Merrill's Atlas CH 3 - Part 1 Anatomy PDF

Merrill’s Atlas 2 layers of tissue covering cavity: closer to organ = visceral layer (covers internal organs: lungs, heart, &) away from organ = parietal layer (or parietal plural) Chapter 3 internal organs Thoracic Viscera...

Merrill’s Atlas 2 layers of tissue covering cavity: closer to organ = visceral layer (covers internal organs: lungs, heart, &) away from organ = parietal layer (or parietal plural) Chapter 3 internal organs Thoracic Viscera (Anatomy)  crosswise for males lengthwise for females costafrenic angles: not #1 position #3 for ICU: if pt cannot 5% 50% acceptable to clip this in chest for chest: lying down stand #2 = Anatomy image bc looking for fluid here (fluid would sit here if there standing to evaulate air upright seated was any) fluid level heart is highest Body habitus: if you have a rectangular cassette, do it crosswise (horizontal) ◼ Body habitus determines the size, shape, position, and movement of the internal organs. do it lengthwise (vertical) Thoracic Cavity: 10% 35% ◼ Bounded by: the walls of the thorax opening of bony thorax 2 top parts: apeces (apex) ◼ Extends from: the superior thoracic aperture, to the where the lungs fit in inferior thoracic aperture. ◼ Diaphragm separates the thoracic cavity from the abdominal cavity. ◼ The anatomic structures that pass from the thorax to the passes from thoracic abdomen go through openings in the diaphragm. cavity to abdomen: 2 mainly the esophagus  thoracic, abdominal, & pelvic cavities : frontal or ventral cavity spleen belongs to Thoracic Cavity abdominal cavity ◼ Contains: Lungs related to immune Heart system Organs of the respiratory, cardiovascular, and lymphatic systems Inferior portion of the esophagus Thymus gland liquid ◼ Has 3 chambers (cavities) lined by serous membranes: to prevent Pericardial surrounding the heart friction Right and left pleural cavities the space btw the lungs ◼ Mediastinum separates pleural cavities and contains all thoracic structures, except lungs and pleurae. trachea, esophagus, layers covering heart, thymus gland the lungs 3 Respiratory System oral pharynx ◼ Consists of: part of both DIGESTIVE Pharynx passageway for food & air & RESPIRATORY nasal pharynx systems Trachea passageway for air ET tubes should be inserted through trachea, 5 cm above the corina Bronchi 2 Lungs ◼ The air passages of these organs communicate with the exterior through the pharynx, mouth, and nose. most common location for a foreign body to be found in a kid: right side bc bronchi is wider & more vertical 4 Trachea (1 of 2) *** allows air to pass through ◼ Fibrous, muscular tube with 16 to 20 C-shaped allows it to withstand cartilaginous rings embedded in its walls for greater rigidity. trauma *** ◼ Approx. ½ inch (1.3 cm) in diameter and 4½ inches (11 cm) in length, and its posterior aspect is flat. ◼ Rings are incomplete posteriorly and extend around the anterior ⅔ of the tube. ◼Lies in the midline of the body, anterior to the esophagus air is front in the neck. *** food is back ◼In the thorax, the trachea is shifted slightly to the right of the midline as a result of arching of the aorta. ◼Carina is a hooklike process on the last cartilage *** 5  bifurcation: branches out into 2 branches Trachea (2 of 2) ◼ At the carina, the trachea divides, or bifurcates, into two AKA main bronchi lesser tubes: the R and L primary bronchi. **arrange superior to inferior ◼ Right primary bronchus is shorter, wider, and more vertical than the left primary bronchus. foreign bodies entering the trachea are more likely to pass into the right bronchus ◼ Subdivisions of bronchial tree: Primary bronchi Secondary bronchi Tertiary bronchi R L bronchi tree ending of smallest Bronchioles component of lung Terminal bronchioles (bronchiole) where carbon dioxide & O2 exchanged: alveoli 6 Alveoli where the O2 & CO2 are exchanged ◼ Terminal bronchioles communicate with alveolar ducts. ◼ Each duct ends in several alveolar sacs. ◼ The walls of the alveolar sacs are lined with alveoli. ◼ Each lung contains millions of alveoli. Oxygen and carbon dioxide are exchanged by diffusion within the walls of the alveoli. 7  Lungs (1 of 4) ◼ Organs of respiration. R lung is shorter bc the liver is located below ◼ Introduce oxygen into blood and removes carbon dioxide. ◼ Composed of a light, spongy, highly elastic substance, the component of our lung called the parenchyma. ** ◼ Covered by a layer of serous membrane. ◼ Superior portion = apex need tro go over clavicle to include apeces Reaches above clavicles heart, patella, ◼ Inferior portion = base lungs have apex costofrenic angles where the rib meets with the Rests obliquely on diaphragm diapragm (costofrenic angle) Lower in back and sides than in front 8  whhen you breathe in lings expand inferiorly Lungs (2 of 4) breathing out lungs shrink & move superiorly ◼ Right lung is approx. 1 inch (2.5 cm) shorter than the left lung because of presence of liver. It is broader than the left lung because of position of the heart. like the upper part of an arrow ◼ Inferior surface of the lung is concave, fitting over the diaphragm, and the lateral margins are thin. ◼During respiration, the lungs move inferiorly for inspiration and superiorly for expiration. the botton part ◼ Costophrenic angles: the deep recesses of the parietal pleura where lateral margins of lungs descend into. always a depression or an opening ◼ Hilum: a depression within mediastinal surface that accommodates bronchi, pulmonary blood vessels, lymph vessels, and nerves. an opening for the bronchi & vesseks to pass through 9  pleural cavity: the space btw the 2 pleura covering the lungs thoracic cavity: the opening that contains all thoracic organs Lungs (3 of 4) ◼ Cardiac notch: a concavity in inferior mediastinal surface of left lung. at the bottom of rthe medisastinal This notch conforms to the shape of the heart ◼ Each lung enclosed in a double walled serous membrane sac called the pleura: Visceral pleura: - inner layer - closely adheres to the surface of the lung. Parietal pleura: away from the lungs & closer to throacic bone - outer layer - lines the wall of the thoracic cavity plerual effusion: affecting the pleural cavity fluid in lungs ◼ Pleural cavity = space between the two pleural layers increase tech additive Contains serous fluid to prevent friction between destructive: pneumothorax: air in the lungs emphysema: air in lungs lungs and chest walls during respiration. 10  Lungs (4 of 4) depressions ◼ Each lung is divided into lobes by deep fissures: Oblique fissures divide lungs into superior & inferior lobes. in common: superior & inferior lobe Right superior lobe is divided further by a horizontal fissure, creating a right middle lobe. *** Right Lung Left Lung 3 lobes 2 lobes R middle lobe is the extra Superior Superior section -> extra fissure: Middle Inferior horizontal fissure Inferior Oblique fissure Oblique fissure Middle fissure No middle fissure *** ◼Lingula: Portion of the left lobe that corresponds in extra structure in L that corresponds to middle lobe: position to the right middle lobe. lingula like the atoms of the lungs ◼Each lobe subdivides into smaller units called primary lobules ◼Primary lobule = anatomic unit of lung structure 11  space btw lungs Mediastinum (1 of 2) ◼ Area of the thorax bounded by the sternum anteriorly, spine posteriorly, and the lungs laterally. ◼ Structures enclosed: Heart Great vessels Trachea Esophagus Thymus play a big role in immune system Lymphatics Nerves Fibrous tissue Fat 12  Mediastinum (2 of 2) ◼ Esophagus: not part of respiratory system posterior to the trachea is part of digestive canal that connects the pharynx with the stomach. btw trachea anteriorly & spine posteriorly descends through posterior part of the mediastinum in front of the vertebral column, with its anterior surface in close relation to the trachea, aortic arch, and heart. barium makes subject contrast higher When the esophagus is filled with barium sulfate, the posterior border of the heart and the aorta are outlined well in lateral and oblique projections *** ◼ Thymus gland =primary control organ of lymphatic system. consists of two pyramid-shaped lobes that lie in the lower neck and superior mediastinum. Maximum size at puberty and then gradually undergoes atrophy until it almost disappears 13 shrinking  Neck ◼ Divided into posterior and anterior portions. difference in image quality btw soft tissue: to look for soft tissue neck & C-spine: ◼ Anterior portion: contrast: pathology not related to bone neck = low contrast #1 reason: to look for AKA vertebra that it c spine = bone vs soft tissue so foreign bodies adams apple Thyroid correlates with: high contrast laryngeal prominence C4/C5 foreign bodies are better seen in soft tissue Parathyroid glands above/around Larger part of the submandibular gland glands below mandible Maximum size at puberty and then gradually undergoes atrophy until it almost disappears 14 Thyroid Gland from c4 (adams apple) to T1 (jugular notch) ◼ Consists of 2 lateral lobes connected at their lower thirds by a narrow median portion called the isthmus. connects 2 ◼ Isthmus lies at the front of the upper part of the sections trachea, and the lobes lie at the sides. ◼ The lobes reach from the lower third of the thyroid cartilage to the level of the T1. above the sternum ◼ Although the thyroid gland is normally suprasternal in position, it occasionally extends into the superior aperture of the thorax. Parathyroid Glands 4 total 2 2 ◼Small ovoid bodies: 2 on each side, superior and inferior ◼ situated one above the other on posterior aspect of adjacent lobe of thyroid gland. 15 Pharynx (1 of 2) ◼ A passage for air and food and is common to the respiratory and digestive systems ◼ A musculomembranous, tubular structure situated in front of the vertebrae and behind nose, mouth, and larynx. ◼ Approx. 5” long. ◼ Extends from undersurface of sphenoid bone and inferiorly to disk between C6 - C7 (where it becomes continuous with the esophagus). ◼ Subdivided into: nasal, oral, and laryngeal portions. ◼ Nasopharynx: Lies posteriorly above the soft and hard palates Anteriorly, communicates with posterior apertures of the nose. 16  Larynx (1 of 2) ◼ Organ of voice and part of respiratory system ◼ Air passage between the pharynx and the trachea ◼ A movable, tubular structure; is broader above than below ◼ Approx. 1½ inches (3.8 cm) in length. ◼ Situated below root of the tongue & in front of laryngopharynx. ◼ Suspended from the hyoid bone and extends from superior margin of C4 to its junction with the trachea (at the level of the inferior margin of C6). *** ◼Epiglottis thin, leaf-shaped & serves as a trap to prevent leakage into the larynx between acts of swallowing. likefood a gate when passes ◼Thyroid cartilage forms the laryngeal prominence, or pathology related to epiglotits: epiglottitis Adam’s apple. (makes it swolllen & wouldnt be working 17 properly) Pharynx (2 of 2) ◼ Oropharynx: extends from soft palate to hyoid bone. base, of the tongue forms anterior wall of oropharynx. ◼ Laryngeal pharynx: posterior to the larynx its anterior wall formed by posterior surface of the larynx. extends inferiorly and is continuous with the esophagus. 18  soft tissue does not require high kVp bc not as dense as bone **** Larynx (2 of 2) -need less penetration so use a lower kVp in order not to overpenetrate & overexpose soft tissue ◼ The laryngeal cavity is subdivided into 3 -(=low contrast) compartments by two pairs of mucosal folds that extend from its lateral walls. ◼ Superior pairs of folds are the vestibular folds, or false vocal cords. Space above them is called the laryngeal vestibule. ◼ Lower two folds are separated from each other by a median fissure called the rima glottidis. They are known as the vocal folds, or true vocal fold. 19 ** additive disease removal of air from lung additive destructive? additive *** destructive *** *** 20  * *** additive *** additive 21 Soft Tissue Neck Radiography ◼ Soft tissue neck radiographs can demonstrate: Foreign bodies Swelling (especially epiglottitis) Masses (intrinsic and extrinsic to airway) Fractures of the larynx and hyoid bone. the only bone not connected to rest of body ◼ Patient position: either upright or recumbent, depending on physical condition. ◼Radiographs are most commonly made of the upper airway, from the superior oropharynx to the proximal trachea. 22 Essential Projections for Soft Tissue Neck AP Lateral 23 AP Soft Tissue Neck (1 of 3) ◼ IR + grid: 10 × 12 inches (24 × 30 cm) lengthwise. ◼ Patient Position: Supine or the upright depending on pt condition. ◼ Part Position: MSP centered to mildline of grid Pt’s shoulders lie in the same transverse plane. Pt’s neck extended slightly that MSP is ⟂ IR AKA adams IR centered at the level of the laryngeal apple, thyroid cartilage, C4/ prominence (for upper airway) or manubrium C5 @ jugular notch (for larynx and superior mediastinum). ◼Respiration: Exposure is made during slow inspiration to ensure that the trachea is filled with air. block is used to avoid angulation of neck(DISTORTION) 24 AP Soft Tissue Neck (2 of 3) ◼ CR: ⟂ MSP at laryngeal prominence (upper airway) or at manubrium (larynx and superior mediastinum) ◼ Collimation: 12” (30 cm) lengthwise and 1” (2.5 cm) beyond the skin line on the sides. 25 AP Soft Tissue Neck (3 of 3) ◼ Evaluation Criteria : Proper collimation and presence of a side maker. Air-filled upper airway, from the pharynx to the proximal trachea (for upper airway) Air-filled airway, from the midcervical to the midthoracic region (for trachea and superior mediastinum) No rotation: the “tear drops” in the center (if not centered that means there is rotation) Spinous processes equidistant to the pedicles and aligned with the midline of the cervical bodies Bony trabecular detail and surrounding soft tissues 26 Lateral Soft Tissue Neck (R or L) (1 of 3) ◼ IR + grid: 10 × 12 inches (24 × 30 cm) lengthwise. SID @ 72” to compensate for the large OID & improve spatial resolution increasing SID ◼ Patient Position: increases spatial resolution * Lateral position, seated or standing. If standing, weight must be equally distributed on feet. ◼ Part Position: EAM (external accoustic meatus (tunnel) ) same level as mastoid tip & C1/C2 Pt clasps hands behind the body and rotates shoulders posteriorly as far as possible. (to keep superimposed shadows of the arms from obscuring the structures of the superior mediastinum). Center the airway to the midline of the IR Center IR at laryngeal prominence (for upper airway) or manubrium (for larynx and superior mediastinum). 27  Lateral Soft Tissue Neck (R or L) (2 of 3) ◼ Part Position (cont.): MSP ∥ IR. Midsag plane is always parallel in lateral Extend the neck slightly. raise chin up a bit ◼Respiration: Exposure is made during slow inspiration to ensure that the trachea is filled with air. ◼CR: Horizontal & ⟂ through MCP. at laryngeal prominence (upper airway) at jugular notch through a point midway between jugular notch & MCP (for trachea and superior mediastinum). ◼ Collimation: 12” lengthwise and 1” beyond the skin line on the sides. 28  Lateral Soft Tissue Neck (3 of 3) ◼ Evaluation Criteria : ---> Proper collimation and presence of a side maker. z joints Air-filled upper airway, from the pharynx to the proximal trachea (for upper airway) Air-filled airway, from the midcervical to the midthoracic region (for trachea and superior mediastinum). No rotation or tilt of the cervical spine Superimposed zygapophyseal joints and open intervertebral joints. Superimposed / nearly superimposed mandibular rami. Bony trabecular detail and surrounding soft tissues gunyon is the angle btw the ramus & body 29