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
Fissura/fistula anichronicum
DM
Precautionary indication
X-ray Examination
Routine : PA
Special :
Lateral
Left
Right

AP
Oblique - Left
- Right
Lateral decubitus
Special methode 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 X-
Ray
Lung 1,5 m
Heart 2 m
Ray concentrated at
- TH 6-7
- KV 50-60
- Mas 10-20
Good chest X-Ray depend on:
1. Good film quality
Depending on :
KV
Mas
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
Hilus
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
Retroternal 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 cassete
Set top part of the cassete 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 cassete 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
- Top : Apertura thoracis sup.
- Dorsal : Vertebral Column.
- Ventral : Sternum.
- Inferior : Diaphragm.
- Lateral : mediastinal pleura.
 Mediastinal
1. Anterior superior med
2. Anterior medius med
3. Anterior inferior med
4. Superior medius med
5. Middle med
6. Posterior superior med
7. Posterior medius med
8. Posterior inferior med
 Mediastinal Studies
1. Radiograph :
Chest film: - PA.
Lateral.
oesophageal contrast studies.
2. Fluoroscope :
To study pulsation
To study placement of organ in chest
cavity
- To study mass relation with adjacent organ
- Diaphragm
- Oesophagus.
- Heart and major vessel
- To study pericardial efusion
3. Tomografi.
4. Angiografi Usually with
CT.
5. CT Scan / MRI.
6. USG : Mass close to
diaphragm / Pericard effusion.
7. Nuclear med. Radioisotop.
Radio isotop angiogram.
To study localisation of tumor.
Eq : thymoma, thyroid, lymph
node.
Location of mediastinal
disorder
Anterior superior med
Aneurisma.
Tymus Hyperpl
Lymphoma.
Intrathoracal Struma
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
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.
Eryhema nodosum
2. Tumor Metastasis
3. Lymphoma
Posterior mediastinal
Oesophagus disorder:
Diverticle.
Achalasia.
Pancoast tumor
Aneurisma.
Neural tumor.
Post medius med.
Neuragenic tumor.
Bronchial defect enteric cyst.

Post inferior med.

Neurogenic origin primary tumor.
Hernia diaphragmatica.
Anterior- superior Med.
1. Often : Thymic Hyperplasia.
Lobuler type, flag fusiform.
Bilat/unilat.
On children
2. Aneurisma : Cardiovascular section
3. Lymphoma.
Ro: tracheo bronchial node enlargement
lobulated Could cause sup 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.
Text book
1. Rontgen sign in diagnostic
imaging : Vol 4 : chest 1987
Meschan.
2. Synopsis of Radiologic
Anatomy with computed
tomography (1978) Meschan.
Bibliography
1. Short textbook of clinical
imaging.,David Sutton, Jeremy W.R
Young, 1990
2. Rontgen sign in diagnostic imaging
col 4 (chest) Meschan Thn 1997
3. Essentials of Coffeys Pediatric X-ray
diagnosis, 1990.