Aberrant left pulmonary artery, also known as pulmonary sling, represents an anatomical variant characterised by the left pulmonary artery arising from the right pulmonary artery and passing above the right main bronchus and in between the trachea and oesophagus to reach the left lung. It may le...
Aberrant right subclavian arteries (ARSA), also known as arteria lusoria, are the commonest of the aortic arch anomalies 2.
The estimated incidence is 0.5-2%.
They are often asymptomatic, but around 10% of people may complain of tracheo-oesophageal symptom...
Accessory fissures of the lung usually occur at the borders of bronchopulmonary segments. They are common normal variants but are less commonly seen on imaging.
Some of the more common accessory fissure include 1:
azygos fissure: most commonly seen accessory fissure
inferior accessory fissur...
The accessory (or superior) hemiazygos vein forms part of the azygos system and along with the hemiazygos vein, it is partially analogous to the right-sided azygos vein. It drains the left superior hemithorax.
Origin and course
The accessory hemiazygos vein is formed by the con...
The alveoli are tiny hollow air sacs that comprise the basic unit of respiration.
Alveoli are found within the lung parenchyma and are found at the terminal ends of the respiratory tree, clustered around alveolar sacs and alveolar ducts. Each alveolus is approximately 0.2 mm in ...
The anatomy curriculum is one of our curriculum articles and aims to be a collection of articles that represent the core anatomy knowledge for radiologists and imaging specialists.
Head and neck anatomy
Abdominal and pelvic anatomy
The anterior junction (junctional) line is a feature of frontal chest x-rays and chest CTs. It is a result of the parietal and visceral pleura meeting anteromedially. It normally contains a small amount of fat but can form a stripe of variable thickness if there is a lot of fat present or by the...
The anterior mediastinum is the portion of the mediastinum anterior to the pericardium and below the thoracic plane.
It forms the anterior part of the inferior mediastinum, and contains the thymus, lymph nodes, and may contain the portions of a retrosternal thyroid.
The aortic arch represents the direct continuation of the ascending aorta and represents a key area for a review of normal variant anatomy and a wide range of pathological processes that range from congenital anomalies to traumatic injury.
origin: continuation of the ascending aorta at...
The aortic hiatus is one the three major apertures through the diaphragm and lies at the level of T12. Strictly speaking, it is not a real aperture in the diaphragm, but an osseoaponeurotic opening between it and the vertebral column.
The hiatus is situated slightly to the left of the midline ...
The aortic-pulmonary stripe is an uncommon feature of frontal chest x-rays and was first described by Keats in 1972 1.
It is formed by the interface of the pleural surface of the anterior segment of the left upper lobe contacting the mediastinal fat that is anterolateral to the pulmonary trunk ...
The ascending cervical artery is 1 of the 4 branches of the thyrocervical trunk (off the first part of the subclavian artery).
It is a small artery that ascends medial to the phrenic nerve on the prevertebral fascia. It contributes many small spinal branches into the intervertebral foramina of ...
Owing to their features, the first, eleventh and twelfth ribs are considered atypical ribs.
Of all ribs, the first is the strongest, broadest and most curved. Ribs eleven and twelve are unique, among other reasons, by not being attached to the sternum.
The azygo-oesophageal recess (AER) is a prevertebral space formed by the interface of the posteromedial segments of the right lower lobe and the azygos vein and oesophagus 1-3. The AER extends from the azygos arch to the aortic hiatus and has the following borders 1, 2:
An azygos lobe is created when a laterally displaced azygos vein creates a deep pleural fissure into the apical segment of the right upper lobe during embryological development. It is a normal anatomic variant of the right upper lobe due to invagination of the azygos vein and pleura during in th...
The azygos vein is a unilateral vessel that ascends in the thorax to the right side of the vertebral column, carrying deoxygenated blood from the posterior chest and abdominal walls. It forms part of the azygos venous system.
The azygos vein is formed by the union of the...
The azygos (venous) system is a collective term given to the H-shaped configuration of the azygos, hemiazygos, accessory hemiazygos veins and left superior intercostal vein.
It is responsible for draining the thoracic wall and upper lumbar region via the lumbar veins and posterior intercostal v...
Bovine arch is the most common variant of the aortic arch and occurs when the brachiocephalic (innominate) artery shares a common origin with the left common carotid artery.
A bovine arch is apparent in ~15% (range 8-25%) of the population and is more common in individuals of African descent. ...
The Boyden classification of bronchi refers to the standard nomenclature used to describe bronchopulmonary segmental anatomy.
Each lung has 10 segments, however on the left, the first two segments share a common trunk and are hence B1/2. Also given the shared trunk on the left of the lower lobe...
Brachiocephalic veins (BCV) drain the head, neck, upper limbs and part of the thorax and mediastinum.
In the root of the neck, the internal jugular and subclavian veins unite to form the brachiocephalic veins posterior to the medial ends of the clavicles.
Useful mnemonics to remember the four branches of the thoracoacromial artery are:
CAlifornia Police Department
Cadavers Are Dead People
B: breast (pectoral)
CAlifornia Police Department
The bronchial arteries are responsible for only 1% of the lung blood flow but they are the major high-pressure oxygenated blood supplier to the supporting structures of the lung parenchyma including pulmonary arteries. The classic pattern described below of two bronchial arteries on the left and...
The bronchial veins are counterparts to the bronchial arteries and drain the bronchi, hilar structures and the mid-portion of the oesophagus.
There is typically a single bronchial vein at each hilum, formed from the superficial bronchial veins with deep bronchial veins draining i...
Bronchioles are the branches of the tracheobronchial tree that by definition, are lacking in submucosal hyaline cartilage.
The bronchioles typically begin beyond the tertiary segmental bronchi and are described as conducting, terminal or respiratory bronchioles. Following the te...
Bronchopulmonary segmental anatomy describes the division of the lungs into segments based on the tertiary or segmental bronchi.
The trachea divides at the carina forming the left and right main stem bronchi which enter the lung substance to divide further. This initial division ...
Mnemonics to remember the bronchopulmonary segments are:
A PALM Seed Makes Another Little Palm (right lung)
ASIA ALPS (left lung)
'A PALM Seed Makes Another Little Palm'
right upper lobe
A: apical segment
P: posterior segment
A: anterior segment
L: lateral segment
The bronchus intermedius is one of the two bronchi which the right main bronchus bifurcates into, the other being the right upper lobe bronchus.
The bronchus intermedius runs distal to the right upper lobe bifurcation and follows the trajectory of the right main bronchus 1. Its m...
The canals of Lambert are microscopic collateral airways between the distal bronchiolar tree and adjacent alveoli. They are poorly formed in children, and along with poorly formed pores of Kohn, are thought to be responsible for the high frequency of round pneumonia in that age group.
A cardiac bronchus is a rare anatomic variant of the tracheobronchial tree, arising from the medial aspect of the bronchus intermedius.
This anomaly is rare and is reported in ~0.3% (range 0.09-0.5%) of individuals 3-5. There may be a predilection for males.
The cardiac plexus is a plexus of nerves situated at the base of the heart. It is formed by cardiac branches derived from both the sympathetic and parasympathetic nervous systems.
Sympathetic cardiac nerves are derived from T1 to T4 segments and partly from the T5 segment of the ...
The carina is part of the trachea and is an important reference point in chest imaging.
The carina is found at the base of the trachea and it is formed as the main bronchi divide into right and left branches.
The carina usually sits in the T4/T5 plane and is at the level of the ...
The superior cavo-atrial junction, generally referred to as simply the cavo-atrial junction (CAJ), is the junction of the right lateral border of the superior vena cava (SVC) and the superior border of the right atrium.
It is an important landmark to recognise because it marks an optimum site f...
A number of cell groups in the reticular formation of the pons and medulla are responsible for the central control of the respiratory cycle:
inspiratory centre (a.k.a. dorsal respiratory group) - bilateral groups of cells in the region of the nucleus of the tractus solitarius in the dorsum of t...
The muscle fibres of the diaphragm converge and attach to the central tendon of the diaphragm. It is a thin but strong layer of aponeurosis which forms an intergral part of respiration.
The central tendon of the diaphragm is located near the centre of the diaphragmatic muscle bu...
The centrilobular region, in context of the lungs and HRCT, refers to the central portion of the secondary pulmonary lobule, around the central pulmonary artery and bronchiole.
Cervical aortic arch is a rare aortic arch anomaly characterised by an elongated, high-lying aortic arch extending at or above the level of the medial ends of the clavicles.
Patients with cervical aortic arch are usually asymptomatic. Symptomatic patients may present with...
Cervical rib is a supernumerary or accessory rib arising from the seventh cervical vertebra. They occur in ~0.5% of the population, and are more common in females.
Although cervical ribs are usually asymptomatic, they are the most important anatomic rib variant clinically, because they can caus...
Chest x-ray lines and stripes are important to recognise on chest radiographs.
Lines are usually less than 1mm in width and are comprised of tissue outlined on either side by air and typically represent pleural-covered structures within the middle and superior mediastinum 1, 2:
Congenital pulmonary venolobar syndrome is a condition comprised of a rare group of cardiac and pulmonary congenital abnormalities occurring variably in combination. The abnormalities include:
anomalous pulmonary venous drainage
particularly scimitar syndrome with hypogenic right lung
The coracoclavicular joint is a normal variant of the pectoral girdle, where the conoid tubercle of the clavicle appears enlarged or elongated, with a flattened inferior surface where it approximates the coracoid process of the scapula to form an articulation.
More common in Asia...
The costal cartilages form part of the thoracic cage and anterior chest wall. There are 10 costal cartilages, one for rib 1-10, with each of which forms a costochondral joint. Costal cartilages 1-7 articulate with the sternum at sternocostal joints, and costal cartilages 8-10 are attached to eac...
The costocervical trunk is one of the branches of the second part of the subclavian artery. It arises from the posterior wall of the subclavian artery, posterior or medial to the anterior scalene muscle and courses posterosuperiorly across the suprapleural membrane where it divides into 2 branc...
The costochondral joints are the joints between each rib and its costal cartilage. They are primary cartilaginous joints. These joints represent the demarcation of the unossified and ossified part of the rib 1. The joint is held together by periosteum, with the lateral aspect of the costal ca...
The costoclavicular ligament or rhomboid ligament is the major stabilising factor of the sternoclavicular joint.
The costoclavicular ligament binds the inferior medial clavicle (via the rhomboid fossa) to the first costal cartilage and adjacent end of the first rib. It is compose...
The costoclavicular space is the anterior portion of the superior thoracic aperture, between the clavicle and first rib. The subclavian vessels and brachial plexus pass though the space related to the scalene muscles. Proximally, the plexus passes through the interscalene space, and distally thr...
The costovertebral joint is an articulation between the ribs and the vertebral column.
The ribs articulate with the thoracic vertebrae via two distinctly different joints:
costovertebral joint - articulation between the head of the rib and the vertebral body
The costoxiphoid ligaments, also known as the chondroxiphoid ligaments, are inconstant fibrous structures joining the anterior and posterior surfaces of the xiphoid to the respective surfaces of the adjacent seventh and, occasionally, sixth costal cartilages.
The diaphragm is the dome-shaped muscle that separates the thoracic cavity from the abdominal cavity, enclosing the inferior thoracic aperture.
The muscular fibres of the diaphragm originate around the circumference of the inferior thorax and converge to a common insertion point ...
The diaphragmatic apertures are a series of apertures that permit the passage of structures between the thoracic and abdominal cavities. There are three main apertures:
aortic hiatus (T12) (not a true aperture)
oesophageal hiatus (T10)
vena caval foramen (T8)
The vertebral levels of these ap...
A useful mnemonic to remember the thoracic spinal levels at which the three major structures pass through the diaphragm is:
I ate (8) 10 eggs at 12
I ate (8): inferior vena cava at T8
10 eggs: (o)esophagus at T10
at 12: aorta at T12
Double aortic arch is the most common symptomatic type of the aortic arch variant. It may account for up to 50-60% of vascular rings.
Double aortic arch is mostly diagnosed in childhood due to of symptoms related to oesophageal and/or tracheal obstruction. Respiratory sym...
The ductus arteriosum (or arteriosus) is the thick short conduit for blood to bypass the non-ventilated lungs in the fetus. It is located between and connects the proximal left pulmonary artery and the undersurface of the aortic arch distal to the origin of the last branch of the arch, at the ao...
Aortic ductus diverticulum is a developmental outpouching of the thoracic aorta.
It is usually seen at the anteromedial aspect of the aorta at site of the ligamentum arteriosum, at the aortic isthmus. This is also the site of 90% of post-traumatic aortic injuries as the ligamentu...
The atypical 11th rib is one of two floating ribs.
The 11th rib has a single facet on its head for articulation with the T11 vertebra. It has a short neck and no tubercle. The angle is slight. Its costal groove is shallow. The internal surface of this rib faces slightl...
The eparterial bronchus is a synonymous term for the right superior lobar bronchus. Its name is derived from the bronchus being the only one originating superior to the level of the pulmonary artery. Conversely, all other bronchi can be referred to by their anatomical relationship to the pulmona...
Epicardial (pericardial) fat pads are normal structures that lie in the cardiophrenic, more so on the right. Unsurprisingly, they are more prominent in obese patients.
They can be affected by fat necrosis (see: epipericardial fat necrosis).
Episternal (or suprasternal) ossicles are accessory bones and a normal variant of the sternum. They result from supernumerary ossification centers and are seen in ~4% (range 1-7%) of the population.
Episternal ossicles are usually located posterior or superior to the superior bor...
The external (or outermost) intercostal muscles are important muscles of respiration. They number eleven on each side and are located in the intercostal space, expanding the transverse dimension of the thoracic cavity during inspiration.
The external intercostal muscles are the o...
The first rib is the most superior of the twelve ribs. It is an atypical rib and is an important anatomical landmark and is one of the borders of the superior thoracic aperture.
Compared to a typical rib, the first rib is short and thick and it has a single articular f...
The foramina of Morgagni, also known as the sternocostal triangles, are small defects in the posterior aspect of the anterior thoracic wall between the sternal and costal attachments of the diaphragm. The internal thoracic vessels descend through these foramina to become the superior epigastric ...
The Haller index (HI), also known as the pectus index, is a simple mathematical way to assess and describe the chest cage on CT of the thorax and is used in the detection of pectus excavatum, as well as preoperative and postoperative assessment 1,5.
The Haller index is calculated by ...
The heart is a hollow, muscular organ of the middle mediastinum, designed to pump oxygenated blood around the systemic circulation and de-oxygenated blood around the pulmonary circulation
The heart has a somewhat conical form and is enclosed by pericardium. It is positioned poste...
There are four heart chambers, the right atrium, left atrium, right ventricle and left ventricle. These receive blood from the body and lungs, and contract to transmit blood to the lungs for oxygenation and to the body for use in metabolism.
It is best to list the four chambers in order of the ...
The hemiazygos vein is the asymmetric counterpart to the azygos vein and forms part of the azygos venous system.
The hemiazygos vein is formed by the confluence of the left ascending lumbar and left subcostal veins.
The hemiazygos vein enters the thorax either ...
The hilar point on chest radiographs is formed by the outer margins of the superior pulmonary vein and the descending pulmonary artery as they cross past each other.
The horizontal fissure (also called the minor fissure) is a unilateral structure in the right lung that separates the right middle lobe from the right upper lobe.
The horizontal fissure arises from the right oblique fissure and follows the 4th intercostal space from the sternum u...
Horseshoe lung is one of the rare congenital anomalies of the lung. A band of pulmonary parenchyma is formed extending between the right and left lungs. The pulmonary tissue can be seen either anterior to the aorta or posterior to the pericardium at the caudal end.
A hyparterial bronchus is any bronchus originating inferior to the level of the pulmonary artery. Conversely, the right superior lobar bronchus can be referred to by its anatomical relationship to the pulmonary arteries as being eparterial.
The term may be encountered in the classification of ...
Incomplete double aortic arch is a rare vascular ring anomaly wherein a segment of the minor aortic arch, usually the left, is atretic.
As in the case of other vascular rings, this anomaly can cause 1:
Some patients may reach adulthood with...
The inferior accessory fissure of the lung, also known as Twining's line, divides the medial basal bronchopulmonary segment from the rest of the lower lobe.
This accessory fissure is present in around 12% of people when examined with CT and is visible on 5-8% of frontal chest x-rays. It is appr...
The inferior mediastinum is the box-shaped space in the mediastinum below the transthoracic plane of Ludwig between the wedge-shaped superior mediastinum above and the diaphragm and inferior thoracic aperture below. There are no physical structures that divide the superior and inferior mediastin...
The inferior pulmonary ligament (or just the pulmonary ligament) is a normal anatomical structure that is often seen on chest x-ray and CT chest.
The inferior pulmonary ligament is a fused triangular-shaped sheet of parietal and visceral pleura that extends from the hilum to the...
The inferior thoracic aperture connects the thorax with the abdomen.
The inferior thoracic aperture is irregular in shape and is more oblique and much larger than the superior thoracic aperture. The diaphragm occupies and closes the inferior thoracic aperture, thereby separating ...
The innermost intercostal muscles are muscles of respiration. They are the deepest intercostal muscles located in the intercostal spaces, and contract along with the internal intercostal muscles to reduce the transverse dimension of the thoracic cavity during expiration.
The intercostal muscles are an important group of muscles in the intercostal spaces (between the ribs) that contract during respiration. Three muscles are classically described, from superficial to deep:
external intercostal muscles
internal intercostal muscles
innermost intercostal muscles
The intercostal nerves are the somatic nerves that arise from the anterior divisions of the thoracic spinal nerves from T1 to T11. These nerves in addition to supplying the thoracic wall also supply the pleura and peritoneum.
Intercostal nerves can be divided into atypical and ty...
The intercostal spaces are the space between the ribs. There are 11 spaces on each side and they are numbered according to the rib which is the superior border of the space.
The intercostal spaces contain three layers of muscle: the external, internal and innermost layers with t...
The interlobular septa (sing: septum) are located between the secondary pulmonary lobules and are continuous with both the subpleural interstitium (peripheral connective tissue) and the peribronchovascular interstitium (axial connective tissue) as well as the more delicate intralobular septa.
The internal intercostal muscles are important muscles of respiration. They number eleven on each side and are located in the intercostal spaces, reducing the transverse dimension of the thoracic cavity during expiration.
The internal intercostal muscles are the middle muscle of ...
The internal thoracic artery (previously called the internal mammary artery) supplies the anterior body wall and its associated structures from the clavicles to the umbilicus.
The internal thoracic artery arises from the first part of the subclavian artery in the base of...
The intralobular septa (sing: septum) are delicate strands of connective tissue separating adjacent pulmonary acini and primary pulmonary lobules. They are continuous with the interlobular septa which surround and define the secondary pulmonary lobules.
The intrapleural or pleural space is the fluid-filled space in between the parietal and visceral layers of the pleura. In normal conditions it contains only a small amount of serous pleural fluid.
A pleural effusion is the pathological accumulation of pleural fluid, and when ...
Intrapulmonary lymph nodes are a type of intrathoracic lymph nodes. They can be quite common on routine CT examinations of healthy patients.
perifissural lung nodules 2
CT: HRCT chest
around 6 mm in size (usually reported range around 3-8.5 mm) 1
most tend to...
The left atrium is one of the four chambers of the heart. It receives oxygenated blood from the pulmonary circulation that is then delivered to the left ventricle and then into the systemic circulation.
The left atrium is grossly cuboidal, and like the right atrium has an appenda...
The left horizontal (or minor) fissure is an accessory fissure found in around 8% of individuals examined with CT 3. In a prospective study of 2,000 consecutive normal chest X-rays (AP and lateral), a definite left horizontal fissure was identified in 1.6% of the subjects 1.
The left lower lobe (LLL) is one of two lobes in the left lung. It is separated from the left upper lobe by the left oblique fissure and subdivided into four bronchopulmonary segments.
Location and structure
The LLL lies in the posterior and lower aspect of the left hemithorax a...
The left lower lobe anteromedial segment (or cardiac segment) is one of the bronchopulmonary segments of the left lower lobe. It is the most anteromedial of the segments within the base of the left upper lobe.
It is the equivalent segment merger of the anterior and medial segments of the right ...
The left main bronchus divides into the left lower lobe bronchus and the left upper lobe bronchus. It is one of the secondary lobar bronchi.
The left lower lobe bronchus is very short and divides immediately into the segmental bronchi. There are usually 10 individual segmental b...
The left lower lobe lateral or lateral basal segment is one of the four bronchopulmonary segments of the left lower lobe. It is the most inferolateral of the segments in the left lower lobe, below the superior segment.
The left lower lobe posterior or posterior basal segment is one of the four bronchopulmonary segments of the left lower lobe. It is the most inferoposterior of the segments in the left lower lobe, below the superior segment.
Due to its low and posterior position, pathology in...
The left lower lobe superior or apical segment is one of the four bronchopulmonary segments of the left lower lobe. It is the most apical of the segments in the left lower lobe, posterior to the upper aspect of the oblique fissure and apicoposterior segment of the left upper lobe.
The left lung is one of two lungs, located in the left hemithorax on the left of the heart and mediastinum.
There are a few differences between the two lungs:
The left lung is smaller in volume than the right lung, with a smaller transverse dimension (due to the heart on the left) but a large...
The trachea bifurcates into the right and left main bronchi at the level of the carina, supplying air to the right and left lungs respectively. Each main or primary bronchus enters the hilum of its lung and gives rise to secondary lobar bronchi, which further divide into tertiary segmental bronc...