Cardiothoracic anatomy

CT anatomy

Overview mediastinum Layer Zone 1 (T1 – T4) Zone 2 (T5 – T8) 1 – Posterior channels Only thoracic duct Thoracic duct Azygos vein Descending thoracic aorta 2 – Tubular viscera Trachea Oesophagus Main bronchi 3 – Heart and arteries Arch of the aorta 3 main branches off aortic arch Ascending aorta Pulmonary trunk Heart 4 – Veins Brachiocephalic veins SVC Heart (no actual veins) 5 – Anterior mediastinal structures and fat Thymus Anterior mediastinal fat ?Thymus Overview mediastinum

Superior mediastinum

Superior mediastinum

Superior mediastinum

Superior mediastinum

Superior mediastinum

Middle zone

Middle zone

Middle zone

Middle zone

Middle zone

Middle zone

Middle zone

Lower zone

Lower zone

Lower zone

Lower zone

Lower zone

Lower zone

Approach to Chest CT

Mediastinum Lungs Pleura MSK Chest wall 5 point checklist

Checklist of pathologies to check Trauma Chest pain / SOB Neoplasm Mediastinum Vascular injury Oesophageal injury Injury to Bronchus Pneumomediastinum Tracheal deviation Pericardial fluids Cardiomegaly Pulmonary embolus Aortic dissection Lymph nodes Mediastinal nodes Pericardial effusions Lungs Pulmonary contusions Pulmonary consolidation Pulmonary collapse Pulmonary mass Hilar shadowing Pulmonary mass – Primary, secondary Pleura Pneumothorax Haemothorax Pleural effusions MSK Fracture – Sternum, Ribs, Vertebrae Rib fractures Kyphoscoliosis Bone mets Chest wall Haematoma NA Previous evidence mastectomy Axillary lymphadenopathy Checklist of pathologies to check