RADIO ANATOMY

RESPIRATORY TRACT
AND MEDIASTINUM

Andi Hendra Yusa, dr, SpRad

Radioanatomy
• Studies of human body seeing through the
roentgenologic examination
Respiratory Tract
– Upper air passage (Cav. Nasi and pharynx)
– Larynx
– Trachea and bronchus
– Lung + Vascular (lymph)
– Thoracic wall + diaphragm
•3,4,5  Chest x-ray
•Lung !
 Lung anatomy-Right
Superior Lobe Apical Segment (1)
Posterior Segment (2)
Anterior Segment (3)

Medial Lobe Lateral Segment (4)

Medial Segment (5)

Inferior Lobe Apicobasal Segment (6)

Mediobasal Segment (7)
Anterobasal Segment (8)
Laterobasal Segment (9)
Posterobasal Segment (10)
 Lung Anatomy-Left

Superior Lobe Apicoposterior Segment (1)

Anterior Segment (2)
Lingula Superior Segment (3)
Inferior Segment (4)
Inferior Lobe Apical (5)
Antero medial basal (6)
Latero basal (7)
Postero basal (8)
 X-ray / Fluoroscopy indication
• Contact person
• Cough > 2 weeks
• Recurrent respiratory infection
• Hemaptoe
• Ekstra pulmonary TBC
• Erytema nodosum / conjuntivitis phlyctenularis
• Fissure/fistula anichronicum
• DM
• Precautionary indication
X-ray Examination
• Routine : PA
• Special :
• Lateral
– Left
– Right

• AP
• Oblique - Left
- Right
• Lateral decubitus
Special method of examination

• Tomografi
• Bronchografi
• USG
• CT scan
• MRI
 PA Position
• Place patient between film – X ray source
• Have the patient stand backward to the X- ray
source, chest close to film with hand on the hip,
with elbow flexed. Distance between film and X-
Ray
Lung– 1,5 m
Heart 2 m
• Ray concentrated at
- V.Th. 6-7
- KV 50-60
- M.As 10-20
Good chest X-Ray depend on:
1. Good film quality
Depending on :
 KV
 M.As
 Processing
2. Symmetry
3. All part of thorax are included
4. Identity /Marking
5. No artefact
6. No motion artefact
7. Maximal inspiration
What studied in chest x-ray
• Soft tissue
• Costae and clavicle
• Trachea
• Size, shape and position of heart
• Lung
– Hillous
– Bronchovaskuler marking
Lung field :
• Lung apex
• Lung top field
• Lung middle field
• Lung lower field
Lateral chest film
Indication
• To study abnormality that is not visible on
PA film
• To study mediastinal disorder
• Heart studies
Lateral chest procedure
• Place patient between film and X-ray
source
• Place lateral side of chest (left/right) on film
• Hands behind the head
• Ray centered on Th 6-7
What studied on lateral chest film
• Trachea and mainbronchial branch - radioluscent
• Heart, aortic arch, asc/ desc aortic
• Left/ Right Lung  bronchovascular marking
superposition
• Retrosternal space
• Retrocardial space
• Costophrenic sinus
• Cardiophrenic sinus
Antero posterior (AP) chest film
Indication :
• Severely ill patient
• Children / babies
• Obese, pregnancy, ascites, abdominal tumor
Procedure:
• Place patient lying down on table with
elbow above head
• Place film on patient’s back
• Centered ray on Th 6-7
Top lordotic chest x-ray
Indication :
• To studies disorder located on apex / medial lobe -
 clavicle turn upward
Procedure:
• Place patient between film and x-ray source, have
the patient face the x-ray source
• Have the patient stand 30 cm in front with back
placed on the cassette
• Set top part of the cassette 1 inch above the
shoulder
• Centered ray on manubrium sterni
Oblique chest film:
Indication :
• Heart studies
• To study abnormality that is not yet clear on PA
studies
Procedure
• Place patient between film and ray source
• Put ventral left/right side of the patient’s thorax on
the cassette making 45 0 angle
• Center ray on Vert. Th 6-7
Lateral decubitus chest film
Indication :
• To study fluid in pleural cavity that is around 100-
200 cc
• Or fluid accumulation that is not yet determined
on PA studies

Procedure
• Have the patient lying down on left/right side with
elbow above the head
• Center ray on vert. Thoracal 6-7 from anterior
/posterior aspect
Mediastinum Borders
- Superior: Apertura thoracis sup.
- Dorsal : Vertebral Column.
- Ventral : Sternum.
- Inferior : Diaphragm.
- Lateral : Mediastinal pleura.
 Mediastinal
1. Anterior superior med
2. Anterior medius med
3. Anterior inferior med
4. Superior medius med
5. Middle med
6. Posterior superior med
7. Posterior medius med
8. Posterior inferior med
 Mediastinal Studies
1. Radiograph :
• Chest film: - PA.
• Lateral.
• esophageal contrast studies.
2. Fluoroscope :
• To study pulsation
• To study placement of organ in chest
cavity
- To study mass relation with adjacent organ
- Diaphragm
- Esophagus
- Heart and major vessel
- To study pericardial effusion
3. Tomografi.
4. Angiografi  Usually with
CT.
5. CT Scan / MRI.
6. USG : Mass close to
diaphragm / Pericard effusion.
7. Nuclear med. Radioisotop.
• Radio isotop angiogram.
• To study localization of tumor.
• Eq : thymoma, thyroid, lymph
node.
Location of mediastinal
disorder
Anterior superior med
• Aneurisma aorta
• Thymus Hyperplasia
• Lymphoma
• Intrathoracal Struma
• Thymoma
Location of mediastinal disorder

Anterior middle med.

 Dermoid
 Teratoma
 Ant. Inferior. Med
 Thymoma.
 Pericardial cyst.
 Hernia diafragmatica.
Superior Mid. Med
 Aneurisma.
 Dermoid.
 Teratoma.
 Mediastinal trauma
Middle Mediastinal
 Dermoid
 Teratoma
 Lymphoma
 Tumor metastasis (Lymph
- spread)
Post superior med.
 Oesophageal disorder
 Aneurism
 Neurinoma, neurofibroma.
 Pancoast tumor
Anterior Inferior med.
1. Thymoma.
• >Female
• Could turn Malignant.
• Round/lobulated.

2. Pericardial cyst.
• Cystic tumor that connected with
pericardium.
• On right cardiophrenic sinus
Middle Mediastinal
1. Infection
• Sarcoidosis
• TBC
• Mycosis.
• Erythema nodosum
2. Tumor Metastasis
3. Lymphoma
Posterior mediastinal
Esophagus disorder:
• Diverticle.
• Achalasia / Chalasia
Pancoast tumor
Aneurisma.
Neurogenic tumor (Neurofibroma,
Neurinoma)
Post medius med.
 Neurogenic tumor.
 Bronchial defect enteric cyst.

Post inferior med.

 Neurogenic origin primary tumor.
 Diaphragmatic hernia.
Anterior- superior Med.
1. Often : Thymic Hyperplasia.
• Lobuler type, flag fusiform.
• Bilat/unilat.
• On children (Thymic Persistent)
2. Aneurisma : Cardiovascular
section
3. Lymphoma Maligna
Ro: tracheo bronchial node enlargement 
lobulated  Could cause superior cava
vein. Syndrome.

4. Intrathoracal Struma
40 years
Usually compress : trachea,
oesophagus, phrenic nerve.
Ro:
Lung apex mass  compress
trachea.

Mediastinum anterior medius

Dermoid cyst: Tumor that consist of
multiple tissue  hair, teeth 
benign.