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RADIO ANATOMY
RESPIRATORY TRACTAND MEDIASTINUM
Rista D. Soetikno, dr, SpR
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Radioanatomy
• Studies of human body seeing through the
roentgenologic examination
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Respiratory Tract
– Upper air passage (a!. "asi and pharynx#
– $arynx
– %rachea and bronchus
– $ung & 'ascular (lymph#
– %horacic all & diaphragm
•),*,+ hest xray•$ung -
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Lung anatomyRig!t Superior $obe pical Segment (/#
0osterior Segment (1#nterior Segment ()#
2edial $obe $ateral Segment (*#2edial Segment (+#
3nferior $obe picobasal Segment (4#
2ediobasal Segment (5#
nterobasal Segment (6#
$aterobasal Segment (7#
0osterobasal Segment (/8#
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Lung AnatomyLe"t
Superior $obe picoposterior Segment (/#
nterior Segment (1#
$ingula Superior Segment ()#3nferior Segment (*#
3nferior $obe pical (+#
ntero medial basal (4#$atero basal (5#
0ostero basal (6#
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9ray : ;luoroscopy indication
• ontact person• ough < 1 eeks
• Recurrent respiratory infection
• =emaptoe• >kstra pulmonary %?
• >rytema nodosum : con@unti!itis phlyctenularis
• ;issure:fistula anichronicum• D2
• 0recautionary indication
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9ray >xamination
• Routine A 0
• Special A
• $ateral – $eft
– Right
• 0
• BbliCue $eft Right
• $ateral decubitus
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Special method of examination
• %omografi
• ?ronchografi• US
• % scan• 2R3
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0 0osition
• 0lace patient beteen film – 9 ray source• =a!e the patient stand backard to the 9 ray
source, chest close to film ith hand on the hip,ith elbo flexed. Distance beteen film and 9
Ray$ung– /,+ m
=eart 1 m
• Ray concentrated at
'.%h. 45
E' +848
2.s /818
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ood chest 9Ray depend onA/. ood film Cuality
Depending on AE'
2.s
0rocessing
1. Symmetry
). ll part of thorax are included
*. 3dentity :2arking
+. "o artefact4. "o motion artefact
5. 2aximal inspiration
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Fhat studied in chest xray
• Soft tissue
• ostae and cla!icle
• %rachea
• SiGe, shape and position of heart
• $ung – =illous
– ?roncho!askuler marking
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$ung field A
• $ung apex
• $ung top field
• $ung middle field
• $ung loer field
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$ateral chest film
3ndication
• %o study abnormality that is not !isible on
0 film
• %o study mediastinal disorder
• =eart studies
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$ateral chest procedure
• 0lace patient beteen film and 9ray
source
• 0lace lateral side of chest (left:right# on film
• =ands behind the head
• Ray centered on %h 45
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Fhat studied on lateral chest film
• %rachea and mainbronchial branch radioluscent
• =eart, aortic arch, asc: desc aortic
• $eft: Right $ung broncho!ascular markingsuperposition
• Retrosternal space
• Retrocardial space• ostophrenic sinus
• ardiophrenic sinus
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Antero posterior #AP$ c!est "i%m
3ndication A
• Se!erely ill patient
• hildren : babies
• Bbese, pregnancy, ascites, abdominal tumor
0rocedureA
• 0lace patient lying don on table ithelbo abo!e head
• 0lace film on patientHs back
• entered ray on %h 45
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%op lordotic chest xray
3ndication A• %o studies disorder located on apex : medial lobe
cla!icle turn upard
0rocedureA
• 0lace patient beteen film and xray source, ha!ethe patient face the xray source
• =a!e the patient stand )8 cm in front ith back placed on the cassette
• Set top part of the cassette / inch abo!e theshoulder
• entered ray on manubrium sterni
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BbliCue chest filmA
3ndication A
• =eart studies
• %o study abnormality that is not yet clear on 0studies
0rocedure
• 0lace patient beteen film and ray source
• 0ut !entral left:right side of the patientHs thorax onthe cassette making *+ 8 angle
• enter ray on 'ert. %h 45
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Latera% decu&itus c!est "i%m
3ndication A
• %o study fluid in pleural ca!ity that is around /88188cc
• Br fluid accumulation that is not yet determined on 0studies
0rocedure
• =a!e the patient lying don on left:right side ithelbo abo!e the head
• enter ray on !ert. %horacal 45 from anterior:posterior aspect
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Mediastinum 'orders
SuperiorA pertura thoracis sup.
Dorsal A 'ertebral olumn.
'entral A Sternum. 3nferior A Diaphragm.
$ateral A 2ediastinal pleura.
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/. nterior superior med
1. nterior medius med
). nterior inferior med
*. Superior medius med
+. 2iddle med
4. 0osterior superior med
5. 0osterior medius med
6. 0osterior inferior med
Mediastina%
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/. Radiograph A
• hest filmA 0.
• $ateral.
• esophageal contrast studies.
1. ;luoroscope A
• %o study pulsation• %o study placement of organ in chest
ca!ity
Mediastina% Studies
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%o study mass relation ith ad@acent organ
Diaphragm
>sophagus
=eart and ma@or !essel
%o study pericardial effusion
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). %omografi.
*. ngiografi Usually ith
%.+. % Scan : 2R3.
4. US A 2ass close todiaphragm : 0ericard effusion.
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5. "uclear med. Radioisotop.
• Radio isotop angiogram.
• %o study localiGation of tumor .
• >C A thymoma, thyroid, lymph
node.
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nterior superior med
•neurisma aorta•%hymus =yperplasia
•$ymphoma
• 3ntrathoracal Struma
•%hymoma
Location o" mediastina%
disorder
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nterior middle med.
ο• Dermoidο• %eratoma
Location o" mediastina% disorder
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Ant( In"erior( Med
• %hymoma.
• 0ericardial cyst.
• =ernia diafragmatica.
Superior Mid( Med
• neurisma.
• Dermoid.
• %eratoma.
• 2ediastinal trauma
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Midd%e Mediastina%
• Dermoid
• %eratoma
• $ymphoma
• %umor metastasis ($ymph
spread#
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Post superior med(
• Besophageal disorder
• neurism
• "eurinoma, neurofibroma.• 0ancoast tumor
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Anterior In"erior med(
)( T!ymoma(• <;emale
• ould turn 2alignant.
• Round:lobulated.
*( Pericardia% cyst(
• ystic tumor that connected ith pericardium.
• Bn right cardiophrenic sinus
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Midd%e Mediastina%
)( In"ection
• Sarcoidosis
• %?• 2ycosis.
• >rythema nodosum
*( Tumor Metastasis
). Lymp!oma
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Posterior mediastina%
>sophagus disorder A• Di!erticle.
• chalasia : halasia
0ancoast tumor
neurisma.
"eurogenic tumor ("eurofibroma, "eurinoma#
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Post medius med(
• "eurogenic tumor.
• ?ronchial defect enteric cyst.
Post in"erior med(
• "eurogenic origin primary tumor.
• Diaphragmatic hernia.
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Anterior superior Med(
/. O"ten A %hymic =yperplasia.
•$obuler type, flag fusiform.
•?ilat:unilat.
•Bn children (%hymic 0ersistent#
1. Aneurisma A ardio!ascular
section). Lymp!oma Ma%igna
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RoA tracheo bronchial node enlargement
lobulated ould cause superior cavavein. Syndrome.
+( Intrat!oraca% Struma
*8 years
Usually compress A trachea,oesophagus, phrenic ner!e.