Read first the text book: Computed Tomography and Magnetic resonance of the Thorax by Nadich et all

Then go through this exercise to assess your comprehension

Pulmonary Hila , Airways and Pulmonary vessels

Q1: What are the Components of hilum?

• Airways

• Pulmonary arteries

• Pulmonary veins

Q2: Which component is the reference landmark and why?

Airways are the reference landmarks

• Air in lumen serves as a contrast agent for easy recognition

• Constant relationship of pulmonary artery and vein to airways

Q3: What are the CT sections by whch you evaluate the right hilum and airways?

• Carina

• Apical segmental bronchus of RUL

• RUL

• Bronchus intermedius

• RML

• RLL basilar segments

Q4: What are the CT section by whch you evaluate the left hilum and airways ?

• Apical-posterior segmental bronchus LUL

• Upper portion of LUL

• Lower portion of LUL

• Upper lobe spur

• LLL basilar segments

Right 

Q5: You are looking at section at the level of Carina. Identify the labeled structures.

• Vertical course of apical segment of RUL

• RUL pulmonary artery. Artery lies just medial to bronchus

• Right superior pulmonary vein. Vein just lateral to bronchus

Q6: You are looking at section at the level of RUL bronchus.  Identify the labeled structures.

• Truncus anterior first major branch of right pulmonary artery lies anterior to RUL bronchus

• Branch of right superior pulmonary vein lies at the angle between anterior and posterior segmental bronchi

• Anterior and medial to truncus anterior lies RUL vein (the apical-anterior vein)

Q7: You are looking at section at the level of  bronchus intermedius.  Identify the labeled structures.

• Inferior to bronchus right superior pulmonary vein lies alongside the lateral border of right interlobar pulmonary artery

• Multiple veins can be identified in this location

• Right main pulmonary artery at the lateral border of intermedius bronchus turns inferiorly and becomes interlobar pulmonary artery.

• At this position the artery may have a triangular configuration

Q8: You are looking at section at the level of RML bronchus  Identify the labeled structures.

• Interlobar pulmonary artery is vertical and lies immediately lateral to RML and RLL bronchi

• Artery has an oval configuration at this point

• Right superior pulmonary vein lies medial to RBL bronchus and can be seen entering the upper portion of left atrium

Q9: You are looking at section at the levell of RLL basilar segments  Identify the labeled structures.

• Branches of right interlobar pulmonary artery are round and lay posterolateral to the proximal portions of basilar segments

• Inferior pulmonary veins are oriented horizontally and can be traced to right inferior pulmonary vein and subsequently into the lower portion of left atrium.

Left 

Q10: You are looking at section at the level of apical-posterior segmental bronchus LUL  Identify the labeled structures.

• Superior pulmonary vein tends to be located anteriorly

Q11: You are looking at section at the level of Carina  Identify the labeled structures.

• Apical-posterior segmental bronchus is separated from the left main bronchus by the left main pulmonary artery, which courses over LUL bronchus at this level

• LUL pulmonary artery cab be traced to its origin from the left main pulmonary artery and lies posterolateral to the left superior pulmonary vein

Q12: You are looking at section at the level of upper portion of LUL  Identify the labeled structures.

• Posterior wall of LUL bronchus is slightly convex because it is indented superiorly and posteriorly by the left main pulmonary artery

  • Posterior to LUL bronchus the left pulmonary artery continues as interlobar pulmonary artery

  • Appears triangular at this level because of the change in course

• Left superior pulmonary vein lies in front of LUL bronchus and has a horizontal course

  • Distinct branching can be identified peripherally

Q13: You are looking at section at the level of lower portion of LUL  Identify the labeled structures.

• Left interlobar artery has a vertical course and lies lateral to the spur

• Lateral to the origin of the lingular bronchus the pulmonary artery to lingula can be identified

• Directly anterior to LUL bronchus is the inferior portion of the left superior pulmonary vein

• Pulmonary parenchyma can be seen between pulmonary artery and descending aorta (retro bronchial stripe)

Q14: You are looking at section at the level of LLL basilar segments  Identify the labeled structures.

• Same as right

• Branches of pulmonary artery to the lower lobe lie lateral and posterior to the basilar bronchi

• Left inferior pulmonary vein is horizontal and cab traced to left atrium

• Left inferior pulmonary vein course along the lateral border of descending aorta

The session is over

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