THORAX • Arteries of the thoracic wall

Left costocervical trunk

Right supreme intercostal artery
Left subclavian artery
Right costocervical trunk
Left common carotid artery
Right subclavian artery
Right common carotid artery
Arch of aorta

Ascending aorta

Thoracic aorta

Posterior intercostal arteries

Internal thoracic arteries

Anterior perforating
branches

Collateral branch of
posterior intercostal artery

41
Anterior intercostal artery

Collateral branch of
anterior intercostal artery

Right superior epigastric artery

Musculophrenic artery

Abdominal aorta
Arteries of the thoracic wall

Head of rib
Ascending aorta
Superior vena cava Pulmonary trunk
Internal thoracic artery

42
Thoracic vertebra

Posterior intercostal arteries

Right atrium
Right ventricle
Arteries of the thoracic wall.
Thoracic aorta
Volume-rendered right lateral view
of structures in the thorax using
multidetector computed tomography

74
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 Veins of the thoracic wall 3
Left superior intercostal vein

Left supreme intercostal vein

Left internal jugular vein

Right internal jugular vein Left subclavian vein

Right subclavian vein Left brachiocephalic vein

Right brachiocephalic vein

Accessory
hemi-azygos vein
Right superior intercostal vein

Internal
Posterior intercostal veins thoracic veins

Azygos vein

44 Anterior intercostal vein

43
Right superior
intercostal vein

Hemi-azygos vein

Left superior Right superior epigastric vein

intercostal vein
Right musculophrenic vein
Azygos vein
Inferior vena cava
Accessory
hemi-azygos vein
Left subcostal vein

Posterior intercostal veins

Hemi-azygos vein

Veins of the thoracic wall

Left ascending lumbar vein

Right
subcostal vein Inferior vena cava

Right ascending
lumbar vein

Azygos system of veins

75
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 THORAX • Nerves of the thoracic wall

Spinal nerve

Posterior branch of lateral

Intercostal nerve cutaneous nerve
Lateral cutaneous
branch of
intercostal nerve

Anterior branch
of lateral
cutaneous nerve

Small collateral branch

of intercostal nerve

Posterior ramus
Intercostal
nerve
Anterior ramus
(intercostal nerve)

Small collateral branch

45
Anterior
cutaneous
Medial cutaneous branch
branch of
of posterior ramus
intercostal nerve
Lateral cutaneous branch
of posterior ramus Posterior ramus
Spinal cord
Posterior branch of
lateral cutaneous nerve

Subcostal nerve (T12)

Nerves of the thoracic wall

Spinal nerve
Intercostal nerve (anterior ramus of
thoracic spinal nerve)
Small collateral branch

46
Anterior cutaneous branch
of intercostal nerve

Lateral cutaneous
branch of intercostal
nerve Medial branch of
anterior cutaneous nerve
Anterior branch of
lateral cutaneous nerve

Lateral branch of
anterior cutaneous nerve
Intercostal nerves and branches

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 Lymphatics of the thoracic wall 3
Thoracic duct
Right internal jugular vein

Right jugular trunk

Left internal jugular vein Right subclavian vein
Thoracic duct
Right bronchomediastinal trunk
Right internal jugular vein
Left jugular trunk Right superior
Right jugular trunk Right
tracheobronchial nodes
paratracheal
Right subclavian trunk Left subclavian trunk
nodes
Right subclavian vein
Left subclavian vein

48
Right bronchomediastinal
trunk Left bronchomediastinal
Brachiocephalic nodes trunk
Inferior
tracheobronchial
nodes
Left parasternal
Thoracic duct
Right parasternal lymphatic vessel
lymphatic vessel
Lymph nodes and
vessels of the trachea

47 Parasternal nodes

Thoracic duct

Intercostal
nodes

Diaphragmatic nodes

Diaphragm

Cisterna chyli

Right internal jugular vein Left internal jugular vein

Left jugular trunk

49
Right jugular trunk
Lateral aortic nodes
Left subclavian trunk
Right subclavian trunk

Right subclavian vein Left subclavian vein

Right lymphatic duct Left bronchomediastinal
trunk
Major lymphatic vessels and nodes Right bronchomediastinal trunk
of the thoracic wall Thoracic duct

Superior vena cava

Termination of the lymphatic trunks

77
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 THORAX • Intercostal nerves and arteries

Lateral cutaneous branch Posterior ramus of spinal nerve

External intercostal

Internal intercostal

White ramus communicans

Intercostal nerve Gray ramus communicans

Innermost Internal intercostal Sympathetic trunk

intercostal membrane
Posterior branch of Spinal nerve
lateral cutaneous nerve

Lateral cutaneous branch

of intercostal nerve
50 Intercostal nerves

Parietal pleura
Transversus thoracis

Anterior cutaneous branch of intercostal nerve

Anterior branch of
Sternum
lateral cutaneous nerve

Lateral branch of anterior cutaneous nerve Medial branch of anterior cutaneous nerve

Posterior branch of posterior intercostal artery

External intercostal

Internal intercostal

Posterior
intercostal artery
Collateral branch
Thoracic aorta
Internal intercostal
Innermost membrane
intercostal

Lateral branch of
posterior intercostal
artery
51 Intercostal arteries

Internal thoracic artery

Anterior intercostal artery

Transversus thoracis

Sternum

Anterior perforating branch

78
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 Pleural cavities and mediastinum 3
Apex of right lung
Trachea
Right main bronchus Left pleural cavity

Parietal pleura Pleural cavity Visceral pleura

52
53 Mediastinum

Costomediastinal recess
Mediastinum Visceral pleura
Parietal pleura
(on lung)
(on thoracic wall)
Costomediastinal
recess

Diaphragm

Costodiaphragmatic recess

54
Right lung Left lung Pleural cavities

Heart in mediastinum Right lung Mediastinum Left lung

55 56
Right lung Left lung Right dome of diaphragm Left dome of diaphragm
Organization of the thoracic cavity. Organization of the thoracic cavity.
CT image, with contrast, in axial plane CT image, with contrast, in coronal plane

79
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 THORAX • Parietal pleura

Cervical pleura
(cupula) 57
Costal pleura

Space for root of lung

Pulmonary ligament

Mediastinal pleura

Costal pleura (cut)

Suprapleural membrane

CVII
TXII
Costal pleura (cut)

Diaphragmatic pleura

Parietal pleural reflections and recesses

Costomediastinal
recess

58
Rib VI

Costodiaphragmatic
Rib VIII
recess

Rib X

80
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 Surface projections of pleural recesses 3

59
Horizontal fissure

Costomediastinal recess

Rib VI Oblique fissure

Rib VIII Costodiaphragmatic recess

Rib X

Parietal pleura

Surface projections of the pleura and lungs (anterior view)

60

Rib V
TIV
Oblique fissure

61
Rib VI

Spinous process of TIV

TX
Rib V
Costodiaphragmatic recess
TXII
Rib VI

Rib VIII

Costodiaphragmatic recess
Rib X
Surface projections of the pleura and lungs (posterior view)

Surface projections of the

pleura and right lung (lateral view)

81
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 THORAX • Right lung

Superior lobe Superior lobe

Oblique fissure

62 Horizontal fissure Hilum

Horizontal fissure
Inferior lobe
Middle lobe

Middle lobe
63
Lobes of the right lung (anteromedial view)

Right common carotid artery

Oblique fissure Rib I
Inferior lobe Right subclavian artery

Right internal jugular vein

Right lung (lateral view)
Right subclavian vein
Brachiocephalic trunk

Right brachiocephalic vein Arch of azygos vein

Costal cartilage of rib I

Left brachiocephalic vein

Oblique fissure

Bronchus to superior lobe

Superior vena cava

Bronchial arteries
Pulmonary artery
Horizontal fissure Bronchus to middle
and inferior lobes
Hilum

Esophagus
Pulmonary veins

Cardiac impression Azygos vein

Pulmonary ligament

Oblique fissure

Diaphragmatic surface
64
Inferior vena cava Inferior border

Right lung and related structures (medial view)

82
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 Left lung 3

Superior lobe Superior lobe

Oblique fissure
Oblique fissure

66
Hilum

Inferior lobe

Lingula

Cardiac notch

Lobes of the left lung (anteromedial view) Lingula

Rib I
65
Left subclavian artery Inferior lobe

Left lung (lateral view)

Left internal jugular vein

Left brachiocephalic vein

Costal cartilage of rib I

Left common carotid artery

Oblique fissure Brachiocephalic trunk

Arch of aorta

Accessory hemi-azygos vein

Pulmonary artery

Bronchial arteries
Bronchus Hilum

Posterior intercostal
Pulmonary veins
arteries and veins
Cardiac impression

Esophagus

Pulmonary ligament Cardiac notch

Thoracic aorta

Hemi-azygos vein
Lingula

Diaphragmatic surface
67
Inferior border

Left lung and related structures (medial view)

83
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 THORAX • Lung lobes: surface relationship

Superior lobe of right lung Superior lobe of left lung

Horizontal fissure
Rib IV Rib IV
Middle lobe of right lung
Rib V Rib V
Oblique fissure Oblique fissure

Inferior lobe of right lung Inferior lobe of left lung

68
Surface projections of the lobes and fissures of the lungs (anterior view)

CVII

Superior lobe of left lung Superior lobe of right lung

TIV
Rib V
Oblique fissure Oblique fissure
Rib VI

Inferior lobe of left lung Inferior lobe of right lung

Rib X TX

69
Surface projections of the lobes and fissures of the lungs (posterior view)

84
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 Lung lobes: imaging 3

Superior lobe of left lung

Superior lobe of right lung

Oblique fissure
70
Oblique fissure

Inferior lobe of right lung Inferior lobe of left lung

Right lung and left lung demonstrating superior and inferior lobes. The oblique fissures are visible.
CT image, with contrast, in axial plane

71
Superior lobe of right lung
Superior lobe of left lung

Middle lobe of right lung

Oblique fissure

Inferior lobe of right lung Inferior lobe of left lung

Right lung demonstrating superior, middle, and inferior lobes and the left lung demonstrating
superior and inferior lobes. The oblique fissure associated with the left lung is visible.
CT image, with contrast, in axial plane

72
Superior lobe of left lung
Middle lobe of right lung

Oblique fissure
Oblique fissure

Inferior lobe of right lung Inferior lobe of left lung

Right lung demonstrating middle and inferior lobes and the left lung demonstrating
superior and inferior lobes. The oblique fissures are visible.
CT image, with contrast, in axial plane

85
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 THORAX • Bronchial tree

Superior thyroid notch

Superior horn of thyroid cartilage

73 Right lamina of thyroid cartilage Left lamina of thyroid cartilage

Inferior horn of Tracheal mucosa

Cricothyroid ligament thyroid cartilage
Arch of cricothyroid cartilage
Cricothyroid articular capsule
Longitudinal folds of mucosa
Fibromuscular posterior wall
Cricotracheal ligament
Tracheal cartilage (cut) Tracheal cartilages
Cut edge of mucosa
Tracheal cartilages
74
Annular ligaments of trachea
75
Tracheal mucosa Tracheal bifurcation Left main bronchus
Trachea
(anterior view) (posterior view)
Right main bronchus

Branches of
right superior
lobar bronchus
Branches of left superior
lobar bronchus

Branches of
right middle
lobar bronchus

Branches of
right inferior
lobar bronchus

Branches of left Bronchial

inferior lobar cartilages
bronchus

Trachea and bronchial tree

86
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 Bronchopulmonary segments 3
76
Apical segment (S I)
Posterior segment (S II)
Apicoposterior segment (S I & II)
77
Superior lobe
Superior lobe
Anterior segment (S III)
Anterior segment (S III)
Superior segment (S VI)

Superior segment (S VI)

Superior lingular
segment (S IV)
Medial segment
(S V) Inferior lobe

Posterior basal Inferior lingular

Inferior lobe segment (S V)
Middle lobe segment (S X)

Posterior basal Anterior basal

Medial basal segment (S X) segment (S VIII)
segment (S VII)
Medial basal segment (S VII)
Anterior basal segment (S VIII) Lateral basal segment (S IX)
Lateral basal segment (S IX)

Right lung (medial view) Left lung (medial view)

Apicoposterior segment (S I & II)

Posterior
segment (S II)
Anterior segment (S III)

Apical segment (S I)
80
Superior lingular segment (S IV)
Anterior segment (S III)
Superior
segment (S VI)
Lateral segment (S IV) Inferior lingular segment (S V)
Medial segment (S V)
Superior
Anterior basal segment (S VIII)
Anterior basal segment (S VIII) segment (S VI)
Posterior basal
segment (S X) Lateral basal segment (S IX)
Lateral basal segment (S IX)
Medial basal
segment (S VII)

Apical segment (S I) Posterior basal segment (S X) Apicoposterior segment

Superior lobe Superior lobe (S I & II)
Posterior segment (S II)
Anterior segment (S III)
Anterior segment (S III)
Superior segment
(S VI)
Superior lingular
Superior segment segment (S IV)
(S VI)
Middle lobe Inferior lingular
segment (S V) Inferior lobe
Medial
Inferior lobe segment
(S V) Posterior basal
segment (S X)
Posterior basal Anterior basal
segment (S X) segment (S VIII)
Lateral

79
segment (S IV)

Lateral basal Anterior basal segment (S VIII) Lateral basal segment (S IX)

78 segment (S IX)

Right lung (lateral view)

Bronchopulmonary segments
Left lung (lateral view)

87
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 THORAX • Pulmonary vessels and plexus
Trachea
Right common carotid artery Left common carotid artery

Apex of right lung

Right subclavian artery

Apex of left lung

Left subclavian artery

81
Brachiocephalic trunk Left brachiocephalic vein

Cut surface of right lung

Cut surface of left lung
Superior vena cava Arch of aorta
Right superior Left pulmonary artery
lobar bronchus Left superior lobar
bronchus
Right pulmonary artery
Left superior lobar
Right middle bronchus
lobar bronchus (lingula division)
Right pulmonary veins Left pulmonary veins
Left inferior lobar
bronchus
Right inferior
lobar bronchus Thoracic aorta

Diaphragmatic
surface Esophagus

Pulmonary vessels Left cervical cardiac nerves from

vagus and sympathetic trunk
Right cervical cardiac nerves from
vagus and sympathetic trunk
First thoracic sympathetic ganglion
Right recurrent laryngeal nerve

Right sympathetic trunk

Left sympathetic trunk 82
Left common carotid artery

Left subclavian artery

Left vagus nerve

Arch of aorta
Left recurrent laryngeal nerve
Right vagus nerve Branch to left plexus from
recurrent laryngeal nerve
Branches to cardiac and pulmonary plexuses
Cardiac plexus
Anterior pulmonary plexus Anterior pulmonary plexus

Right pulmonary artery Left pulmonary artery

Right main broncus Left main bronchus

Fifth thoracic sympathetic ganglion Posterior pulmonary plexus

Esophagus
Left vagus nerve
Right vagus nerve Thoracic aorta

Pulmonary plexus
88
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 Pulmonary vessels: imaging 3

83
Ascending aorta
Pulmonary trunk
Superior vena cava
Left pulmonary artery
Right main bronchus Left main bronchus

Esophagus Thoracic aorta

B 84
Ascending aorta Pulmonary trunk
Superior vena cava Left pulmonary artery
Right superior pulmonary vein Left superior pulmonary vein

Right pulmonary artery

Right main bronchus Left main bronchus

Esophagus Thoracic aorta

C 85
Ascending aorta Pulmonary trunk
Superior vena cava

Right superior pulmonary vein Left superior pulmonary vein

Left main bronchus

Right pulmonary artery
Right main bronchus Left pulmonary artery
Esophagus Thoracic aorta

A through C – Relationships of the pulmonary arteries, pulmonary veins, and bronchi in the mediastinum.
CT images, with contrast, in axial plane

89
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 THORAX • Pulmonary vessels: imaging

86
Right ventricle
Ascending aorta

Superior vena cava

Right superior pulmonary vein Left superior pulmonary vein

Right pulmonary artery

Right main bronchus Left main bronchus
Left pulmonary artery
Esophagus Thoracic aorta

E
87
Ascending aorta Right ventricle

Right atrium

Left atrium Left ventricle

Right superior pulmonary vein Left superior pulmonary vein

Right pulmonary artery
Right main bronchus Bronchi
Left pulmonary artery
Esophagus

Thoracic aorta

88
Right ventricle

Right atrium
Left ventricle

Left atrium Left inferior pulmonary vein

Esophagus

Thoracic aorta

D through F – Relationships of the pulmonary arteries, pulmonary veins, and bronchi in the mediastinum.
CT images, with contrast, in axial plane

90
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 Mediastinum 3
Esophagus Trachea
Left common carotid artery
Right common carotid artery
Right internal jugular vein Left internal jugular vein

Right subclavian artery Left subclavian artery

Right subclavian vein

Left subclavian vein

Right brachiocephalic vein Left brachiocephalic vein

Brachiocephalic trunk
Arch of aorta
Sternal angle
Left pulmonary artery
Branches of right
pulmonary artery

Heart

Diaphragm

89

Structures of the mediastinum as they relate to the surface

Anterior mediastinum

91
I

Superior mediastinum
II
III 90
IV
Sternal angle
V
VI
Middle mediastinum Middle
Inferior mediastinum VII mediastinum
VIII
Posterior mediastinum
IX

XI
Anterior mediastinum Posterior
mediastinum
XII

Diaphragm

Subdivisions of the mediastinum Subdivisions of the mediastinum

(sagittal section) (transverse section)

91
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 THORAX • Pericardium

Trachea
Left common carotid artery
Right common carotid artery Cervical parietal pleura
Cervical parietal pleura
Right phrenic nerve
Right subclavian artery
Left phrenic nerve

Left subclavian artery

92
Right internal thoracic artery
Left internal thoracic artery
Right brachiocephalic vein
Left brachiocephalic vein
Brachiocephalic trunk
Arch of aorta
Superior vena cava
Ligamentum arteriosum

Branches of right Left pulmonary artery

pulmonary artery

Right
pericardiacophrenic
vessels Left
pericardiacophrenic
vessels
Right phrenic
Fibrous pericardium
nerve and
pericardiacophrenic
artery and vein
Cut edge of
costal pleura

Diaphragm
Esophagus

Pericardium with nerves and vessels

93
Brachiocephalic trunk
Right brachiocephalic vein Left brachiocephalic vein

Arch of aorta

Superior vena cava

Pulmonary trunk

Ascending aorta

Right atrium
Left ventricle

Mediastinal structures and lungs.

CT image, with contrast, in coronal plane

92
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 Pericardial layers 3

94
Junction between fibrous
pericardium and adventitia
of great vessels

Pericardial cavity Trachea

Visceral layer of serous
Aorta
Fibrous pericardium pericardium (epicardium)
Myocardium
Pulmonary artery

Transverse pericardial sinus

Oblique pericardial sinus

Left atrium

Endocardium
Parietal layer of serous Subepicardial fat
pericardium Esophagus
Pericardial cavity

Left ventricle

Diaphragm Thoracic aorta

Inferior vena cava

Sagittal section of the pericardium and heart

Superior vena cava

95
Arch of aorta

Left pulmonary artery

Transverse pericardial sinus
Ascending aorta

Branches of right
pulmonary artery

Left pulmonary veins

Right pulmonary veins

Cut edge of parietal pleura

Cut edge of Oblique pericardial sinus

mediastinal pleura

Cut edge of fibrous

pericardium and
parietal layer of
serous pericardium Esophageal prominence

Cut edge of fibrous

pericardium and
parietal layer of
Diaphragm serous pericardium

Inferior vena cava

Pericardial sac with heart removed

93
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 THORAX • Anterior surface of heart

Cut edge of pericardium 96

Arch of aorta

Superior vena cava Ligamentum arteriosum

Ascending aorta Branches of left

pulmonary artery

Pulmonary trunk
Branches of right
pulmonary artery Left pulmonary veins
Left auricle
Right atrium

Anterior interventricular
branch of left coronary artery
Right pulmonary veins (left anterior descending)
Great cardiac vein
Coronary sulcus Anterior interventricular
sulcus (containing vessels)
Right coronary artery

Left ventricle

Obtuse margin

Small cardiac vein

Inferior vena cava Apex

Right ventricle Inferior margin

Anterior surface of the heart

97
Ascending aorta
Pulmonary trunk

Right auricle

Right atrium Anterior interventricular branch

of left coronary artery
(left anterior descending)
Right coronary artery
Left ventricle

Right ventricle

Anterior view of the heart.

Volume-rendered anterior view using multidetector computed tomography

94
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 Base and diaphragmatic surface of heart 3
Arch of aorta
Left pulmonary artery Left atrium
Pericardial reflections
Left pulmonary veins Right pulmonary artery
Right pulmonary artery Right pulmonary vein

Left pulmonary artery Superior vena cava

Left superior
pulmonary vein

Left atrium
98 99
Left inferior
pulmonary
vein
Right atrium

Right
pulmonary veins
Left ventricle Right atrium
Right ventricle
Posterior view of the heart.
Volume-rendered posterior view using
Sulcus terminalis multidetector computed tomography

Arch of aorta

Inferior vena cava

Apex

Left ventricle Right ventricle

Left pulmonary artery Superior vena cava
Coronary sinus

Base of the heart

Right pulmonary artery

Left pulmonary veins

Great cardiac vein Right pulmonary veins

100 Left atrium

Circumflex branch of
Right atrium

left coronary artery

Inferior vena cava
Coronary sulcus

Coronary sinus Small cardiac vein

Left ventricle
Posterior interventricular
branch of right coronary artery
(right posterior descending)

Diaphragmatic surface of the heart Posterior interventricular sulcus

(containing vessels)
Right ventricle
Apex Middle cardiac vein

95
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 THORAX • Right atrium

Arch of aorta

101
Right auricle
Superior vena cava

Tricuspid valve
Limbus of fossa ovalis

Right ventricle

Crista terminalis

Musculi pectinati

Fossa ovalis

Inferior vena cava

Valve of inferior vena cava Opening of coronary sinus

Valve of coronary sinus

Internal view of right atrium

102
Right ventricle

Right atrium
Left ventricle

Left atrium

Positioning of right atrium in relation to other cardiac chambers.

CT image, with contrast, in axial plane

96
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 Right ventricle 3

Superior vena cava

Arch of aorta 103
Ligamentum arteriosum

Pulmonary trunk

Right auricle
Left auricle

Anterior semilunar cusp

Right semilunar cusp Pulmonary
valve
Right atrium Left semilunar cusp

Conus arteriosus

Anterior cusp
Septal papillary muscle
Tricuspid
Septal cusp
valve
Trabeculae carneae
Posterior cusp

Septomarginal trabecula

Chordae tendineae

Inferior vena cava

Anterior papillary muscle Posterior papillary muscle

Internal view of right ventricle

104
Right ventricle

Right atrium Left ventricle

Left atrium

Positioning of right ventricle in relation to other cardiac chambers.

CT image, with contrast, in axial plane

97
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 THORAX • Left atrium

Arch of aorta
105
Left auricle Superior vena cava

Pulmonary arteries

Left ventricle

Pulmonary veins

Valve of foramen ovale

Left atrium

Mitral valve

Inferior vena cava

Internal view of left atrium

106
Right ventricle

Right atrium
Left ventricle

Left atrium

Positioning of left atrium in relation to other cardiac chambers.

CT image, with contrast, in axial plane

98
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