ANATOMY OF THORAX

On Chest X-Ray

DEPARTMENT OF RADIODIAGNOSIS, AMU, Aligarh

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• Thorax is cylindrical shaped structure with
-narrow opening superiorly : superior thoracic
aperture- is open ,continues with neck
-relatively larger opening inferiorly : inferior
thoracic aperture- closed by diaphragm

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• Superior thoracic aperture- boundaries
posteriorly- body of T1
anteriorly- manubrium sterni
on each side-medial border of 1st ribs
Plane of superior thoracic aperture is oblique
angle, facing anteriorly.

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• Inferior thoracic aperture-
posteriorly- T12
anteriorly- xiphoid process
posterolaterally- 11 and 12 ribs
anterolaterally- anterior ends of ribs 7 to 10

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• Thoracic cavity enclosed by the thoracic wall
and the diaphragm, is subdivided into 3 main
compartments-
• 1. left and right pleural cavity , each
surrounding a lung
• 2.mediastinum – is soft tissue partition ,
longitudinally in median sagittal position . It
contains heart ,esophagus , trachea, major
blood vessels and nerves

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Importance of vertebral
level T4/T5

1. Passes through sternal angle

2.Anterior articulation of costal

cartilage of rib 2 with sternum

3.Separates superior mediastinum

from inferior mediastinum, superior
limit of pericardium.

4.AOA begins and ends

5.Tracheal bifurcation

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-On full inspiration
anterior ends of
the 6th ribs or
posterior ends of
the 10th are above
the right
hemidiaphragm
-cardiac shadow is
larger on expiration

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 PA view
1.standing
2.Less magnification
3. scapula peripheral
4.Ribs position oblique
5.Clavicles overlie lung field
6.Posterior ribs clearly
Visualised
AP view
supine or sitting
more magnifica
overlie lung fields
ribs lie horizontal
clavicles higher
anterior ribs clearly
Visualised

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1.Vertebrae, scapula, clavicle, ribs

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• All the ribs articulate with thoracic vertebra
posteriorly
• Costal cartilages of ribs 1 to 7 articulate with
sternum(TRUE RIBS)
• Costal cartilages of ribs 8 ,9, 10 articulate with
inferior margins of the costal cartilages above
them.
• 11 and 12 ribs – no anterior articulation-
floating ribs
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 2.Trachea
• Trachea spans downwards C6 to T5
• Midline structure , slight deviation to right
around aortic knucle (more marked- expiration)
• Normal maximum coronal dia M-25mm, F-21mm
• Right paratracheal strip- rt border of trachea in
contact with lung , from clavicles to rt main
bronchus( less than 5mm)
• Left paratracheal line not visualised – left border
of trachea lies adjacent to great vessels
• Bifurcates at T4-T5 level.

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CARINA
-normal angle 60 to 75
-level T4/T5 – sternal angle
-widening on inspiration
RIGHT MAIN BRONCHUS
-shorter , wider,more vertical, bifurcates earlier
-rul bronchus- 2.5 cm below carina
-lul bronchus- 5cm below carina
LEFT MAIN BRONCHUS
-longer, narrower

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3. Lung lobes , fissures

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azygos lobe

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 4.The hila
• In 97% left hilum is higher, in 3% they are at same
level
• Both hila – equal density – concave lateral
borders
• Pulmonary arteries and upper lobe veins –
contribute significantly
• Left hilum 2.5cm higher than right as
left pulmonary artery - above the bronchus
right pulmonary artery – anterior to its bronchus

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5.Vascular structures

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Cardiothoracic ratio

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• The maximum diameter of descending branch of
the pulmonary artery measured 1cm lateral to
hilar point is 16 mm for males and 15mm for
females.
• Upper lobe veins- lie lateral to the arteries-
separated from mediastinum by approx 1cm of
lung tissue.
• Lower lobe veins- larger than upper lobe veins in
erect position (in supine position the vessels
equalise)
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Felson classification of mediastinum

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 6.Diaphragm
Diaphragm is dome shaped muscle that separtes
thoracic cavity from abdominal cavity.

Right hemidiaphragm is higher than left- heart

depressing the left side.
• Difference more than 3cm is significant
• Supine – diaphram is higher

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 7.Cp angle
• Normally – acute angled and well defined
• Becomes obliterated when diaphragms are
flat

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Soft tissue

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Thank you,have a nice day

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