Radial Anatomy of The Thorax

RADIOLOGICAL
ANATOMY OF THE
THORAX AND
VERTEBRAL COLUMN
By Odu Chinyere Michelle and Kamani Elijah Victor

. Learning objectives
• To understand radiological anatomy of the thorax and the vertebral column
Introduction
• We'll be discussing the thorax also known as the chest cavity, we'll look at radiological
pictures of the thorax from different views.
• Also the vertebral column
Reason for Chest radiography
Chest radiography is a sensitive but non-specific test to detect pulmonary TB. Radiographic
examination of the thorax may be useful to identify persons for further evaluation, but a diagnosis of
TB should never be established by radiography alone. Reliance on the chest radiograph as the only
diagnostic test for TB will result in both over-diagnosis and missed diagnosis of TB. HIV-infected
patients who present with an abnormal chest radiograph but no respiratory symptoms may still have
significant pulmonary disease. TB may also present with respiratory symptoms and a normal chest
radiograph. Similarly, active pulmonary TB cannot be distinguished from inactive disease on the
basis of radiography alone, and readings of “fibrosis” or “scarring” do not exclude active disease.
THORAX
• The thorax is the part of the trunk between the neck and the abdominal cavity. It extends from the
first rib to the diaphragm and is bounded by the sternum, twelve thoracic vertebrae, the twelve
pairs of ribs, and the muscles that attach to these bones. The thorax contains the lungs surrounded
by pleural spaces. It also contains the mediastinum, the block of tissue between the lungs consisting
of the heart, esophagus, trachea, vessels, lymph nodes, connective tissue, and nerves. The heart is
the approximate length of the body of the sternum. The great vessels and bifurcation of the trachea
are behind the manubrium. The dome-shaped diaphragm extends over the liver on the right and
spleen and stomach on the left. The apices of the lungs are above the first rib and clavicle. The
parietal pleura that lines the pleural cavities extends more inferiorly than the lungs themselves in
the recess between the diaphragm and the rib cage. The bases of the lungs during quiet respiration
are near the seventh rib, whereas the costodiaphragmatic recess of the parietal pleura extends
down to the ninth rib laterally. The right and left hemidiaphragms, pleural cavities, and lungs extend
to a lower level in the posterior thorax than they do anteriorly.
Posteroanterior and Chest X-Ray (Male and Female)
• For a standard posteroanterior (PA) chest x-ray the patient “hugs” the x-ray recording plate. This protracts
the shoulder girdles and moves the scapulae off the lungs. Having the x-ray beam pass from posterior to
anterior through the patient, with the anterior chest adjacent to the recording plate, minimizes the
magnification of the heart by the divergent beam. The lung fields appear dark because of their high air
content. The larger pulmonary vessels (arteries and veins) are the white tubular densities near the lung
roots. Note the air (darker area) in the midline trachea and in the stomach and splenic flexure of the
colon under the left hemidiaphragm. Also note the clavicles, scapulae, and arch of each hemidiaphragm.
The heart borders are seen clearly against the air-filled lungs. The right margin of the heart on the PA
view is the right atrium. The left margin is the left ventricle. The right ventricle and left atrium do not
contribute to the heart borders on a PA x-ray. They are better seen in a lateral view.
Anterior Axillary CT and MRI
• Both computed tomography (CT) and magnetic resonance imaging (MRI) are used for chest studies, although
CT is more common. MRI is used for some heart studies and in cases in which patients may have allergies or
other problems with receiving iodinated contrast used in CT. On the CT examination (A), the contrast was
introduced into a left arm vein, and it is just entering the heart and lungs. The superior vena cava is bright white,
and the white profiles in the lungs are blood vessels with some contrast. The very bright nodule at the left lung
base medially is a calcified granuloma.
• The window width and level of images can be adjusted on the computer screen to visualize either the soft tissue
structures or the lung parenchyma. On this mediastinal window setting, the soft tissue structures of the
mediastinum are visualized. The details of the lung parenchyma are poorly seen, and the lungs appear
predominantly black. The window width and level can also be adjusted to make the white contrast in the blood
vessels look brighter or less intense.
Lateral Chest X-Ray
• Routinely a left lateral chest radiograph (x-ray beam passing from right to left) is obtained to keep the
heart closest to the image receptor. The patient’s arms are elevated to move the humeri and soft tissues
of the arms out of the field of view. Lateral radiographs are used in conjunction with the PA view to
evaluate the thorax in three dimensions and better localize any pathology that may be present. The roots
of both lungs are superimposed on each other in the middle mediastinum. The right upper lobe
bronchus is higher than the left upper lobe bronchus. Each is seen on end where the trachea ends. The
distal arch of the aorta is seen posterior to the trachea. The clear space behind the sternum superiorly
corresponds to the anterior mediastinum. The right ventricle is the most anterior heart chamber and
makes up the anterior superior margin of the heart on the lateral view. The left atrium comprises the
superior posterior border of the heart, and the left ventricle is the inferior posterior border of the heart.
The contour of the left hemidiaphragm is not seen anteriorly because it is silhouetted by (against) the
heart. The right hemidiaphragm contour can normally be followed along its entire course.
• Sagittal CT and MRI
• In the CT reconstruction in A, the descending aorta, clavicle, and breast indicate that the section is to the
left of the midline. Iodinated intravenous contrast is seen in the left ventricle, aortic arch, and descending
thoracic aorta and two of the branch arteries of the aortic arch. The lungs appear black on this image
viewed with a mediastinal window. The anterior clear space is the upper lobe of the left lung projecting
over the anterior mediastinum. The heart and aorta are in the middle mediastinum, and the thoracic
vertebral column (spine) is in the posterior mediastinum. In the upper abdomen portions of the left lobe of
the liver, stomach, pancreas and left kidney are seen. B is a corresponding MRI sagittal section of the chest.
Blood vessels can appear white on MRI without the injection of gadolinium contrast, depending on the
pulse sequence used. On this image the ascending aorta and aortic arch are seen clearly. The heart is located
anteriorly. Some blood vessels are seen in the left lung, and the left kidney is seen in the upper abdomen
Chest X-rays categories pathology with related labels in Chest X-ray14.
Each image is labelled with one pathology. (A) Atelectasis, (B) cardiomegaly, (C) consolidation, (D) edema,
(E) effusion, (F) emphysema, (G) pneumonia, ( H) phenothorax.
RADIOGRAPHIC
ANATOMY
OF VERTEBRAL COLUMN
V E RT E B R A L C O L U M N
33 vertebrae:
7 cervical
12 thoracic
5 lumber
5 sacral (fused)
4 coccygeal (fused)
Curvature:
Primary: fetus , C-shaped
Secondary: lordosis- cervical and lumber
Spinal Curvature terms
Term Description
Lordosis Normal compensatory concave curvature
of Cervical & Lumber spines, or
Abnormal exaggerated Lumber curvature
with increased concavity
Kyphosis Abnormal exaggerated Thoracic curvature
with increased concavity
Scoliosis Abnormal lateral curvature
Typical Vertebra
Typical Vertebra
(1) Body:
(2) Arch: 2 pedicles (lat)+ 2 laminae (post)
 Pedicle + Lamina  Transverse process
 Lamina + Lamina  Spinous process
(3): Intervertebral Foramina:
 Superior + Inferior vertebral notch
 31 spinal nerves (8C+12T+5L+5S+1co)
(4) Intervertebral Joints:
(5) Intervertebral Disc:
 Annulus fibrosus + Nucleus pulposus
Anterior Lateral Posterior
Cervical spines
The Cervical Vertebrae
(1): Transverse process:

 Foramen
(2): Spinous processes:
 Short and bifid
(C2-C6)
(3): Intervertebral canal:
 Triangle
The Atlas – C1
Inferior view Superior view
• No body
• Large lateral mass
• Articular facets
• Anterior arch
The Axis – C2
Superior view Lateral view Inferior view

Vertebra Prominence – C7
Spinous process:
1. Long
2. Easily felt
3. Nonbifid
Transverse process:
Foramen is small or
absent
Cervical
AP
Cervical
Lateral
Cervical
Oblique
Cervical, pen mouth
The Thoracic Vertebrae
The Thoracic Vertebrae
Articular facet on the body (ribs)

T1: Complete facet superior
Demi-facet inferior
T2 - T10: Demi-facet on superior and inferior
T11 – T12: Single complete facet at midlevel
Articular facet on transverse process
Sipnous process: long, downward
Thoracic
AP Lat
Vertebrae
The Lumber Vertebrae
The Lumber Vertebrae
• The bigger body

• Transverse processes:
Upper 4: increase in size from above downward
Fifth: shorter , stronger, pyramidal
• Sipnous process:
square, horizontal
Lumber
Vertebrae
AP Lat
The Sacrum
5 fused vertebrae , Triangle in shape, Concave anteriorly
Central mass (fused body)
Sacral promontory (superior anterior border)
4 Sacral foramina
The ala (upper anterior surface)
Sacral crest: fused spinous processes (posterior)
Transverse process: rudimentary
Lateral articular surface: sacroiliac joint
3 vertebrae in male & 2 vertebrae in female
The Sacrum
The Coccyx
4 (3-5) fused vertebrae, 1st often separate

Different shape and size
Articulate at acute angle with sacrum
The Sacroiliac joint
Joint surface:
 Flat,
 Irregular
 Oblique : backward, downward

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RADIOLOGICAL

By Odu Chinyere Michelle and Kamani Elijah Victor

(1): Transverse process:

Inferior view Superior view

Superior view Lateral view Inferior view

Articular facet on the body (ribs)

• The bigger body

4 (3-5) fused vertebrae, 1st often separate

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