The Normal Chest

Question 1

Describe the major fissure.

Answer 1

Run oblique anteroinferiorly from 5th thoracic vertebra, pass through the hilum and contact the diaphragm 0-3cm behind anterior costophrenic angle. Below hila bow forward, above hilarious bow backward

Question 2

Describe the minor fissure

Answer 2

Run anterolaterally from right hilum in horizontal direction to reach chest wall. Contacts chest wall at axillary portion of right 6th rib and curve downwards.

Question 3

What vessel causes the aortic nipple?

Answer 3

Left superior intercostal vein

Question 4

Write all segment for bronchi division.

Answer 4

RUL - apical bronchus, posterior and anterior bronchus.

RML - medial and lateral bronchus

RLL - apical, medial/lateral/anterior/posterior basal

LUL - as right with superior and inferior bronchus

LLL - apical, anterior basal, lateral basal, posterior basal

Question 5

What is the size of the thymus in adults?

Answer 5

Decreases from 8-9cm to 5-6cm older than 20 years, thickness of each lobe up to 15mm

Question 6

Describe the relationship of the vessels at the hilum.

Answer 6

Right PA passed anterior to bronchi, left arches superior to left main bronchi.

Superior pulmonary vein is the anterior structure in upper and mid hilum both sides. On the right, separated from bronchi by lower division of right PA and on left separated from pulmonary artery by bronchial tree

Question 7

What are the 9 areas of regional lymph nodes?

Answer 7

1) highest mediastinal
2) upper paratracheal
3) retrotracheal
4) lower para tracheal
5) subaortic
6) paraortic
7) subcarinal
8) paraoesophageal
9) pulmonary ligament
10) hilar
11) interlobar
12) lobar
13) segmental
14) subsegmental

1-9 within mediastinal pleural envelope

Question 8

Write short notes on the right and left diaphragm measurements.

Answer 8

Right anterior portion of 6th rib, 1.5 to 2.5 cm higher than left

Question 9

Describe the difference between veins and arteries peripherally Vs centrally.

Answer 9

Peripheral - no difference

Central - lower lobe arteries vertical, lower lobe veins horizontal

Question 10

What are the measurements of the trachea on xray?

Answer 10

Max coronal 21mm for women and 25nm for men, max sagittal 23mm for women and 27mm for men

Question 11

Name the accessory fissures and where they are located.

Answer 11

Azygos fissure - right upper lobe

Superior accessory fissure - separates superior and basal segment of right lower lobe

Inferior accessory fissure - divides medial basal segment from other basal segment

Left minor fissure - separates lingula and left upper lobe