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RADIO ANATOMY

RESPIRATORY TRACT
AND MEDIASTINUM
Rista D. Soetikno, dr, SpR

Radioanatomy
Studies of human body seeing through the
roentgenologic examination

Respiratory Tract
Upper air passage (Cav. Nasi and pharynx)
Larynx
Trachea and bronchus
Lung + Vascular (lymph)
Thoracic wall + diaphragm

3,4,5 Chest x-ray


Lung !

Lung anatomy-Right
Superior Lobe

Apical Segment (1)


Posterior Segment (2)
Anterior Segment (3)

Medial Lobe

Lateral Segment (4)


Medial Segment (5)

Inferior Lobe

Apicobasal Segment (6)


Mediobasal Segment (7)
Anterobasal Segment (8)
Laterobasal Segment (9)
Posterobasal Segment (10)

Lung Anatomy-Left

Superior Lobe

Apicoposterior Segment (1)


Anterior Segment (2)

Lingula

Superior Segment (3)


Inferior Segment (4)

Inferior Lobe

Apical (5)
Antero medial basal (6)
Latero basal (7)
Postero basal (8)

X-ray / Fluoroscopy indication

Contact person
Cough > 2 weeks
Recurrent respiratory infection
Hemaptoe
Ekstra pulmonary TBC
Erytema nodosum / conjuntivitis phlyctenularis
Fissure/fistula anichronicum
DM
Precautionary indication

X-ray Examination
Routine : PA
Special :
Lateral
Left
Right

AP
Oblique - Left
- Right
Lateral decubitus

Special method of examination

Tomografi
Bronchografi
USG
CT scan
MRI

PA Position
Place patient between film X ray source
Have the patient stand backward to the X- ray

source, chest close to film with hand on the hip,


with elbow flexed. Distance between film and XRay
Lung 1,5 m
Heart 2 m
Ray concentrated at
- V.Th. 6-7
- KV 50-60
- M.As 10-20

Good chest X-Ray depend on:


1. Good film quality
Depending on :
KV
M.As
Processing
2. Symmetry
3. All part of thorax are included
4. Identity /Marking
5. No artefact
6. No motion artefact
7. Maximal inspiration

What studied in chest x-ray

Soft tissue
Costae and clavicle
Trachea
Size, shape and position of heart
Lung
Hillous
Bronchovaskuler marking

Lung field :

Lung apex
Lung top field
Lung middle field
Lung lower field

Lateral chest film


Indication
To study abnormality that is not visible on
PA film
To study mediastinal disorder
Heart studies

Lateral chest procedure


Place patient between film and X-ray
source
Place lateral side of chest (left/right) on film
Hands behind the head
Ray centered on Th 6-7

What studied on lateral chest film


Trachea and mainbronchial branch - radioluscent
Heart, aortic arch, asc/ desc aortic
Left/ Right Lung bronchovascular marking

superposition
Retrosternal space
Retrocardial space
Costophrenic sinus
Cardiophrenic sinus

Antero posterior (AP) chest film


Indication :
Severely ill patient
Children / babies
Obese, pregnancy, ascites, abdominal tumor
Procedure:
Place patient lying down on table with
elbow above head
Place film on patients back
Centered ray on Th 6-7

Top lordotic chest x-ray


Indication :
To studies disorder located on apex / medial lobe
- clavicle turn upward
Procedure:
Place patient between film and x-ray source, have
the patient face the x-ray source
Have the patient stand 30 cm in front with back
placed on the cassette
Set top part of the cassette 1 inch above the
shoulder
Centered ray on manubrium sterni

Oblique chest film:


Indication :
Heart studies
To study abnormality that is not yet clear on PA
studies
Procedure
Place patient between film and ray source
Put ventral left/right side of the patients thorax on
the cassette making 45 0 angle
Center ray on Vert. Th 6-7

Lateral decubitus chest film


Indication :
To study fluid in pleural cavity that is around 100-200
cc
Or fluid accumulation that is not yet determined on PA
studies
Procedure
Have the patient lying down on left/right side with
elbow above the head
Center ray on vert. Thoracal 6-7 from anterior
/posterior aspect

Mediastinum Borders
- Superior: Apertura thoracis sup.
- Dorsal : Vertebral Column.
- Ventral : Sternum.
- Inferior : Diaphragm.
- Lateral : Mediastinal pleura.

1.
2.
3.
4.
5.
6.
7.
8.

Mediastinal

Anterior superior med


Anterior medius med
Anterior inferior med
Superior medius med
Middle med
Posterior superior med
Posterior medius med
Posterior inferior med

Mediastinal Studies
1.

2.

Radiograph :
Chest film: - PA.
Lateral.
esophageal contrast studies.
Fluoroscope :
To study pulsation
To study placement of organ in chest
cavity

To study mass relation with adjacent organ


Diaphragm
Esophagus
Heart and major vessel
To study pericardial effusion

3.
4.
5.
6.

Tomografi.
Angiografi Usually with
CT.
CT Scan / MRI.
USG : Mass close to
diaphragm / Pericard effusion.

7.

Nuclear med. Radioisotop.


Radio isotop angiogram.
To study localization of tumor.
Eq : thymoma, thyroid, lymph
node.

Location of mediastinal
disorder
Anterior superior med
Aneurisma aorta
Thymus Hyperplasia
Lymphoma
Intrathoracal Struma
Thymoma

Location of mediastinal disorder


Anterior middle med.

Dermoid

Teratoma

Ant. Inferior. Med

Thymoma.

Pericardial cyst.

Hernia diafragmatica.
Superior Mid. Med

Aneurisma.

Dermoid.

Teratoma.

Mediastinal trauma

Middle Mediastinal

Dermoid

Teratoma

Lymphoma

Tumor metastasis (Lymph


- spread)

Post superior med.

Oesophageal disorder
Aneurism
Neurinoma, neurofibroma.
Pancoast tumor

Anterior Inferior med.


1. Thymoma.
>Female
Could turn Malignant.
Round/lobulated.
2. Pericardial cyst.
Cystic tumor that connected with
pericardium.
On right cardiophrenic sinus

Middle Mediastinal
1. Infection
Sarcoidosis
TBC
Mycosis.
Erythema nodosum
2. Tumor Metastasis
3. Lymphoma

Posterior mediastinal

Esophagus disorder:
Diverticle.
Achalasia / Chalasia
Pancoast tumor
Aneurisma.
Neurogenic tumor (Neurofibroma,
Neurinoma)

Post medius med.

Neurogenic tumor.

Bronchial defect enteric cyst.


Post inferior med.

Neurogenic origin primary tumor.

Diaphragmatic hernia.

Anterior- superior Med.


1. Often : Thymic Hyperplasia.
Lobuler type, flag fusiform.
Bilat/unilat.
On children (Thymic Persistent)
2. Aneurisma : Cardiovascular
section
3. Lymphoma Maligna

Ro: tracheo bronchial node enlargement


lobulated Could cause superior cava
vein. Syndrome.

4.

Intrathoracal Struma
40 years
Usually compress : trachea,
oesophagus, phrenic nerve.

Ro:
Lung apex mass compress
trachea.
Mediastinum anterior medius
Dermoid cyst: Tumor that consist of
multiple tissue hair, teeth
benign.