M-1 CHEST RADIOLOGY

Francis H. Neuffer, MD USC-SOM

OBJECTIVES
 Understand chest X-ray anatomy  Relate catheters and medical devices

to anatomy
 Identify landmarks at standard CT section levels  Correlate common pathology to anatomy
2

NORMAL CHEST X-RAY

PA

LATERAL
3

NORMAL HEART BORDERS

4

LEFT 4TH RIB

POSTERIOR AND ANTERIOR PORTIONS

POSTERIOR
4

ANTERIOR
4TH

BRONCHOGRAMCONTRAST OUTLINING AIRWAY

TRACHEA

LT. MAIN BRONCHUS

RT. MAIN BRONCHUS CARINA

ENDOTRACHEAL TUBE IN POST OPERATIVE PATIENT

NORMAL CHEST ANATOMY LATERAL CHEST XRAY

Diaphragm-AP view AORTIC ARCH
TRACHEA

LT.

HORIZONTAL FISSURE

Diaphragm- Lateral view OBLIQUE FISSURE LT.

RT. HEMIDIAPHRAGM RT. LT. HEMIDIAPHRAGM COLON GAS LT.

FISSURES DIVIDE LUNGS INTO LOBES

RIGHT lung has: UPPER

HORIZONTAL FISSURE

MIDDLE LOWER

lobes

LEFT lung has: UPPER LOWER lobes

Lt

NUCLEAR MEDICINE LUNG SCANS

10

MR ARTERIOGRAM

11

PULMONARY ARTERIOGRAM
CATHETER LT. BRACHIOCEPHALIC VEIN

LT. PULMONARY ARTERY

LT. UPPER LOBE VESSELS

RT. UPPER LOBE VESSELS

RT. MIDDLE LOBE VESSELS

RT. PULMONARY ARTERY

MAIN PULMONARY ARTERY RT. LOWER LOBE VESSELS LT. LOWER LOBE VESSELS

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INT. JUG. VEIN

PULMONARY ARTERY CATHETER

SVC

RT. PUL .ART.

PA

SWAN CATHETER

RA

RV

13

INT. JUG. VEIN

SUBCLAVIAN VEIN

BRACHIOCEPHALIC VEIN

UPPER EXTREMITY
VENOUS DRAINAGE

SVC

ELECTRODES

(NOTE CATHETERS)

14

INT. JUG. VEIN

BRACHIOCEPHALIC VEINS SUBCLAVIAN VEIN

UPPER EXTREMITY
VENOUS DRAINAGE

SVC

ELECTRODES

(NOTE CATHETERS)

15

RT. COMMON CAROTID

LT. COMMON CAROTID

LT. SUBCLAVIAN ARTERY

RT. PUL ARTERY

LT. PUL ARTERY

AORTA

LT ATRIUM

SUBTRACTION IMAGE
AORTA

MR CONTRAST ARTERIOGRAM
16

OBLIQUE ESOPHAGUS
OBLIQUE SPINE

TRACHEA

BARIUM FILLED ESOPHAGUS

LEFT HEMIDIAPHRAGM

FUNDUS OF STOMACH

17

X-RAY MAMMOGRAPHY

Marker is always put on the axillary side of the breast

PATIENT POSITIONING FOR MAMMOGRAPHY

18

SCREENING MAMMOGRAPHY VIEWS

MLO

FATTY TISSUE
CC

MUSCLE

CC VIEW
CRANIO - CAUDAL
GLANDULAR AND FIBROUS TISSUE

MLO VIEW
MEDIO-LATERAL OBLIQUE
19

NORMAL HEART

20

AORTA

Aorta

Pulmonary artery

PA RA

RV

LV

Left Ventricle

21

PACEMAKER WITH RT. ATRIAL AND RT. VENTRICULAR LEADS

RA

RV

22

TRICUSPID AND MITRAL VALVE REPLACEMENT

ARROWS SHOW DIRECTION OF BLOOD FLOW THROUGH VALVES FROM ATRIA TO VENTRICLES

Right to left

Posterior to anterior

23

POST OP VALVE REPAIR

M- MITRAL A- AORTIC

24

Pacemaker

AORTIC AND PULMONARY VALVE REPLACEMENT

Electrode on skin
A

Pacer in Rt. Ventricle

25

CORONARY ARTERY ANATOMY

26

CORONARY ARTERIES

RT.

LT.

LAD

CIRCUMFLEX

27

CORONARY ARTERY STENTS

28

LAD

CORONARY ARTERIOGRAM
CIRCUMFLEX

LEFT MAIN ARTERIAL INJECTION

29

CHEST- POST OP CABG

CORNARY ARTERY BYPASS GRAFT

ENDO TRACHEAL TUBE CATHETER ENTERS SKIN AT LT SUBCLAVIAN VEIN

x
LT. BCV

RT SUBCLAVIAN VEIN RT. PUL .ART.

SVC

STERNAL WIRES

PA

RA RV

CARDIAC ELECTRODES

LV

CATHETER PATH SUBCLAVIAN VEIN LT. BRACHIOCEPHALIC VEIN SUPERIOR VENA CAVA RIGHT ATRIUM THROUGH TRICUSPID VALVE RT VENTRICLE PULMONARY ARTERY RT PULMONARY ARTERY

30

SAPHENOUS VEIN GRAFT TO RIGHT CORONARY ARTERY

3D CT MODEL OF CORONARY ARTERIES

31

LEFT INTERNAL THORACIC (MAMMARY) ARTERY GRAFT

APPLIED

SURGICAL CLIPS

RADIOLOGY 7/2008

32

CT THORACIC ANATOMY
LOOK AT AN X-RAY AS IF THE PATIENT IS LOOKING AT YOU.

LOOK AT A CT SCAN AS IF THE PATIENT IS LYING ON THEIR BACK AND YOU ARE LOOKING FROM THEIR FEET TO THEIR HEAD.

Anterior projection
33

RT

SCAN LEVELS
GREAT VESSELS AORTIC ARCH PULMONARY/CARINA ATRIA VENTRICLES

CT CHEST ANATOMY
34

RT

GREAT VESSELS

RT

CT CHEST ANATOMY
35

CHEST-- CT
RT

BRACHIOCEPHALIC ARTERY SVC TRACHEA LT. COMMON CAROTID ART. LT. SUBCLAVIAN ART.

Great vessels

36

AORTIC ARCH

CT CHEST ANATOMY
37

CHEST -- CT
INTERNAL MAMMARY (THORACIC) ARTERY AND VEIN

SVC AORTIC ARCH

ESOPHAGUS SCAPULA

Aortic arch

38

PULMONARY & CARINA

CT CHEST ANATOMY
39

CHEST -- CT
STERNUM ASCENDING AORTA

LT. PULMONARY ARTERY

CARINA DESCENDING AORTA

PULMONARY & CARINA

40

CHEST - CT

LT. ATRIUM

ATRIA

ASCENDING AORTA

RT ATRIUM

LT ATRIUM DESCENDING AORTA

Atria
42

VENTRICLES

CT CHEST ANATOMY
43

CHEST -- CT
RT. VENTRICLE SEPTUM

DOME OF DIAPHRAGM

LT. VENTRICLE

DESCENDING AORTA

Ventricles

44

CORONAL SLICES

STERNUM

COSTAL CARTILAGE

LIVER

45

CORONAL SLICES

PULMONARY OUTFLOW RT. VENTRICLE

LT. VENTRICLE

LIVER

46

CORONAL SLICES

PULMONARY ARTERY AORTA

RT. ATRIUM

LEFT VENTRICLE

47

CORONAL SLICES

SVC

RT. ATRIUM

48

CORONAL SLICES

RT. PULMONARY ARTERY

LT. ATRIUM

49

CORONAL SLICES
AORTA CARINA

LT. PULMONARY ARTERY

LT. ATRIUM

DESCENDING AORTA

50

CORONAL SLICES

DESCENDING AORTA

LIVER

SPLEEN

51

WHO DREW THIS PICTURE ?

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INTERESTING CASES
You will be assigned one of the following cases. I will email your case to you. Please send the slide back to me with your diagnosis typed in the space provided within 2 days. I will then send you a the correct diagnosis in a 4 slide ppt. You will be asked to label and answer questions concerning your case. You will have 3 days to return the completed ppt. to me. If you have any questions please call me @ 733-3298, or come by my office.(Basement of the Library)
Penny Al-Emam RT, (R) (M) Department of Radiology

Please note: You will be working on the case with a partner. I want only 1 returned ppt. Do not copy the case so that I receive a ppt. from each partner. Thanks.
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CHEST CASE # 1
Patient with chest pain and cough.

Study the images. Add your diagnosis and return to me . Penelople.Al-Emam@uscmed.sc.edu

Diagnosis______________________

Students____________________ ____________________________ Date_________

CHEST CASE # 2
56 year old female goes to ED with cough and fever.

Review the radiographs and add your Diagnosis. Return to me. Penelope.Al-Emam@uscmed.sc.edu

Diagnosis :_______________

Student s ________________ ______________

CHEST CASE # 3
4 week old infant taken to the ED because of a cough x 2 weeks.

Review the film. Add your diagnosis in the space given and return to me. Penelope.Al-Emam@uscmed.sc.edu

Diagnosis____________________

Students___________________ ___________________ Date___________

CHEST CASE # 4
Patient in Doctors office with peripheral edema.

Review the image-add your diagnosis and send back to me. Penelope.Al-Emam@uscmed.sc.edu

Diagnosis______________

Students_______________ ________________ Date_____________

CHEST CASE # 5
Patient in the ICU with decreased O2 saturation over 12 hours

Review the image Add your diagnosis And return to me . Penelope.Al-Emam@uscmed.sc.edu

Diagnosis :____________

Students__________________ __________________ Date____________

CHEST CASE # 6
35 year old male presents to the ED with SOB

Review the film. Give your diagnosis and return to me. Penelope.Al-Emam@uscmed.sc.edu

Diagnosis:______________

Students_______________ _______________________ Date________________

CHEST CASE # 7
Patient in the ICU becomes SOB

Review the film. Give your diagnosis and return to me. Penelope.Al-Emam@uscmed.sc.edu

Diagnosis:______________

Students_______________ _______________________ Date________________

CHEST CASE # 8
70 year old female goes to doctor with complaint of difficulty breathing.

Review the film. Give your diagnosis and return to me. Penelope.Al-Emam@uscmed.sc.edu

Diagnosis:______________

Students_______________ Date________________

CHEST CASE #9
Automobile accident victim brought in to the ED by paramedics.
Review the film. Give your diagnosis and return to me. Penelope.Al-Emam@uscmed.sc.edu

Diagnosis:______________

Students_______________________ _______________________ Date________________

CHEST CASE #10

A 33 year old male post 4-wheeler accident.
Review the film. Give your diagnosis and return to me. Penelope.Al-Emam@uscmed.sc.edu

Diagnosis:______________

Students_______________ _______________________ Date________________

CHEST CASE #11

Mother brings child into the ED stating that the child has swallowed something and is now drooling more that usual.

Review the film. Give your diagnosis and return to me.

Penelope.Al-Emam@uscmed.sc.edu

Diagnosis:_________

Students_________ Date_____________