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ORIENTATION: VIEWING HEART IN AXIAL CT AND MRI

ORIENTATION: VIEWING HEART IN AXIAL CT AND MRI. Orientation of heart in axial CT and MRI. RV. LV. RA. LA. 5 CHAMBERED HEART?. 4 CHAMBERED HEART. 20 MINUTE ANATOMY VIDEOS No sinner is ever saved after the first twenty minutes of a sermon - Mark Twain. INVERTED Y SHAPE?.

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ORIENTATION: VIEWING HEART IN AXIAL CT AND MRI

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  1. ORIENTATION: VIEWING HEART IN AXIAL CT AND MRI Orientation of heart in axial CT and MRI RV LV RA LA 5 CHAMBERED HEART? 4 CHAMBERED HEART 20 MINUTE ANATOMY VIDEOS No sinner is ever saved after the first twenty minutes of a sermon - Mark Twain INVERTED Y SHAPE?

  2. ORIENTATION: THORACIC CONTENTS ANTERIOR VIEW Esophagus Trachea Left Int. Jugular V. Subclavian V. R. Brachiocephalic V. AORTA Sup. Vena Cava Structures at Root of Lung Pulmonary Trunk diaphragm L R

  3. POSTERIOR VIEW INCLUDING TRACHEA, ESOPHAGUS Esophagus, Thoracic duct 1) Arch of Aorta 2a) Trachea (bifurcation) 2) Pulmonary Arteries Order similar to root of Lung 3) Pulmonary Veins diaphragm IVC R L

  4. HEART IS ON LEFT: REASON: ROTATED SO LEFT ATRIUM IS IN MIDLINE Left Atrium - receives Pulmonary Veins symmetrically from both sides Right Ventricle - anterior Left Pulmonary Veins LA Right Pulmonary Veins RV

  5. POSTERIOR VIEW: KNOW SEQUENCE SVC 1) Arch of Aorta 2) Pulmonary Arteries Pulmonary Veins 3) Pulmonary Veins IVC

  6. ANTERIOR VIEW AT TOP (SUPERIORLY) - VEIN IN FRONT OF ARTERIES Left Brachiocephalic Vein Brachiocephalic Trunk Left Common Carotid A Left Subclavian A Right Brachiocephalic Vein SVC Arch of Aorta ANTERIOR VIEW Reason: All venous blood drains to Right Atrium

  7. ANTERIOR VIEW PULMONARY TRUNK - arises from Right Ventricle; crosses anterior to Ascending Aorta; then branches Arch of Aorta Ascending Aorta Pulmonary Trunk - from Conus Arteriosus RV

  8. Conus Arteriosus

  9. CONUS ARTERIOSUS EXTENDS TOWARD LEFT; THEN PULMONARY TRUNK BIFURCATES RA Y LA PULMONARY TRUNK ON LEFT IN AXIAL SECTIONS Conus Arteriosus RV LV

  10. AORTA ARISES IN MIDDLE OF HEART RA LA AXIAL SECTIONS LOOK LIKE 5 CHAMBERED HEART RV LV

  11. POSTERIOR VIEW: KNOW SEQUENCE SVC 1) Arch of Aorta 2) Pulmonary Arteries Pulmonary Veins 3) Pulmonary Veins R L IVC

  12. ORIENTATION: VIEWING HEART IN AXIAL CT AND MRI RV Orientation of heart in axial CT and MRI LV RA LA

  13. CT, MRI VIEW HEART FROM BELOW LV RV LA RA * - AORTA IN CENTER OF HEART L IMAGE FLIPPED VERTICALLY R

  14. START AT DIAPHRAGM Diaphragm Inferior vena cava Muscles of ventricles Esophagus Azygous vein Thoracic (descending) aorta R L

  15. Right ventricle Interventricular septum Inferior vena cava Left ventricle Esophagus Azygous vein Thoracic (descending) aorta R L 2 CHAMBERED HEART - ventricles only

  16. Right ventricle Right atrium Left ventricle Left atrium Esophagus Thoracic (descending) aorta R L 4 CHAMBERED HEART!

  17. Right ventricle Right atrioventricular orifice Interventricular septum Right atrium Left ventricle Right pulmonary vein Left atrioventricular orifice LA Left atrium Thoracic (descending) aorta Azygous vein Left pulmonary vein R L 4 CHAMBERED HEART!

  18. Right ventricle * - AORTA - arising from Vestibule Right atrium Left ventricle Left atrium Right pulmonary vein Azygous vein Left pulmonary vein Esophagus R Thoracic (descending) aorta L 5 CHAMBERED HEART?

  19. Right ventricle Superior vena cava Ascending aorta RV Azygous vein Left main bronchus R L RIGHT VENTRICLE EXTENDS TO LEFT

  20. Right ventricle to Pulmonary Trunk Ascending aorta Superior vena cava Left pulmonary artery Y Y Right pulmonary artery Thoracic (descending) aorta Carina at tracheal bifurcation R L PULMONARY TRUNK BRANCHES

  21. Arch of aorta Superior vena cava Trachea Esophagus R L

  22. Superior vena cava Left subclavian artery Trachea Scapula Spinal cord Esophagus R L

  23. Left brachiocephalic vein Right brachiocephalic vein Right lung Brachiocephalic trunk Left common carotid R L Left subclavian artery Trachea Esophagus LEFT BRACHIOCEPHALIC VEIN CROSSES ANTERIORLY

  24. Summary - Orientation of heart in CT and MRI is complex; rarely appears to have 4 chambers. 1. Position and Orientation of heart - Heart is rotated and tilted so Right Ventricle is anterior and inferior; this makes functional sense; as a result, Left Atrium is located in midline and receives blood symmetrically from Pulmonary Veins (low pressure). 2. Sequence of Structures Inferior to Superior - Pulmonary Veins, Pulmonary artery, Arch of Aorta. 3. Pulmonary artery - arises from Conus arteriosus (Infundibulum) of Right Ventricle; ascends toward left and crosses anterior to Aorta; Pulmonary artery then bifurcates (appears Y shaped in axial CT and MRI). 4. Aorta - arises from Left Ventricle and first courses in middle of heart (Heart appears to have 5 chambers in axial CT and MRI at this level). 5. Order of Structures in Superior Mediastinum - Veins (R and L Brachiocephalic) are anterior to Arteries (Brachiocephalic, L Common Carotid, L Subclavian) arising from Arch of Aorta.

  25. REMEMBER: ANATOMICAL DETAILS ARE COMPLEX AND DIFFICULT TO LEARN BUT PATIENTS CAN DIE FROM 'MINOR DETAILS' OF ANATOMY.

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