A PA View of Cardiac Anatomy

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http://www.vh.org/adult/provider/radiology/icmrad/chest/chest.html

A PA View of Cardiac Anatomy

A Lateral View of Cardiac Anatomy

On PA projection, the right cardiac border is formed by

the right atrium while the left cardiac border is formed by
the left ventricle. The right ventricle and left atrium are
superimposed structures and are not border forming. The
Superior vena cava: forms a right paramedian border.

On the lateral projection, the anterior cardiac border is the right ventricle while the
posterior cardiac border is composed of both the LV and LA. The right atrium is not a
border-forming structure. The inferior vena cava is seen best on lateral projection. The
posterior boarder is evident in contrast to the air-filled lungs.

The Segmental Anatomy of the Lung

Tracheobronchial Anatomy

The trachea appears as an air-shadow coursing down the midline of

the chest and terminating at the carina. The left and right mainstem
bronchus may be evident as well as the lobar bronchi.

Left Hilum

Right Hilum

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A PA View of Cardiac Anatomy

On the left side, the left pulmonary artery is directed posterolaterally, toward
the left scapula. This artery goes over the left main stem bronchus. Therefore,
the left pulmonary artery is located higher than the right pulmonary artery. On
the lateral projection, the left pulmonary artery is posterior to a line drawn
down the trachea air column.

The Mediastinal Compartments

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As opposed to the left pulmonary artery, the right pulmonary artery (RPA)
courses underneath the left main stem bronchus. As a result, the right hilar
shadow is inferior to the left on the PA projection. This is true in 70% of the
population. In the remaining 30%, the hilar shadows are equal in height. The
right hilum is never superior to the left hilum. On the lateral projection, the
right hilum is anterior to a line drawn through the tracheal air column. The
right pulmonary artery is approximately 3 times larger than the LPA. This is a
result of the more horizontal course of the RPA.

Anterior Mediastinal Compartment

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A PA View of Cardiac Anatomy

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The anterior mediastinal compartment is bordered by the sternum

anteriorly, and the ventral cardiac surface posteriorly. This compartment
contains fat, ascending aorta, lymph nodes, internal mammary artery and
vein, adjacent osseous structures (ribs and sternum), thymus. Therefore
will most likely see masses typical to these structures, ie a lymphoma in
lymph nodes. Knowledge of the mediastinal contents can aid in your
differential diagnosis.

Middle Mediastinal Compartment

Posterior Mediastinal Compartment

The borders are composed of the anterior mediastinal compartment

ventrally, and the anterior surface of the spine, posteriorly. Structures in
the middle mediastinal compartment include the esophagus (which will
not be visible unless there is a problem), vagus nerve, recurrent laryngeal
nerve, heart, proximal pulmonary arteries and veins (hilar), trachea and
root of the bronchial tree, and superior and inferior vena cava

The posterior mediastinum borders the anterior surface of the spine

posteriorly to the ribs. Structures in the posterior mediastinal compartment
include the descending aorta, adjacent osseous structures (the spine and
ribs) and nerves, roots, spinal cord, and the azygous and hemiazygous
veins.

Superior Mediastinal Compartment

Aortopulmonary Window

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A PA View of Cardiac Anatomy

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It is located above a horizontal line drawn from the angle of Louis

posteriorly to the spine. Structures in the superior mediastinal
compartment include the thyroid gland, aortic arch and great vessels,
proximal portions of the vagus and recurrent laryngeal nerves,
esophagus and trachea.

The Diaphragm

Osseous Structures

The left and right diaphragm appear as sharply marginated domes. The
peripheral margins of the diaphragm define the costophrenic sulci. The
right diaphragm is higher than left due to the position of the liver.
Recall that the right diaphragm will appear larger on a lateral chest
film.

Most Often Missed Areas With Pathology

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A PA View of Cardiac Anatomy

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In a retrospective review of medical legal cases involving missed diagnosis

of chest films, the most commonly missed pathology occured in the right
upper lobe. Other high risk areas included the retrocardiac area, the
peripheral lung margins, and posterior costophrenic sulci.

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