- represents the combined thickness of the tracheal and esophageal walls and intervening fat - produced by the presence of air in the esophagus

Tracheoesophageal stripe should measure less than 5mm thickening is commonly seen with esophageal ca

Chest Flashcards by Enrhico Rivera

Flat band of muscle and connective tissue that completes the posterior aspect of the trachea

Posterior tracheal membrane

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Tracheal mucosa are composed of _____

Pseudostratified ciliated columnar epithelium
W/c contains scattered neuroendocrine(APUD) cells

*submucosa contains cartilage,smooth muscle and seromucous glands

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Composed of the right lateral tracheal wall, a small amount of mediastinal fat, paratracheal lymph nodes, and the visceral and parietal pleural layers of the right upper lobe

-interface of the RUL with the right lateral tracheal wall

Right paratracheal stripe

should be uniformly smooth,should not exceed 4mm in width
thickness or nodularity reflects disease in any of the component tissues, including medial tracking pleural effusion

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Normal TRACHEA approximate measurements:
A.length in adults
B. Upper limit of normal coronal diameter in men? In women?
C. Coronal-to-Sagittal diameter ratio

A. 12 cm.
B. 25 mm(men); 21 mm(women)
C. 0.6:1.0

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A narrowing of the tracheal coronal diameter producing a coronal-to-Sagittal ratio of <0.6 is termed a _____

Saber sheath trachea

*seen in patients with COPD

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Normal or abnormal?

Slight tracheal deviation to right after entering the thorax

Normal

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represents the combined thickness of the tracheal and esophageal walls and intervening fat
produced by the presence of air in the esophagus

Tracheoesophageal stripe

should measure less than 5mm
thickening is commonly seen with esophageal ca

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Bronchi gradually lose their cartilaginous support between generations ___ and _____

1;12 to 15

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1-3mm airways

Bronchioles

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Bronchioles bearing alveoli on their walls

Respiratory bronchioles

*divide into alveolar ducts and sacs

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The airway just before the first respiratory bronchiole

-smallest bronchiole without respiratory exchange structures

Terminal bronchiole

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Divides the lungs; invaginations of the visceral pleura

Interlobar fissures

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Arises from the truncus anterior

Upper lobe bronchus and its artery

*3 segmental branches: anterior, apical, posterior

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Arises from the intermediate bronchus

-supplied by a branch of the right interlobar pulmonary artery

Middle lobe bronchus

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4 segments of the LUL

Anterior, apicoposterior(supplied by the upper division of the left main pulmonary artery), superior and inferior lingula segments

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Gas exchanging units of the Lung

Alveolar ducts and alveolar sacs

*pulmonary alveolus is lined by type 1 (squamous) and type 2 (cuboidal) pneumocytes

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The major and minor fissures are best visualized on _____ radiographs

Lateral

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Left major fissure begins more ______ and has a slightly more ______ course than the right major fissure

Superiorly; vertical

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Projects at the level of the right 4th rib and is seen as a thin undulating line on frontal radiographs in approx. 50% of individuals

Minor fissure

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Most common accessory fissure ; approx 10% to 20% of individuals
-separates the medial basal from the remaining basal segments of the lower lobe, is often incomplete

Inferior accessory fissure

*a small triangle of extrapleural fat at its point of insertion in the diaphragm is a clue for identification

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This is seen in 0.5% of individuals

composed of 4 layers of pleura (2 viscera and 2 parietal)
represents an invagination of the right apical pleura by the azygos vein

Azygos fissure

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Separates the superior segment from the basal segments of the lower lobe
-distinguished from the minor fissure on lateral radiographs because it extends posteriorly from the major fissure to the chest wall

Superior accessory fissure (rare)

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Separates the lingula from the remaining portions of the upper lobe

Left minor fissure

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A sheet of connective tissue that extends from the hilum superiorly to a level at or just above the hemidiaphragm

contains the inferior pulmonary vein superiorly and a variable number of lymph nodes
accounts for the media, location and triangular appearance of lower lobe collapse

Inferior pulmonary ligament

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- mistaken for the inferior pulmonary ligament | - a linear structure seen on CT near the inferior pulmonary ligament extending into the lung from mediastinal pleura

Sublobar septum

A triangular density extending toward the lung that is seen along the posterior aspect of the right heart border on lung windows on chest ct -represents a reflection of pleura over the inferior portion of the phrenic nerve and pericardiophrenic vessels

Pericardiophrenic ligament

The right interlobar artery course ANTEROLATERAL to the bronchus

EPIARTERIAL

...the LLL ARTERY over the left hilar bronchi ***page 332-333

HYPOARTERIAL bronchus

Primary nutrient vessels of the lung

Bronchial arteries

Usually arise from the POSTEROlateral wall of the aorta in common with an intercostal artery as an intercostobronchial trunk

Right bronchial artery

Arise individually from the ANTEROLATERAL aorta or rarely from an intercostal artery

Left bronchial arteries

Arise within the interlobular septa from the alveolar and visceral pleural capillaries

Pulmonary veins

When distended by fluid, these account for the radiographic appearance of Kerley A lines

Perivenous lymphatics and their surrounding connective tissue

Scaffolding of the lung , provides support for the airways and pulmonary vessels

Pulmonary interstitium * axial interstitium(extends from the mediastinum and envelopes the bronchovascular bundles) * centrilobular interstitium(provide support for the air-exchanging portions of the lung) * peripheral interstitium(divides secondary pulmonary lobules,contains subpleural interstitium and interlobular septa)

Interstitium where pulmonary veins and lymphatics lie

Peripheral interstitium

A thin network of fibers that bridges the gap between the centrilobular and peripheral compartments

Intralobular interstitium

Edema involving the axial interstitium is recognized radiographically as ________

Peribronchial cuffing

Edema of the peripheral and subpleural interstitium accounts for ____

Kerley b lines and thickened fissures

Seen as sharp edges where the lung and adjacent pleura reflect off of various mediastinal structures

Lung-mediastinal interfaces

Relate directly to the space available in 3 regions viewed on the lateral film: retrosternal space, retrotracheal triangle, retrocardiac space

Lung-lung interfaces

An inferior extension of the upper lobe reflections off the inominate veins -obliquely oriented from right superior to left inferior; extends from upper sternum to base of heart

Anterior junction line

A.Small retrotracheal triangle----- | B.Large retrotracheal triangle-----

A. Right paraesophageal interface B. Posterior junction line (vertically oriented in the midline; extends from upper thoracic spine to level of azygos and aortic arches)

Large retrocardiac space-----

Inferior posterior junction line

Separates the right paraesophageal from the upper azygos esophageal space

Arch of the azygos vein *measurement should be made thru the midpoint of the azygos arch perpendicular to the right main bronchus a diameter of greater than 10mm on a PA view should raise poss.of mass,adenopathy,or dilated arch of the azygos vein

2 conditions that will increase azygos venous diameter

1. Supine positioning | 2. Performance of the Muller maneuver (forced inspiration against a closed glottis)

Aortic nipple | -normally measures <5mm

Left superior intercostal vein

A vertically oriented interface overlying thoracic spine

Azygoesophageal recess interface

A line produced when air is present in the distal portion of the esophagus and the azygoesophageal recess interfaces with the right lateral wall of the esophagus

Right inferior esophagopleural stripe

A straight vertical interface extending the length of the right hemithorax and represents contact of the right lung with a small amount of tissue lateral to the thoracic spine

Paraspinal interface

Interface immediately inferior to the aortic arch

Aortopulmonary window

Immediately inferior to the Aortopulmonary window

Left lateral border of the main pulmonary artery

A reflection of the LLL with the esophagus anterior to the descending aorta,extending vertically from the undersurface of the aortic knob a variable distance toward the diaphragm

Preaortic recess interface

Represents the reflection of the left lung off the Paraspinal soft tissues

Left paraspinal interface

Forms a concave interface immediately below the main pulmonary artery

Left atrial appendage

Comprises most of the left heart border

Left ventricle

Fat adjacent to the cardiac apex

Epipericardial fat pad

The apex of the right hemidiaphragm typically lies at the level of the ________

6th anterior rib *approx. 1/2 interspace above the apex of the left hemidiaphragm

Borders of the retrotracheal (or Raider) triangle

Posterior border of the trachea/esophagus, anterior border of the spine, top of the aortic arch

Impression on the anterior surface of the lingula

Cardiac incisura

Contains central cardiovascular, tracheobronchial structures, and esophagus enveloped in fat with intermixed lymph nodes

Mediastinum

A line drawn thru the _______anteriorly and __________ posteriorly divides the mediastinum into superior and inferior compartments

Sternal angle; 4th thoracic intervertebral space

A triangular or bilobed structure that is maximal in size at puberty and then undergoes gradual fatty involution

Thymus

Space seen between the trachea posteriorly and the posterior margin of the ascending aorta anteriorly and is contiguous with the precariously space inferiorly

Pretracheal space

4 contents of the Aortopulmonary window

Fat, lymph nodes, ligamentum arteriosum, left recurrent laryngeal nerve

Represents the junction of the lung with the mediastinum and is composed of upper lobe pulmonary veins and branches of the pulmonary artery and corresponding bronchi

Hilum

In more than 90% of individuals, the left hilar shadow is _______ than the right

Higher

The avascular aspect of the composite hilar shadow , inferior to the shadow of the right pulmonary arteries and veins and anterior to the descending left pulmonary artery and left superior vein

Inferior hilar window

A serosal membrane that envelopes the lung and lines the costal surface, diaphragm and mediastinum

Pleura

A potential space between the two pleural layers and normally contains a small amount of fluid (<5mL) that reduces friction during breathing

Pleural space

Diaphragmatic opening that lies in the midline, immediately behind the diaphragmatic crura and anterior to the 12th thoracic vertebral body

Aortic hiatus

Diaphragmatic opening that usually lies slightly to the left of midline, cephalad to the aortic hiatus

Esophageal hiatus *transmits the esophagus and vagus nerves

Diaphragmatic opening that pierces the central tendon of the diaphragm at the level of the 8th thoracic intervertebral disk space

Inferior vena cava

Triangular gaps in the muscles of the anteromedial diaphragm | -site of potential intrathoracic herniation of abdominal contents

Foramina of Morgagni

Defects in the closure of the POSTEROlateral diaphragm at the junction of the pleuroperitoneal membrane with the transverse septum

Foramina of Bochdalek

Lines the ribs and endothoracic muscles

Endothoracic fascia