources (Phase I
lectures and the Read After anatomy guide).
2Nasal Cavity and Sinuses
- This CT is like studying a parasagittal
section of a head in the Dissecting Room, but the
sinuses are visible.
Ethmoid
Frontal
Sphenoid
Middle concha
Inferior concha
3Nasal Cavity and Sinuses
- Where do the sinuses open?
- What opens into the inferior meatus?
Ethmoid
Frontal
Sphenoid
Middle concha
Inferior concha
4Nasal Cavity and Sinuses
- The sphenoid sinus opens into the
spheno-ethmoidal recess above the superior
meatus. The frontal, ethmoidal and maxillary open
into the middle meatus. - The nasolacrimal duct drains lacrimal fluid from
the conjunctival sac to the inferior meatus of
the nasal cavity. - Look at the next two slides showing horizontal
sections of the maxillary, and then ethmoid
sinuses, just to appreciate their relationships
to each other and to the nasal cavity.
5Nasal septum ?
Maxillary sinus ?
6Ethmoid air cells ?
Sphenoid air cells ?
Mastoid air cells ?
7Nasal Cavity and Sinuses
- Note the close proximity of the orbits, and the
brain in the cranial cavity, to the nasal cavity. - To what do the arrows point?
Brain
?
Orbit
?
?
?
?
8Nasal Cavity and Sinuses
Brain
Ethmoid Sinus
Middle Concha
Orbit
Maxillary Sinus
Inferior Concha
Septum
9Nasal Cavity and Sinuses
- The nasal conchae create a large surface for
carrying out nasal function. - But the nasal passages are narrow and easily
obstructed.
Position of Maxillary Sinus Opening
10Nasal Cavity and Sinuses
- The nasal cavity and sinuses are lined by a
vascular mucous membrane with pseudostratified,
ciliated, columnar epithelial cells to slow,
warm, filter and humidify the inhaled air. - Ciliary action empties the sinuses.
- The maxillary sinus opening is high in the medial
wall of the sinus and anything affecting the
ciliary action, or narrowing the passageways may
prevent proper emptying.
11Sinusitis
- The right maxillary and ethmoid sinuses are
obstructed. - The frontal sinuses are enlarged.
Frontal
Maxillary
12Sinusitis
- Thickened mucous membrane in maxillary sinuses.
- Deviated septum.
Septum
13Thorax Cross Section
- Identify the numbers 1 to 10
1
2
10
9
3
8
4
7
5
6
141 Ascending aorta 2 Pulmonary trunk (artery) 3
Left PA 4 Left bronchus 5 Descending aorta 6
Oesophagus 7 Azygos vein 8 Right bronchus 9
Right PA 10 Superior vena cava.
1
2
10
9
3
8
4
7
5
6
15Thorax
- This is a contrast enhanced CT. As the injection
is intravenous, the SVC is brighter. - Identify 1, 2 and the arrows.
- You are looking from the feet upwards.
Sternum
?
?
1
2
Vertebra
16Thorax
- 1 is trachea, 2 is oesophagus.
- What vertebral level is this?
SVC
Aortic Arch
2
2
2
2
17Thorax
- The aortic arch is in the superior mediastinum
opposite T4. - The white spots in the lungs are contrast in
pulmonary vessels that are cut in section as they
radiate into the lungs. - What would be visible at a higher and at a lower
level?
18Thorax T3
- The trachea and oesophagus are still visible.
The left and right brachiocephalic veins join to
form the SVC. The aortic arch has given the
brachiocephalic trunk (1), left common carotid,
with vagus just lateral (2) and left subclavian
(3)
SVC
1
2
3
T3
19Thorax T4/5
- 1 and 2 Ascending and descending aorta.
- 3 Tracheal bifurcation.
- 4 SVC.
- What lies behind the bifurcating trachea?
1
4
3
2
20Thorax T4/5
- The oesophagus on the left with the azygos vein
just to the right of it. The vein can be followed
to the SVC. 5 is the pulmonary trunk.
1
4
5
3
2
Azygos vein
Oesophagus
21Thorax T5/6
- 1, 2 and 4 are as before but 3 is now the left
main bronchus. Look at 5, the pulmonary artery
dividing. Remember for next slide!
Left pulmonary artery
1
5
Right pulmonary artery
4
3
Oesophagus
2
Azygos vein
22Thorax Pulmonary Embolus
- Compare this slide and the previous one. Note the
filling defects in the contrast at the
bifurcation of the pulmonary artery and at the
bifurcation of the left pulmonary artery
thrombotic emboli. What is the likely site of
origin of the thrombus, and its route to the
lung? What is visible posteriorly?
Asc. Ao.
Embolus in PA
SVC
Embolus in left PA
Right bronchus
Left bronchus
?
23Thorax Pulmonary Embolus
- The thrombus originated in a deep vein in the
lower limb, e.g. the posterior tibial. - It then moved to popliteal, femoral, external
iliac, common iliac, inferior vena cava, right
atrium, right ventricle, pulmonary trunk (artery)
and left pulmonary artery. - Posteriorly on the left, there is a little lung
consolidation and pleural effusion following the
embolus. - The next slide is a case presentation
24Male (63) CT Pulmonary Angiogram after acute
massive pulmonary embolus. Occluded Rt. main P.
artery (arrow) and filling defect Lt. P. artery
(arrow). Presented with acute dyspnoea, hypoxia,
low BP, acute Rt. heart strain on ECG No clot
seen in IVC or iliofemoral veins on CT
Abdo/Pelvis Negative coagulopathy and
auto-antibody screens. Treated with thrombolysis
and low molecular weight heparin, then warfarin.
?
?
25Thorax Heart at T 7 or 8
- Identify the 4 chambers of the heart seen here in
cross-section.
?
?
?
?
26Thorax Heart at T 7 or 8
Right ventricle
Right atrium
Left ventricle
Left atrium
27Normal Chest Radiograph
- 1 Clavicle
- 2 Trachea, centrally positioned
- 3 Heart shadow
- 4 Vertebral column
- 5 Gas in fundus of stomach
- Note that the lung vascular markings fill the
thoracic cavity
1
2
3
4
5
28Right Pneumothorax
- The arrows point to the edge of the right lung.
- There is air outside it, within the pleural
cavity. The edge is barely visible, but there are
no vascular markings lateral to the arrows. - The trachea is still central but may shift away
from the side of the lesion in a tension
pneumothorax.
29Here is another, very obvious right-sided
pneumothorax, note how the lung markings stop and
the right lung only fills about half of the right
thoracic cage.
30Lung Tumour
- The arrow indicates a mass near the left lung
hilum. - Why might this condition present with hoarseness
of the voice?
31Lung Tumour
- The mass is seen here, compressing the left
pulmonary artery. - The mass could compress the left vagus or
recurrent laryngeal nerve.
32A Rarity!
- Look for the expected aortic knuckle (arch) on
the left. It is not there. - The arrow shows this patient has a right-sided
aortic arch.
33Tumour, ball valve affect
- The arrow shows a tumour compressing the left
main bronchus. It acts like a valve allowing air
in but not out, as would an inhaled foreign body
in the bronchus. Consequently the left lung is
hyperinflated. It looks more radiolucent than
the right lung and the vascular markings are
reduced.
34Pneumonia
- The arrow shows the consolidation of pneumonia.
- 1 is the upper part of the right lobe of the
liver, bulging upward under the diaphragm.
1
35The End
- Those 34 slides complete the radiological revue
of the anatomy of the Respiratory System and
Thorax. A knowledge of topographical and surface
anatomy is essential to understand the images.
This presentation was created with the support
and guidance of Dr Tom Taylor, consultant
radiologist, Ninewells Hospital, who provided the
radiographic images.