Tampilkan postingan dengan label Thorax. Tampilkan semua postingan
Tampilkan postingan dengan label Thorax. Tampilkan semua postingan

Selasa, 11 Januari 2011

Tomogram of lungs, AP Projection, L87, Thorax, Atlas of Radiologic Anatomy, Lothar Wicke

Thorax PA projection - How to read a CXR
  • general review – is the film well penetrated and symmetrical. Are breast shadows (if present) equal? Are nipple shadows (if present) equal? Are there artefacts such as wire sutures after cardiac surgery?
    • The film is well penetrated and symmetrical
    • No breast shadows are present
    • No Nipple Shadows
    • No artifacts present
  • is the image centred? – inner clavicles should be the same distance from the midline
    • The Image is centered
  • is the trachea central?
    • The trachea is central
    • Carina - Bifurcation of trachea
  • follow the mediastinal outline downwards. Are their any bumps that shouldn’t be there? What might they be?
    • Left
      • Aortic arch
      • Pulmonary Vein
      • Left Auricle
      • Left Ventricle
    • Right
      • Superior Vena Cava - T3
      • Right Atrium
      • Inferior Vena Cava
  • does the lowest part of the heart shadow meet the diaphragm at a sharply defined angle? If not why not?
    • Yes
  • does the dome of the diaphragm have a normal sweep? Why not?
    • Yes
  • is the heart width less than twice the chest width (cardiothoracic ratio over 50% is abnormal e.g. in heart failure)
    • Yes
  • does the outer edge of the diaphragm meet the pleura at a sharp acute angle? If not why not?
    • Cannot see if the Costodiaphragmatic recess is sharp
  • is the sweep from the cardiophrenic angle to the lung apex symmetrical and equal? If not, why not?
    • Cannot see
  • do the lung markings go from the mediastinum to all areas of the lung normally?
    • Yes
    • Left Primary Bronchus
    • Pulmonary Vein
  • check the skeleton. Fractured ribs are difficult to see but there may be signs of old fractures. They may be at different stages or places suggesting previous trauma. Bony metastases or osteoporotic signs may be seen.
    • No fractures
    • Medial Margin of the Scapula
    • Superior Angle of the Scapula
    • Clavicles
    • 1st Rib
Other
  • Fundus of Stomach


10. Al-Jabbar The Overpowering Lord Whoever recites Ya Jabbaru will not be subjected to coercion, and will not be exposed to violence, severity or harshness.

Thorax Lateral Projection, L83, Thorax, Atlas of Radiologic Anatomy, Lothar Wicke

  • Trachea
  • Left Primary Bronchus
  • Right Primary Bronchus
  • Inferior Lobar Bronchus
  • Pulmonary Veins
  • Humerus
  • Clavicle
  • Manubrium of the Sternum
  • Angle of the Sternum (Louis)
  • Body of the Sternum
  • Heart
lat chest LLL consolidation
lat chest LLL consolidation
10. Al-Jabbar The Overpowering Lord Whoever recites Ya Jabbaru will not be subjected to coercion, and will not be exposed to violence, severity or harshness.

Thorax PA projection, L83, Thorax, Atlas of Radiologic Anatomy, Lothar Wicke

Thorax PA projection - How to read a CXR
  • general review – is the film well penetrated and symmetrical. Are breast shadows (if present) equal? Are nipple shadows (if present) equal? Are there artefacts such as wire sutures after cardiac surgery?
    • The film is well penetrated and symmetrical
    • The breast shadows are present and equal
    • No Nipple Shadows
    • No artifacts present
  • is the image centred? – inner clavicles should be the same distance from the midline
    • The Image is centered
  • is the trachea central?
    • The trachea is central
    • Carina - Bifurcation of trachea
  • follow the mediastinal outline downwards. Are their any bumps that shouldn’t be there? What might they be?
    • Left
      • Aortic arch
      • Pulmonary Vein
      • Left Auricle
      • Left Ventricle
    • Right
      • Superior Vena Cava - T3
      • Right Atrium
      • Inferior Vena Cava
  • does the lowest part of the heart shadow meet the diaphragm at a sharply defined angle? If not why not?
    • Yes
  • does the dome of the diaphragm have a normal sweep? Why not?
    • Yes
  • is the heart width less than twice the chest width (cardiothoracic ratio over 50% is abnormal e.g. in heart failure)
    • Yes
  • does the outer edge of the diaphragm meet the pleura at a sharp acute angle? If not why not?
    • Yes
    • Costodiaphragmatic recess sharp
  • is the sweep from the cardiophrenic angle to the lung apex symmetrical and equal? If not, why not?
    • Yes
  • do the lung markings go from the mediastinum to all areas of the lung normally?
    • Yes
    • Left Primary Bronchus
    • Pulmonary Vein
  • check the skeleton. Fractured ribs are difficult to see but there may be signs of old fractures. They may be at different stages or places suggesting previous trauma. Bony metastases or osteoporotic signs may be seen.
    • No fractures
    • Medial Margin of the Scapula
    • Superior Angle of the Scapula
    • Clavicles
    • 1st Rib
Other
  • Fundus of Stomach
The main regions where a chest X-ray may identify problems may be summarized as ABCDEF by their first letters:[3]
  • Airways, including hilar adenopathy or enlargement
  • Breast shadows
  • Bones, e.g. rib fractures and lytic bone lesions
  • Cardiac silhoutte, detecting cardiac enlargement
  • Costophrenic angles, including pleural effusions
  • Diaphragm, e.g. evidence of free air
  • Edges, e.g. apices for fibrosis, pneumothorax, pleural thickening or plaques
  • Extrathoracic tissues
  • Fields (lung parenchyma), being evidence of alveolar filling
  • Failure, e.g. alveolar air space disease with prominent vascularity with or without pleural effusions

Senin, 03 Januari 2011

Mediastinum and pericardium, G1.25, Anatomy, Thorax, Mediastinum

Mediastinum and pericardium, G1.25, Anatomy, Thorax, Mediastinum

Transverse Thoracic Plain from the Manubrio-Sternal Junction to the T4 / T5 Space separates Superior from Anterior, Middle and Posterior Mediastinum

Transverse section - Inferior View

Nothing else to note

Respiratory System, G1.24, Anatomy, Thorax, Pleural Cavities

Respiratory System, G1.24, Anatomy, Thorax, Pleural Cavities

Differentiate between Parietal and Visceral Pleura
Parietal Part: 

  • Mediastinal Part 
  • Diaphragmatic Part
  • Costal Part
  • Cervical Part
The Visceral and Parietal Pleura are continuous around the root of the Lung. Note the costodiaphragmatic Recess.


Radiograph of Chest, G1.23, Anatomy, Thorax, Thoracic Contents

Radiograph of Chest, G1.23, Anatomy, Thorax, Thoracic Contents

Widening Mediastinum (> 8cm on PA CXR)

  • aortic aneurysm


  • aortic dissection


  • hilar lymphadenopathy 


  • inhalational anthrax. A widened mediastinum was found in 7 of the first 10 victims infected by anthrax (Bacillus anthracis) in 2001.


  • esophageal rupture - presents usually with pneumomediastinum and pleural effusion. It is diagnosed with water soluable swallowed contrast.


  • mediastinal mass


  • cardiac tamponade


  • pericardial effusion


  • thoracic vertebrae fractures in trauma patients.


Trauma Post head-on collusion MVA -  bleeding into the Mediastinum after 
Laceration of the Large Vessels such as the Aorta or the SVC
Lymphoma enlarges the Mediastinal Lymph nodes
Cardiac hypertrophy widens the Inferior Mediastinum

Topography of the lungs and mediastinum, G1.22, Anatomy, Thorax, Thoracic Contents

Topography of the lungs and mediastinum, G1.22, Anatomy, Thorax, Thoracic Contents

Lungs:

  1. The Apex of the Lungs is at the level of the 1st Rib, 
  2. Inferior boarder of the lungs at 6th Rib in the Left Midclavicular Line and 8th Rib in the Lateral Aspect of the Thorax at the Midaxillary Line.
  3. Inferior reflection of the Parietal Pleura is at the 8th RIB MCL and 10th Rib MAL
Cardiac Apex 
  1. 5th Intercostal space Left MidClavicular Line
  2. Right Atrium forms the right boarder of the heart and extends just beyond the lateral margin of the Right Sternum
  3. Branches of the Great Vessels pass through the Superior Thoracic Aperture

Thoracic Contents in Situ, G1.21, Anatomy, Thorax, Thoracic Contents

Thoracic Contents in Situ, G1.21, Anatomy, Thorax, Thoracic Contents

Nerves: The Phrenic Nerves are lateral to the Vagus Nerves.

  1. Left Phrenic Nerve runs anteriorly to the root of the Left Lung. The Vagus Nerve runs Anterior to the Arch of the Aorta and then Posterior to the Root of the Left Lung.
  2. Right Vagus Nerve passes anterior to the right Subclavian Artery, 
    1. Recurrent Branch
    2. Branch to the esophageal, cardiac and pulmonary plexuses

Root of the Left Lung

The Pericardium is called the Fibrous pericardium and mediasinal part of the parietal pleura

Both Lungs have an Oblique fissure - dividing Superior and Inferior Lobes of the Lung
the Right Lung has a Horizontal Fissure - Superior, Middle and Inferior Lobe

Muscles of Respiration, G1.21, Anatomy, Thorax, Thoracic Wall

Quiet Breathing:

  1. Inspiration
    1. Diaphragm
    2. Tonic contraction of the external intercostals and intracondral portion of the internal intercostals to resist negative pressure
  2. Expiration
    1. Passive or elastic recoil
    2. Tonic contraction of muscles of the anteriolateral abdominal walls to antagonise the diaphragm
Active (Forced).
  1. Inspiration
    1. Diaphragm
    2. Tonic contraction of the external intercostals and intracondral portion of the internal intercostals to resist negative pressure
    3. Sternocleidomastoid, Descending (superior ) Trapezius, Pectoralis Minor and Scalenes
    4. Subcostales, Levatores Costarum and Serratus Posterior Superior to Elevate Ribs  
  2. Expiration
    1. Passive or elastic recoil
    2. Tonic contraction of muscles of the anteriolateral abdominal walls to antagonise the diaphragm
    3. Rectus abdominis, External and Internal Obliques, and Transverse Abdominis
    4. Internal Intercostals and Serratus Posterior to depress ribs

Internal aspect of anterior thoracic wall, G1.20, Anatomy, Thorax, Thoracic Wall

Internal aspect of anterior thoracic wall, G1.20, Anatomy, Thorax, Thoracic Wall

Muscles:

  1. Sternohyoid and Sternothyroid muscles
Nothing else notable

External aspect of thoracic wall, G1.19, Anatomy, Thorax, Thoracic Wall

External aspect of thoracic wall, G1.19, Anatomy, Thorax, Thoracic Wall:

  1. Muscles
    1. Sternothyroid
    2. Sternohyoid
    3. Scalene - Anterior, Middle and Posterior
  2. Parasternal Lymph nodes
  3. Subclavian Vessels between the Subclavius Muscle and 1st Rib

Muscles of the Thoracic Wall, G1.19, Anatomy, Thorax, Thoracic Wall

Muscles of the Thoracic Wall, G1.19, Anatomy, Thorax, Thoracic Wall:

  1. Serratus posterior superior
  2. Serratus posterior inferior
  3. Levatores costarum

Contents of the intercostal space, transverse section, G1.18, Anatomy, Thorax, Thoracic Wall

Contents of the intercostal space, transverse section, G1.18, Anatomy, Thorax, Thoracic Wall:

  • Musculocutaneous layers:
    1. External Intercostal Muscle and Membrane
    2. Internal Intercostal Muscle and Membrane
    3. Innermost Intercostal Muscle, Transverse Thoracis muscle and membrane
  • Nerves
    1. Anterior Rami of T1 to T11 are the Intercostal Nerves. T12 is the Subcostal Nerve.
    2. Posterior Rami innervate the deep muscle of the back and skin adjacent to the vertebral column

Anterior ends of inferior intercostal spaces, G1.17, Anatomy, Thorax, Thoracic Wall

Anterior ends of inferior intercostal spaces, G1.17, Anatomy, Thorax, Thoracic Wall:

  • External Intercostal and External Oblique muscle fibers run inferomedially
  • Internal Intercostal and Internal Oblique Muscles are continuous
  • The Intercostal nerves run parallel to the ribs and cartilages. On reaching the abdominal wall:
    • T7 and T8 continue superiorly
    • T9 continue horizontally
    • T10 continue inferomedially towards the umbilicus

Vertebral Ends of external aspect of inferior intercostal spaces, G1.16, Anatomy, Thorax, Thoracic Wall

Vertebral Ends of external aspect of inferior intercostal spaces, G1.16, Anatomy, Thorax, Thoracic Wall:

Nerves:

  • Posterior ramus of thoracic nerve
  • Collateral Branch of intercostal Nerve
  • The Intercostal Nerve is most inferior of the VAN - Important when doing a plural tap - but high enough to avoid the collaterals

Muscles: 

  1. Semispinalis Muscle 
  2. Longissimus Muscle
  3. Illiocostalis Muscle
  4. Levatores Costarum Muscle
  5. External Intercostal Muscle
  6. Internal Intercostal Muscle - is continuous with the internal intercostal membrane
  7. Innermost Intercostal Muscle
Ligaments:
  • Internal Intercostal Membrane
  • Lateral costotransverse ligament

Vertebral Ends of internal aspect of intercostal spaces, G1.15, Anatomy, Thorax, Thoracic Wall

Vertebral Ends of internal aspect of intercostal spaces, G1.15, Anatomy, Thorax, Thoracic Wall:

  • Posterior Intercostal Vein, Artery and Nerve - VAN
    • Collateral Branches of intercostal vessels and nerve
  • Nerves:
    • Communication from the the sympathetic trunk via Rami Communicates 
      • Anterior Ramus runs anterior to the costotransverse ligament and 
      • the Posterior Ramus of the Thoracic Nerve runs posterior to the Costotransverse Ligament
      • Visualise the spinal ganglion
    • Splanchnic Nerve is a visceral branch of the Sympathetic Trunk
  • Ligaments:
    • Radiate Ligaments of the head of the Rib
    • Superior Costotransverse Ligaments
    • Internal Intercostal Membrane is continuous with the superior costotransverse ligament
    • Anterior Longitudinal Ligament
  • Muscles:
    • Innermost intercostal Muscle
    • Subcostales Muscle
    • External Intercostal Muscle

Rib and Sternum anomalies , G1.14 ,Anatomy, Thorax, Bony Thorax and Joints

Rib and Sternum anomalies , G1.14 ,Anatomy, Thorax, Bony Thorax and Joints

  1. Cervical Ribs - Enlarged costal element of the 7th cervical vertebra. Pressure on the Inferior root of the Brachial Plexus can produce sensory and motor changes of the Ulnar Nerve
  2. Bifid Ribs -
  3. Bicipital Ribs - fusion of the 1st 2 ribs
  4. Sternal Foramen 
  5. Ossification of the Sternum - from inferior to superior - 
    1. 3 to 4th Body of sternum - 7y - , 
    2. 2nd Body of sternum - 14y and 
    3. 1st Body of sternum - 21 years.

Ligaments of Costovertebral articulations, G1.13 ,Anatomy, Thorax, Bony Thorax and Joints

Ligaments of Costovertebral articulations, G1.13 ,Anatomy, Thorax, Bony Thorax and Joints

  1. Radiate Ligament of the Head of the Rib to the two vertebral bodies and the interposing vertebral disc:
    1. Cosotrasverse joints rotate increasing AP diameter (Rib 1 to 7) and Ribs  8 to 10 Glide increasing Transverse appature 
  2. Superior costotransverse Ligament joins the transverse process of the vertebra to the crest of the neck of the rib
  3. Intra-articular Ligament joining the crest of the head of the rib to the intervertebral disc
Note the Anterior Longitudinal Ligament

Costovertebral articulations, G1.12 ,Anatomy, Thorax, Bony Thorax and Joints

Costovertebral articulations, G1.12 ,Anatomy, Thorax, Bony Thorax and Joints:

  1. Joints of the head of the Rib
    1. Superior costal facet (smaller)  and Inferior Costal Facet (Larger) of the Vertebra - for articulation with the head of ribs.
    2. The crest on the head of the rib separate the superior and inferior articular costal facets
  2. Costotransverse Joint
    1. Transverse costal facet for the tubercle of the corresponding rib
  3. Movement: 
    1. 1 to 7 Ribs rotate at the costotransverse joints increasing the AP diameter
    2. 8, 9 and 10th Ribs glide increasing the transverse diameter of the upper abdomen

Ribs, G1.11 ,Anatomy, Thorax, Bony Thorax and Joints

Ribs, G1.11 ,Anatomy, Thorax, Bony Thorax and Joints

The head of a Rib is posterior.
2nd rib - Turbercle for serratus anterior. Middle scalene attachment not shown.