Thorax Radiology

This image represents one of the common mammographic views. The breast tissue is compressed in a medial lateral oblique (MLO) orientation in order to obtain a large surface area for imaging. Fibroglandular tissue, the breast ducts and lobules, comprises the bulk of the dense material seen in a mammogram. All normal breast tissue lies superficial to the pectoralis major muscle, and is separated from this muscle by clavipectoral fascia.

Ductogram

A ductogram is a procedure performed to visualize the ductal anatomy of a breast lobe, often to evaluate patients with nipple discharge. A very thin, blunt cannula is inserted into the opening of a particular lactiferous duct, and contrast dye is injected followed by mammographic imaging. This example shows the ductal anatomy of a breast lobe, with reflux of dye into the lobular tubuloalveolar system.

Chest Wall

Radiography of the Chest Wall

A chest X-ray (CXR) is one of the most common imaging tests you will encounter as a clinician. Two views (PA and lateral) are obtained at 90 degrees from each other in order to gain an appreciation of dimensionality.

Structures of the chest wall can be evaluated on radiographs. The breast tissue cannot be evaluated on standard CXR due to poor visualization of the breast parenchyma.

In the lateral view, the anterior and posterior limits of the thoracic cavity are visible.

PA Chest - Chest Wall

This is a normal PA chest xray. When the image is taken, the scapula is protracted to minimize its overlap with the chest wall. Can you see where the medial border of the scapula is overlapping with the chest wall? Notice that the anterior and posterior parts of the ribs are superimposed. The portion of the rib that is more horizontal is the posterior part, while the anterior part of the rib slopes from superior to inferior.

BONUS: Counting ribs on a CXR is a skill that requires some practice. Radiologists typically find rib 1 and count from there. On the right side of the patient, see if you can find the intersection between the anterior part of the 5th rib and the posterior part of the 8th rib. When you add the labels to the image a dot will appear at this intersection.

Chest Wall - Quiz

Radiology Quiz

Anatomy Quiz

Osteology Quiz

Practical Quiz

Lungs

PA Chest - Lung

Air does not absorb X-ray beams, so areas filled with air, such as the lungs and bronchial tree, appear dark on a CXR. Notice that there are white "streaks" in the lungs, especially near the hilum. These streaks are formed by the branches of the bronchial tree and pulmonary vessels. Notice that in a normal chest film, the right hemidiaphragm is slightly higher than the left hemidiaphragm.

Lateral Chest - Lung

A lateral film is taken with the left side of the patient against the detector plate to reduce magnification of the heart (structures farther from the detector become magnified). Because of this, the right ribs are slightly magnified and appear larger than the left ribs. Notice that the right and left lungs are superimposed on a lateral film.

Lobar Anatomy - PA

Portions of each lobe of the lung are superimposed on one another on a CXR. Because of this, it is not always possible to pinpoint the lobar location of a nodule on a PA CXR.

Lobar Anatomy - Lateral

The lower lobes of each lung are completely superimposed on one another on a lateral CXR, and portions of the upper and right middle lobes are superimposed. Because of this, it is not possible to determine which lung an abnormality is in on a lateral CXR.

Abnormal Chest Radiograph

Lung Dissection Video

Lungs - Quiz

Anatomy Quiz

Practical Quiz

Mediastinum

PA Chest Radiograph

Many of the mediastinal structures are of similar density, so it is difficult to differentiate them with radiography. However, structures that are adjacent to the radiolucent lungs (less dense) can be visualized due to the difference in density.

CT: Axial Superior Mediastinum

This is a series of axial (transverse) CT images of the thorax of one patient. The images have been "windowed" (contrast adjusted) in order to highlight soft-tissue structures, and consequently, the lungs appear mostly black. As you work through these images, it may be helpful to remember the structures in the previous "slice" in order to be able to trace those structures and maintain orientation. This first image will ask you to name several structures for reference, most of which will continue to be present in subsequent slices. In all of these images, vascular structures are bright due to the injection of contrast dye in the venous system (usually via the arm) of the patient. You can assume that black represents air. The reference chest radiographs show the approximate level of the axial slice.

Slices

Each of the following CT slices is more caudal than the slice prior.

Mediastinum - Quiz

Anatomy Quiz

Practical Quiz

Radiology Quiz

Heart

PA Chest Radiograph

The size of the heart and the borders of certain chambers can be evaluated on a PA chest film. By performing the film PA, the heart is placed close to the detector plate, preventing magnification of the heart.

Cardiomegaly

This is a comparison of a normal-sized heart (right image) with an enlarged heart (left image). Notice that the enlarged heart is more globular in shape. The left heart borders is closer to the left lateral chest wall, and the right heart border extends out farther from the spine compared to the normal heart.

Lateral Chest Radiograph

In this view, the anterior and posterior heart borders are visible. There is some superimposition of the heart chambers on this view. The most posterior chamber is the left atrium, and the most anterior chamber is the right ventricle.

CT Heart

This is an axial CT image of the heart. Below are a reference PA chest radiograph and a comparable anatomic image from the Visible man showing the approximate level of this axial slice. As in all axial (transverse) images, the patient is lying supine and you are observing from the patient's feet looking towards the head.

An iodine based CT contrast agent was injected intravenously to opacify (increase the density of) the heart chambers and blood vessels.

Coronal CT

This image is of the same patient as in the previous image. CT images are obtained as a helix of data that can then be reformatted into imaging planes. This is a coronal reformated image of the contrast enhanced chest CT.

Cardiac Chambers

The borders of each cardiac chamber are not discernable on radiography (except where they are border forming with the lung, like the lateral margin of the right atrium). This demonstrates the approximate position of the chambers and large vessels.

Cardiac Chambers on Radiography (Lateral)

This demonstrates the approximate position of the chambers and large vessels on the lateral radiograph.

Imaging the Heart Video

Linked below is a 10 minute introduction into imaging the heart recorded by Nancy McNulty, MD (Professor of Radioloy and Medical Education) that is intented to supplement the material covered in class.

Angiography

Aortic Arch Angiogram

An aortic arch angiogram is obtained by threading a catheter into the ascending aorta and injecting iodine-based dye. Sequential X-rays are then taken as the dye is injected. This image is a static image from the angiogram series.

Left Coronoary Angiogram

An angiogram of the coronary arteries is performed by threading a small catheter from the femoral artery in the groin up into the aorta, and selectively cannulating the coronary ostia. Radio-opaque dye is then injected and X-ray images are obtained via fluoroscopy to evaluate the coronary anatomy. Fluoroscopy allows for real-time acquisition of images, and is a technique which is conceptually similar to the standard X-ray radiographs which you have seen thus far. A major difference is that radio-dense material appears dark rather than bright. This image of the left coronary system is obtained via a right anterior oblique view of the heart.

Right Coronary Angiogram

This image was obtained via a left anterior oblique view (almost as thought you were looking "down the barrel" of the heart) in order to view the right coronary artery as it courses along the outside of the atrioventricular groove on the right. Because of the angle, the posterior interventricular artery branch will look significantly foreshortened.

Left Ventriculogram

This image is obtained by threading the catheter into the left ventricle and injecting contrast dye. The dynamic ejection of blood into the aorta can then be evaluated.

Breast

Mammogram (right mediolateral oblique)

Ductogram

Chest Wall

Radiography of the Chest Wall

PA Chest - Chest Wall

Chest Wall - Quiz

Radiology Quiz

Quiz

Which part of the rib is labeled?

Anatomy Quiz

Quiz

Which costal cartilage joins the sternum at the sternal angle?

Osteology Quiz

Quiz

Practical Quiz

Quiz

Lungs

PA Chest - Lung

Lateral Chest - Lung

Lobar Anatomy - PA

Lobar Anatomy - Lateral

Abnormal Chest Radiograph

Quiz

Lung Dissection Video

Lungs - Quiz

Anatomy Quiz

Quiz

The horizontal fissure separates:

Practical Quiz

Quiz

Mediastinum

PA Chest Radiograph

CT: Axial Superior Mediastinum

Mediastinum - Quiz

Anatomy Quiz

Quiz

Your patient has a tumor on the root of the lung - specifically it is located on the posterior aspect of the right primary bronchus. Which of the following would most likely be compressed by the tumor?

Practical Quiz

Quiz

Radiology Quiz

Quiz

Heart

PA Chest Radiograph

Lateral Chest Radiograph

CT Heart

Cardiac Chambers

Imaging the Heart Video

Angiography

Aortic Arch Angiogram

Left Coronoary Angiogram

Right Coronary Angiogram

Left Ventriculogram

Heart - Quiz

Anatomy Quiz

Quiz

Which structure is associated with the right ventricle?

Practical Quiz

Quiz

Identify the labeled structure.

Thorax Radiology Quiz

Radiology Quiz

Quiz

Identify the labeled chamber of the heart.

Axial CT Slices