*Cardiothoracic anatomy

*CT anatomy

*Overview mediastinum

Layer Zone 1 (T1 – T4) Zone 2 (T5 – T8)

Zone 3 (T9 – T12)

1 – Posterior channels

Only thoracic duct •Thoracic duct •Azygos vein •Descending thoracic aorta

•Thoracic duct •Azygos vein •Descending thoracic aorta

2 – Tubular viscera

Trachea Oesophagus

Oesophagus Main bronchi

Oesophagus

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

•Anterior mediastinal fat •?Thymus

Anterior mediastinal fat

* 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

*5 point checklist

*Mediastinum *Lungs *Pleura *MSK *Chest wall

*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• Tracheal deviation

• Lymph nodes • Mediastinal nodes• Pericardial effusions

Lungs • Pulmonary contusions • Pulmonary consolidation

• Pulmonary collapse• Pulmonary mass• Hilar shadowing

• Pulmonary mass – Primary, secondary

Pleura • Pneumothorax • Haemothorax

• Pneumothorax • Pleural effusions

• Pleural effusions

MSK • Fracture – Sternum, Ribs, Vertebrae

• Rib fractures • Kyphoscoliosis

• Bone mets

Chest wall • Haematoma • NA • Previous evidence mastectomy

• Axillary lymphadenopathy