Radiography of the Chest
Projections

       A set of introductory notes in pdf format can be found in the Tutorial Notes section

Indications for imaging (RCR 1998) Chest X-ray

 

Clinical Problem Recommended? Comment
Chest pain ?MI Yes Assessment of heart size & pulmonary oedema
Departmental PA preferable to mobile
Chest pain Yes To exclude other causes, rarely diagnostic
Acute aortic dissection Yes CT more helpful
Pulmonary embolus Yes Nuclear medicine more definitive
Pericariditis Yes May be normal
Pericardial effusion Yes US more helpful
Vascular disease Yes Initial assessment
Chest trauma Yes If ? pneumothorax
Pneumonia follow up Yes To confirm resolution (>10 days)
Haemoptysis Yes + lateral
ITU Yes Symptomatic change
     
Indications when Chest X-Ray is NOT indicated
Non specific chest pain   Main purpose is reassurance
Chest trauma   Showing rib # does not change management
Pre employment screening   Only justified in high risk (e.g. divers)
Upper respiratory tract infection   Follow up after treatment only valuable after 10+ days
Chronic obstructive lung disease   Only if symptoms change
     

*These are general  recommendations*
     

Basic Anatomy

  1. Bony Thorax - contains and protects structures, also provides attachments for muscles.

    1. Vertebrae - 12 thoracic segments

    2. Ribs - 12 on each side, articulate with the vertebral bodies and transverse processes

    3. Sternum - manubrium and body

    4. Clavicles

  2. Mediastinum

    1. Anterior Compartment

      1. Thymus

      2. Lymph Nodes

    2. Middle Compartment

      1. Heart and Pericardium

        1. the right atrium forms the right heart border on the frontal view

        2. the left ventricle forms the left heart border on the frontal view

        3. the left atrium forms the posterior heart border on the lateral view

        4. the right ventricle forms the anterior heart border on the lateral view

      2. Ascending and Transverse Arch of the Aorta

      3. Brachiocephalic Arteries and Veins

        1. the aortic arch has three branches

          1. the brachiocephalic which divides into the right subclavian and right common carotid arteries

          2. the left common carotid

          3. the left subclavian artery

        2. the brachiocephalic veins are formed by the joining of the subclavian and jugular veins on each side, the left brachiocephalic vein moves across the mediastinum from left to right to join with the right brachiocephalic vein thus forming the superior vena cava

         

      4. Pulmonary Arteries and Veins

        1. the main pulmonary artery or trunk arises anteriorly out of the right ventricle and divides into the left and right pulmonary arteries. The left pulmonary artery is shorter and higher passing over the left mainstem bronchus. The right pulmonary artery is larger, longer, and slightly lower passing between the right upper lobe bronchus superiorly and the bronchus intermedius posteriorly

        2. there are superior and inferior pulmonary veins bilaterally which drain into the left atrium

         
           

      5. Trachea and Main Bronchi - at the carina the trachea divides into the left and right mainstem bronchi, the left mainstem bronchus divides into the left upper and lower lobe bronchi, the right mainstem bronchus is shorter giving rise to the right upper lobe bronchus and then continuing on as the bronchus intermedius which divides into the right middle and lower lobe bronchi.

      6. Nerves

      7. Lymph Nodes

    3. Posterior Compartment

      1. Esophagus

      2. Descending Thoracic Aorta

      3. Azygos and Hemiazygos Veins

      4. Thoracic Duct

      5. Lymph Nodes

      6. Sympathetic Nerves

Lung

  1. Lobes and Fissures

    1. Right Lung - major (oblique) and minor (horizontal) fissures divide the right lung into three lobes - upper lobe, middle lobe, and lower lobe

    2. Left Lung - major (oblique) fissure divides the left lung into two lobes - lower lobe and upper lobe (the lingula is part of the upper lobe)

     

  2. Segments - the lobes of the lungs are further subdivided into segments based on the branching pattern of the bronchial tree.

    1. Right Upper Lobe - three segments - apical, posterior, and anterior

    2. Right Middle Lobe - two segments - medial and lateral

    3. Right Lower Lobe - five segments - superior, medial basal, anterior basal, lateral basal, and posterior basal

    4. Left Upper Lobe - four segments - apical-posterior, anterior, superior lingular, and inferior lingular

    5. Left Lower Lobe - four segments - superior, anteromedial basal, lateral basal, an posterior basal

     

  3. Pleura

Cross sectional images of the chest to demonstrate Anatomy

References:
Text based on- Gross Anatomy Radiology of the Chest by Perry G. Pernicano, MD
http://www.med.umich.edu/lrc/coursepages/M1/anatomy/radiology/rad_chest.html

Images
http://www.vh.org/Providers/TeachingFiles/NormalRadAnatomy/Images/