[SUBJECT]

GEISEL SCHOOL OF MEDICINE AT DARTMOUTH

BREAST

Mam Fibroglandular tissue

mogram (right mediolateral oblique)
 All normal breast tissue lies superficial to the
 This image represents one of the common pectoralis major muscle, and is separated from this
mammographic views. muscle by clavipectoral fascia
 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.

Pector
alis major muscle

nipple

Subcut
aneous fat

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the heart (structures farther from the detector become

magnified)
CHEST WALL  Because of this, the right ribs are slightly magnified
 A chest xray (CXR) is one of the most common and appear larger than the left ribs.
imaging tests you will encounter as a clinician.  Notice that the right and left lungs are superimposed
 Two views (PA and lateral) are obtained at 90 on a lateral film
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.

PA View Trachea

 This is a normal PA chest xray

 When the image is taken, the scapula is protracted to
minimize its overlap with the chest wall.
 Notice that the posterior part of a particular rib is more
horizontal, while the anterior part of the rib slopes
from superior to inferior.

Oblique (major) fissure

Lateral View
 In the lateral view, the anterior and posterior limits of
the thoracic cavity are visible
 A lateral film is taken with the left side of the patient
against the detector plate to reduce magnification of

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Trachea and main stem bronchus

Horizontal (minor) fissure

LUNGS
 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
Left Hemidiaphragm
hemidiaphragm is slightly higher than the left
hemidiaphragm 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

Right hemidiaphragm

Left upper lobe

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Right middle lobe

Left lower lobe

Right lower lobe

Right upper lobe
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

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PA CHEST – PNEUMOTHORAX

Heart
 This patient has a right pneumothorax (air in the
pleural cavity).
 Here is the edge of the collapsed lung

Aortic knob

 The absence of the branching pulmonary vessels and

bronchi (the “white streaks”) is a clue that there is no
lung tissue in the black area.
 The collapsed right lung is denser than the normally
inflated left lung because there is little to no air within
the alveoli and the bronchi and vessels are crowded.

MEDIASTINUM
 Many of the mediastinal structures have intermediate
levels of density, so it is difficult to discern them with
radiography.
 However, structures that are adjacent to the
radiolucent lungs (less dense) can be visualized due
to the difference in density
Right lateral edge of SVC

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Left lateral edge of descending aorta

Manubrium
CT: Axial Superior Mediastinum

 This is the first in a series of axial (transverse) CT

images of the thorax.
 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.
 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 the black represents air.

Vertebral body

Level of slice

Spinal cord

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Spinous process Adipose tissue

Scapulae

Ribs

Trachea
Pectoralis major

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Esophagus Brachiocephalic (innominate) artery

Left brachiocephalic vein Left Common Carotid Artery

Right brachiocephalic vein Left Subclavian Artery

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 This is a more caudal slice than the one prior

 Level of the slice

Pulmonary vessels

Left pectoralis minor

Aortic arch

Infraspinatus muscles

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 This is a more caudal slice than the one prior

 Level of slice

SVC

Sternum

Azygos vein

Costal Cartilage

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 This is a more caudal slice than the one prior

 Level of slice

Ascending aorta

Descending Aorta

Bifurcation of the trachea

Pulmonary trunk

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Aortic arch
Left pulmonary artery

HEART

 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

SVC

Right heart border

Left heart border

Right Atrium

Left heart border

Left Ventricle

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Apex

Cardiomegaly C
 This is a comparison of a normal-sized heart with an ardiomegaly
enlarged heart
 Notice that the enlarged heart is more globular in
shape Lateral Chest Film
 The left heart borders is closer to the left lateral chest  In this view, the anterior and posterior heart borders
wall, and the right heart border extends out farther are visible.
from the spine compared to the normal heart
 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

Normal heart

Right ventricle

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Sternum
Left Atrium

Left ribs

Aortic Arch

CT: Axial Heart

 This is an axial CT image of the heart.
 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

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Right pulmonary vein Left ventricle

Mitral valve

Left atrium

Right Atrium
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CT- Coronal heart

 CT images are obtained as a helix of data that can
then be reformatted into imaging planes.
 This is a coronal reformatted image of the contrast
enhances chest CT

Left Ventricle

Right ventricle

Myocardium

Interventricular septum

Ascending aorta

Descending Aorta

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Aortic valve Interventricular septum

Pulmonary trunk Right ventricle

Right Atrium Diaphragm

SVC

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