25 Transaxial CT Images of the Thorax

These images have been windowed to accentuate the water density

structures of the heart and great vessels. As a result the lungs appear
black, with little detail in them. Only the larger pulmonary vessels appear,
as white spots around the hilar areas.

On campus students must draw and identify the anatomy on the line-
drawings on the next slide. Students in the degree completion course
should have an understanding of vascular anatomy that make testing on the
drawings unnecessary. But if you need a refresher try these drawings. The
ability to visualize these structures is important to the study of cross sectional
anatomy of the thorax.

First page number in parenthesis is Netter’s 3rd edition

Second page number in parenthesis is Netter’s 4th edition
Introduction to the Thorax
 Can you draw (or visualize) these anatomical structures:
Thorax drawings An exercise in thoracic cross sectional anatomy recognition
1 Superior & inferior vena cava
See plate 208 (212) 2 Rt. atrium
3 Tricuspid valve
4 Rt. ventricle
5 Pulmonic valve
6 Pulmonary trunk
7 Pulmonary arteries
8 Pulmonary circulation
9 Pulmonary veins
10 Left atrium
11 Mitral valve
12 Left ventricle
See plate 233 (237) 13 Aortic valve
14 Ascending aorta

Drawing the heart &

pulmonary vessels is
more of a challenge. If
you can’t draw it can you
visualize the trip blood
makes from the vena cava
to the aorta?
In addition to plate 208, this
drawing from Netter’s Atlas,
(dropped from the 3rd edition)
is helpful for following
See plate 234 (238) pulmonary circulation.
 7
Image 9

1. Superior vena cava

1 2 2. Arch of the aorta
3. Trachea
3 4. Esophagus
4 6 5. Body of the Rt scapula
6. Spinal cord
7. Body of the sternum
5
Presentation of Thorax Images
Reference
When viewing images from superior to inferior
the arteries and veins to the head and upper
extremities are numerous, and can be difficult for
students to identify. However, beginning at the
level of the arch of the aorta, the origin of these
vessels (Brachiocephalic, Rt common carotid, Rt
subclavian, and the Superior vena cava) are easier
to identify as they follow the course studied in a
traditional anatomy course.

For this reason the thorax will be studied in two

parts: first everything above the heart, then the
heart. The first image is 9, and progresses
superior to 1. Then back to image 10 and on to
25. Images will be tested in this order.
 Reference
4
2 1. Superior vena cava
5 1 3 2. Brachiocephalic artery (233) (237)
3. Lt common carotid artery *
4. Rt pectoralis major muscle
5. Rt pectoralis minor muscle

6. Manubrium of the sternum

7. Rt brachiocephalic vein (234) (238)
8. Lt brachiocephalic vein **
9. Lt costovertebral articulation (joint)
6 10. Rt costotransverse articulation
8
7 * Unlike the illustration in Netter’s Atlas, the
Lt. subclavian artery on this patient is
9 considerably higher on the arch of the aorta
than the Rt common carotid. The Lt subclavian
will not appear until image #5.
10 **Notice the shape of the superior vena cava
in image #8. It is not a circle like in image 9
because, as is evident from image 7, it is
at the anastomosis of the Rt and Lt
brachiocephalic veins.

Images 8 & 7
Images 8-5
 Reference

Image #6 is very similar to 7. There is

nothing new to identify.

1. Rt brachiocephalic vein
2. Lt brachiocephalic vein
3. Brachiocephalic artery
4. Lt common carotid artery*
5. Lt subclavian artery
6. Spine of the Rt scapula (scapular spine)
2
* Because the Lt common carotid is against 4
the Lt brachiocephalic vein the two blend 1
together. 3 5

Images 6 & 5
 6 Reference

1. Rt brachiocephalic vein
2 2. Lt brachiocephalic vein
1 3 4
5 3. Brachiocephalic artery
4. Lt common carotid artery
8 5. Lt subclavian artery
6. Rt sternoclavicular articulation (joint)
7 7. Rt lamina of a thoracic vertebra (16) (17)
8. Rt. pedicle of a thoracic vertebra
15 10 11
9. Rt. subclavian artery
10. Rt common carotid artery
11. Lt axillary vein*
13 12
9 12. Lt subclavian vein
14 13. Lt. internal jugular vein**
14. Rt subclavian vein
15. Sternal end of Rt. clavicle

* The left axillary and subclavian veins are

showing iodine contrast which is being drip
infused into the left median cubital vein. The
arms are above the patient’s head.
** At the anastomosis of the internal jugular
Images 4 & 3
and subclavian veins. Note the ring of
contrast created by the non-iodinated blood
from the head dumping iodine contrast into
the subclavian vein.
Images 4-1
 Reference 2 3 4

1. Rt subclavian artery* (410, 412)(427 ,429)

2. Rt subclavian vein** 5
3. Rt internal jugular vein 1 6
4. Rt common carotid artery
5. Lt common carotid artery
6. Lt subclavian artery***

7. Shaft of the Lt clavicle 10

8. Lt axillary vein with iodine contrast 9 7
8
9. Rt & Lt common carotid arteries
10. Rt & Lt internal jugular veins 13
11 14
11. Apex of Rt lung (plural = apices)
12. Acromion process of Lt scapula
13. Trachea 12
14. Esophagus

* The circular part of the Rt subclavian artery (in the mediastinum) has been seen in previous sections.
Now we see the lateral part of the artery after it crossed the apex of the lung and dropped back into
view on this section, as it heads toward the axillary artery.
** Compare the relationship of the subclavian artery and vein to plate 412 (429). The arrow (#2) points to the
area where a subclavian (central venous) catheter is punctured.
*** Unlike the Rt side, the lateral portion of the Lt subclavian does not come into view in this study.

Images 2 & 1
 Reference

1. Superior vena cava

1 5 2. Arch of Azygos vein* (226, 234)(230, 238)
3. Azygos vein
2 6 4. Hemiazygos vein
5. Trachea
3 4 6. Esophagus

7. Parietal pleura (228)(232)

8. Visceral pleura** (192-194)(196-198)
9. Rt intervertebral foramen
7 10. Ascending aorta
10 11. Descending aorta
12. Pulmonary vessels***
12
8 * Where the azygos turns anteriorly and joins the
SVC. The circular structure in the middle area
9 11 of this arch is probably an enlarged lymph node.
See plate 235 (239).
** The pleural lining are not seen on this study, and
are not normally identifiable unless there is
pleural thickening or an effusion. But we know
they are there.
*** Arteries and veins above the hilum of the left lung.
Images 10 & 11
Images 10-13
 Reference

1. Superior vena cava 2

2. Ascending aorta 1
3. Descending aorta 4
4. Lt pulmonary artery*
5. Carina of the trachea (198, 199) (202,203) 5 3
6. Rt main bronchus (main stem)
7. Rt superior lobar bronchus
8. Tertiary (3rd level or segmental) bronchi
9. Lt pulmonary artery
10. Rt pulmonary artery** (202) (206)
10
8

7 6
* ** 9

Images 12 & 13
 Reference

2 4 1. Superior vena cava

1 3 2. Ascending aorta
3. Rt pulmonary artery
4. Pulmonary trunk*
5 5. Lt pulmonary artery

6. Azygos vein
7. Pulmonary trunk
8. Esophagus

* At this level the right pulmonary artery is just

arising from the pulmonary trunk. In image
15 (#7) the trunk is clearly seen, differentiated
7 from the artery.

8 5
6

Images 14 & 15
Images 14-17
 Reference

1. Auricle of Rt atrium (208) (212) 1 4

2. Rt pulmonary artery*
3. Lt atrium
4. Pulmonary trunk 2

5. Aortic sinus (root of the aorta)** (219) (223)

6. Lt coronary artery (212, 215) (226-219) 3
7. Lt (superior & inferior pulmonary)
pulmonary veins (210-213) (214-217)
8. Thoracic aorta***

* At this level we see the last remnant of the Rt

pulmonary artery. Notice that the emerging 6
Lt atrium (#3) looks similar to the Rt pulmonary 1
artery in image 15, but is in a different position.
** The Rt coronary artery (#5) identifies this as
the area of the cusps of the valves known as 7
the aortic sinus or root of the aorta. (219)(223)
***At the level of the aortic sinus the descending 5
aorta becomes the thoracic or descending 3
thoracic artery.
8

Images 16 & 17
 Another Look

4 3D image of the thorax. Can you identify

2 the pulmonary vessels. Click for the legend.
1
6
5

1. Rt pulmonary artery
2. Lt pulmonary artery
3. Pulmonary trunk
4. Ascending aorta
5. Rt pulmonary vein
6. Lt pulmonary vein
7. Thoracic aorta
4 3
1
2

Another Look: 3D Thorax

 Reference

2
1. Rt atrium
1 2. Rt ventricle
4
3. Lt atrium
4. Lt ventricle
3
The divisions between the chambers of the heart
become a bit vague, especially on image 19, but
there is no doubt where they are.

A good mental exercise is to identify the structures

on previous images that gave rise to each of the
chambers, then look back on those images to
appreciate why the chambers are where they are.

2
1

4
3

Images 18 & 19
Images 18-21
 Reference

5 8
1. Rt atrium
2. Lt atrium 3
1
3. Rt ventricle
4. Lt ventricle 7 4
5. Rt atrioventricular septum
6. Lt atrioventricular septum
2 6
7. Interatrial septum
8. Interventricular septum

On image 21 the atria are receded, as

the ventricles dominate.

Images 20 & 21
 Reference

1 3 1. Rt ventricle
2. Lt ventricle
3. Interventricular septum
4 2 4. Inferior vena cava (216) (220)
5. Coronary sinus (210, 216) (214, 220)
5 6. Esophagus
6
7. Liver
8. Dome of the Lt hemidiaphragm*
9. Pericardial sac (pericardium) (211, 214, 215)
(215, 218, 219)
* The hazy appearance of the dome and the
pulmonary vasculature in the base of the Lt.
lung are seen together due to the partial
9 volume effect. This is a good demonstration
of two separate structures imaged in a one cm
cut thickness.
7 Pulmonary vasculature

4
6

8
1 cm cut
thickness {
Dome of diaphragm
Images 22 & 23
Image
s 22-
25
 Reference

1. Rt ventricle
2. Lt ventricle 1
3. Posterior interventricular branch of the 3
Rt coronary artery (Posterior descending 2
artery) (212) (216)
4. Spleen
4
5. Stomach
6. Intrahepatic inferior vena cava
7. Abdominal aorta

The lung tissue in image 25, deep in the posterior

costophrenic recess, has been windowed to best
demonstrate lesions therein, which is why the
water density organs of the abdomen appear
different than they did at this level in the
Abdomen unit.

6 5

7
Images 24 & 25
 1. Superior vena cava
2. Ascending aorta
3. Rt pulmonary artery
4. Descending aorta
2 5. Lt pulmonary artery
1 3
5
4 Another Look: Double Window

Another Look

This double windowed image of the thorax utilizes a cut and paste type of function
to combine a lung window and water density window in a single image. The
disadvantage is a loss of spatial resolution at the edges of the lung fields. Can you
identify the mediastinal structures? Click for the legend.