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Pulmonary Circulation


32807b03.8s heart cardiac pulmonary circulation pulmonary artery pulmonary vein left atrium Davidoff art copyright 2009



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Relationship of the Left Sided Pulmonary Veins to the Esophagus



The normal indentations on the esophagus include the aortic arch and knob seen in bright red in b. The left bronchus is usually seen as a oblique line crossing the back of the esophagus, but in this case is seen as a focal indentation on the anterior wall. The left atrium is seen pulsating against the distal esophagus (maroon) usually when the left atrium is enlarged.
Copyright 2009 Courtesy Ashley Davidoff MD 76119c02




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Relationship of the Left Sided Pulmonary Veins to the Esophagus



The normal indentations on the esophagus include the aortic arch and knob seen in bright red in b. The left bronchus is usually seen as a oblique line crossing the back of the esophagus, but in this case is seen as a focal indentation on the anterior wall. The left atrium is seen pulsating against the distal esophagus (maroon) usually when the left atrium is enlarged.
Copyright 2009 Courtesy Ashley Davidoff MD 76119c02




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Copyright 2009 Courtesy Ashley Davidoff MD 76119c02

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Copyright 2009 Courtesy Ashley Davidoff MD 76119c02

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Thrombosed left Upper Lobe Vein in Coronal and Sagittal View



75413c08 26 male SOB s/p RFA ablation for atrial fibrillation lung pulmonary let upper lobe pulmonary vein thrombosed dx pulmonary vein thrombosis secondary to radiofrequency ablation therapy iatrogenic CT scan Courtesy Ashley Davidoff MD Scott Tsai MD pulmonary infarction venous infarction



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Thrombosed left Upper Lobe Vein in Coronal and Sagittal View



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75413c07 26 male SOB s/p RFA ablation for atrial fibrillation lung pulmonary let upper lobe pulmonary vein thrombosed secondary lobule interlobular septa are thickened secondary lobule destroyed dx pulmonary vein thrombosis secondary to radiofrequency ablation therapy iatrogenic CT scan Courtesy Ashley Davidoff MD Scott Tsai MD ground glass changes pulmonary infarction venous infarction



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75413b01 26 male SOB s/p RFA ablation for atrial fibrillation lung pulmonary let upper lobe pulmonary vein thrombosed secondary lobule interlobular septa are thickened secondary lobule destroyed dx pulmonary vein thrombosis secondary to radiofrequency ablation therapy iatrogenic CT scan Courtesy Ashley Davidoff MD Scott Tsai MD ground glass changes pulmonary infarction venous infarction



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Thrombosed Left Upper Pulmonary Vein and Secondary Hemorrhage



26 year old male who presents with shortness of breath a few months following RFA ablation for atrial fibrillation.  Image a shows the left upper lobe thrombosed and the left lower vein contrast filled
  Image b (the lung windows) shows thickening of the interlobular septa and secondary lobules distended with material, probably representing blood.
 
following male SOB s/p RFA ablation for atrial fibrillation lung pulmonary let upper lobe pulmonary vein thrombosed secondary lobule interlobular septa are thickened secondary lobule destroyed dx pulmonary vein thrombosis secondary to radiofrequency ablation therapy iatrogenic CTscan Courtesy Ashley Davidoff MD Scott Tsai MD ground glass changes pulmonary infarction venous infarction
75413c01



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Thrombosed Left Upper Pulmonary Vein and Secondary Hemorrhage



26 year old male who presents with shortness of breath a few months following RFA ablation for atrial fibrillation.  Image a shows the left upper lobe thrombosed and the left lower vein contrast filled
  Image b (the lung windows) shows thickening of the interlobular septa and secondary lobules distended with material, probably representing blood.
 
following male SOB s/p RFA ablation for atrial fibrillation lung pulmonary let upper lobe pulmonary vein thrombosed secondary lobule interlobular septa are thickened secondary lobule destroyed dx pulmonary vein thrombosis secondary to radiofrequency ablation therapy iatrogenic CTscan Courtesy Ashley Davidoff MD Scott Tsai MD ground glass changes pulmonary infarction venous infarction
75413c01



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  Image b (the lung windows) shows thickening of the interlobular septa and secondary lobules distended with material, probably representing blood.
 
following male SOB s/p RFA ablation for atrial fibrillation lung pulmonary let upper lobe pulmonary vein thrombosed secondary lobule interlobular septa are thickened secondary lobule destroyed dx pulmonary vein thrombosis secondary to radiofrequency ablation therapy iatrogenic CTscan Courtesy Ashley Davidoff MD Scott Tsai MD ground glass changes pulmonary infarction venous infarction
75413c01
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A?P Embolization of AVM



24137 Copyright 2009 Courtesy Ashley Davidoff MD



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A?P Embolization of AVM



24137 Copyright 2009 Courtesy Ashley Davidoff MD



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24131 Copyright 2009 Courtesy Ashley Davidoff MD



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24131 Copyright 2009 Courtesy Ashley Davidoff MD



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Scimitar Syndrome
Partial Anomalous Pulmonary Venous Return to the IVC



01714c03 Copyright 2009 Courtesy Ashley Davidoff MD



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Partial Anomalous Pulmonary Venous Return to the IVC



01714c03 Copyright 2009 Courtesy Ashley Davidoff MD



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Virtual Study Showing Entry of Pulmonary Veins into the LA



This series of MDCT demonstrates the pulmonary veins and the left atrium in coronal projection (a) , and using virtual projections (b,c,d). Courtesy Ashley Davidoff MD 37236C code CVS heart cardiac left atrium LA pulmonary vein virtual MDCT imaging radiology CTscan virtual CTscan



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Virtual Study Showing Entry of Pulmonary Veins into the LA



This series of MDCT demonstrates the pulmonary veins and the left atrium in coronal projection (a) , and using virtual projections (b,c,d). Courtesy Ashley Davidoff MD 37236C code CVS heart cardiac left atrium LA pulmonary vein virtual MDCT imaging radiology CTscan virtual CTscan



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CTscan with both Venous and Arterial Phases



This compounded CT of the chest shows the pulmonary vascular circulation including the the pulmonary veins draining into the left atrium. The pulmonary arteries can be seen in the background. Courtesy Philips Medical Systems 32653 code chest lung pulmonary vein LA RVOT infundibulum normal anatomy radiology imaging CTscan



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CTscan with both Venous and Arterial Phases



This compounded CT of the chest shows the pulmonary vascular circulation including the the pulmonary veins draining into the left atrium. The pulmonary arteries can be seen in the background. Courtesy Philips Medical Systems 32653 code chest lung pulmonary vein LA RVOT infundibulum normal anatomy radiology imaging CTscan



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CTscan with both Venous and Arterial Phases

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Venous Phase of the Pulmonary Angiogram Showing the Venous System



This is a normal venous phase of a digital pulmonary angiogram with arborization of the vessels almost from the venules to the upper vertically oriented veins and the lower horizontally oriented veins. Courtesy Ashley Davidoff MD.



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Venous Phase of the Pulmonary Angiogram Showing the Venous System



This is a normal venous phase of a digital pulmonary angiogram with arborization of the vessels almost from the venules to the upper vertically oriented veins and the lower horizontally oriented veins. Courtesy Ashley Davidoff MD.



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Secondary Lobule and Interlobular Septa
Kerley B line


44194b01 81F hx atrial fibrillation cardiac failure heart failure CHF RA enlarged LA enlarged ground glass mosaic perfusion Kerley B lines varicose pulmonary veins squiggly sign Courtesy Ashley Davidoff MD



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Kerley B line


44194b01 81F hx atrial fibrillation cardiac failure heart failure CHF RA enlarged LA enlarged ground glass mosaic perfusion Kerley B lines varicose pulmonary veins squiggly sign Courtesy Ashley Davidoff MD



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Secondary Lobule and Interlobular Septa



Normal lung histology This image is a panoramic view of the lung showing secondary lobules and interlobular septa. Within the interalveolar septae, one sees small venules and lymphatics.Courtesy Armando Fraire MD. 32649b code lung pulmonary alveoli alveolus secondary lobule interlobular septa vein lymphatic histology interstitium interstitial



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Secondary Lobule and Interlobular Septa



Normal lung histology This image is a panoramic view of the lung showing secondary lobules and interlobular septa. Within the interalveolar septae, one sees small venules and lymphatics.Courtesy Armando Fraire MD. 32649b code lung pulmonary alveoli alveolus secondary lobule interlobular septa vein lymphatic histology interstitium interstitial



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 Diagram of the Secondary Lobule
Veins and Lymphatics Travel Together



The arteries and airways pair up and travel together down the respiratory tree branching in exactly the same way until they reach the pulmonary lobule. The pulmonary lobule, also called the secondary lobule is a structural unit surrounded by a membrane of connective tissue, and it is smaller than a subsegment of lung but larger than an acinus. This diagram shows two secondary lobules lying side by side. The pulmonary arteriole (royal blue) and bronchiole (teal) are shown together in the centre of the lobule (“centrilobular”), with two other pairs of bronchovascular bundles, while the oxygenated pulmonary venules (red) and lymphatics (yellow) are peripheral and also form formidable and almost inseparable pairs. Courtesy Ashley Davidoff MD art code lung secondary lobule bronchovascular bundle centrilobular polyhedral drawing normal anatomy histology 42440b08



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 Diagram of the Secondary Lobule
Veins and Lymphatics Travel Together



The arteries and airways pair up and travel together down the respiratory tree branching in exactly the same way until they reach the pulmonary lobule. The pulmonary lobule, also called the secondary lobule is a structural unit surrounded by a membrane of connective tissue, and it is smaller than a subsegment of lung but larger than an acinus. This diagram shows two secondary lobules lying side by side. The pulmonary arteriole (royal blue) and bronchiole (teal) are shown together in the centre of the lobule (“centrilobular”), with two other pairs of bronchovascular bundles, while the oxygenated pulmonary venules (red) and lymphatics (yellow) are peripheral and also form formidable and almost inseparable pairs. Courtesy Ashley Davidoff MD art code lung secondary lobule bronchovascular bundle centrilobular polyhedral drawing normal anatomy histology 42440b08



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    [textContent] => The arteries and airways pair up and travel together down the respiratory tree branching in exactly the same way until they reach the pulmonary lobule. The pulmonary lobule, also called the secondary lobule is a structural unit surrounded by a membrane of connective tissue, and it is smaller than a subsegment of lung but larger than an acinus. This diagram shows two secondary lobules lying side by side. The pulmonary arteriole (royal blue) and bronchiole (teal) are shown together in the centre of the lobule (“centrilobular”), with two other pairs of bronchovascular bundles, while the oxygenated pulmonary venules (red) and lymphatics (yellow) are peripheral and also form formidable and almost inseparable pairs. Courtesy Ashley Davidoff MD art code lung secondary lobule bronchovascular bundle centrilobular polyhedral drawing normal anatomy histology 42440b08
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 Diagram of the Secondary Lobule
Veins and Lymphatics Travel Together

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 Diagram of the Secondary Lobule
Veins and Lymphatics Travel Together

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Anatomy of the Left Atrium



The anatomic specimen has been opened from its posterior aspect revealing a relatively smooth walled inner lining. The left atrial appendage(laa) has been opened revealing fine pectinate muscles. 5 pulmonary veins are seen entering the left atrium, with 2 entering from the left lower vein. The atrial septum with fossa ovalis and foramen ovale are smooth except for the “u” shaped upper border of the septum primum tha allows identification of the left atrium. the glistening surface of the endothelium is exemplified in this image.
Courtesy Ashley Davidoff copyright 2009 all rights reserved  06426c01.81s




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Anatomy of the Left Atrium



The anatomic specimen has been opened from its posterior aspect revealing a relatively smooth walled inner lining. The left atrial appendage(laa) has been opened revealing fine pectinate muscles. 5 pulmonary veins are seen entering the left atrium, with 2 entering from the left lower vein. The atrial septum with fossa ovalis and foramen ovale are smooth except for the “u” shaped upper border of the septum primum tha allows identification of the left atrium. the glistening surface of the endothelium is exemplified in this image.
Courtesy Ashley Davidoff copyright 2009 all rights reserved  06426c01.81s




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The anatomic specimen has been opened from its posterior aspect revealing a relatively smooth walled inner lining. The left atrial appendage(laa) has been opened revealing fine pectinate muscles. 5 pulmonary veins are seen entering the left atrium, with 2 entering from the left lower vein. The atrial septum with fossa ovalis and foramen ovale are smooth except for the “u” shaped upper border of the septum primum tha allows identification of the left atrium. the glistening surface of the endothelium is exemplified in this image.
Courtesy Ashley Davidoff copyright 2009 all rights reserved  06426c01.81s

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The anatomic specimen has been opened from its posterior aspect revealing a relatively smooth walled inner lining. The left atrial appendage(laa) has been opened revealing fine pectinate muscles. 5 pulmonary veins are seen entering the left atrium, with 2 entering from the left lower vein. The atrial septum with fossa ovalis and foramen ovale are smooth except for the “u” shaped upper border of the septum primum tha allows identification of the left atrium. the glistening surface of the endothelium is exemplified in this image.
Courtesy Ashley Davidoff copyright 2009 all rights reserved  06426c01.81s

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Anatomy of the Left Atrium
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Anatomy of the Left Atrium
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Posterior View
Veins and Arteries



This normal anatomic specimen from a posterior aspect showing the LPA (1) and upper lobe pulmonary veins (2) and lower lobe pulmonary veins (3) shows the left pulmonary veins (1) and left pulmonary artery. The two veins to one artery is the usual. Venous inflow must of course equal arterial outflow and so each vein carries about half the load and are about half the size of the main branch pulmonary artery
Courtesy Ashley Davidoff MD. 06881labelled




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Posterior View
Veins and Arteries



This normal anatomic specimen from a posterior aspect showing the LPA (1) and upper lobe pulmonary veins (2) and lower lobe pulmonary veins (3) shows the left pulmonary veins (1) and left pulmonary artery. The two veins to one artery is the usual. Venous inflow must of course equal arterial outflow and so each vein carries about half the load and are about half the size of the main branch pulmonary artery
Courtesy Ashley Davidoff MD. 06881labelled




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Courtesy Ashley Davidoff MD. 06881labelled

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Courtesy Ashley Davidoff MD. 06881labelled

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Posterior View
Veins and Arteries

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Posterior View
Veins and Arteries

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LA and Pulmonary Veins from Posterior



The specimen of heart and lungs is examined from posteriorly with the left atrium and 4 pulmonary veins. (overlaid in pearl white) The trachea and bronchi are intact (green). The left atrium lies just below in the angle of the carina.
Courtesy Ashley Davidoff copyright 2009 all rights reserved 08376c02.82s




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LA and Pulmonary Veins from Posterior



The specimen of heart and lungs is examined from posteriorly with the left atrium and 4 pulmonary veins. (overlaid in pearl white) The trachea and bronchi are intact (green). The left atrium lies just below in the angle of the carina.
Courtesy Ashley Davidoff copyright 2009 all rights reserved 08376c02.82s




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Courtesy Ashley Davidoff copyright 2009 all rights reserved 08376c02.82s

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Courtesy Ashley Davidoff copyright 2009 all rights reserved 08376c02.82s

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LA and Pulmonary Veins from Posterior

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LA and Pulmonary Veins from Posterior

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 ostia (cms)


 1cms from ostia (cms)




  RSPV


1.7 +/-.24 cms


 1.4 +/-.21 cms




 RIPV


 1.59+/- .25 cms


1.16  +/-.25 cms




 LSPV


 1.76 +/-.41 cms


1.45 +/-.32 cms




 LIPV


 1.39 +/- .29 cms


 1.23 +/-.24 cms




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 ostia (cms)


 1cms from ostia (cms)




  RSPV


1.7 +/-.24 cms


 1.4 +/-.21 cms




 RIPV


 1.59+/- .25 cms


1.16  +/-.25 cms




 LSPV


 1.76 +/-.41 cms


1.45 +/-.32 cms




 LIPV


 1.39 +/- .29 cms


 1.23 +/-.24 cms




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 1.23 +/-.24 cms

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 1.23 +/-.24 cms

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 1.39 +/- .29 cms

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 1.39 +/- .29 cms

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 LIPV

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 LIPV

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1.45 +/-.32 cms

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1.45 +/-.32 cms

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 1.76 +/-.41 cms

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 1.76 +/-.41 cms

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 LSPV

    [nodeType] => 1
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 LSPV

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1.16  +/-.25 cms

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1.16  +/-.25 cms

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 1.59+/- .25 cms

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 1.59+/- .25 cms

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DOMElement Object
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 RIPV

    [nodeType] => 1
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 RIPV

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 1.4 +/-.21 cms

    [nodeType] => 1
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 1.4 +/-.21 cms

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1.7 +/-.24 cms

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1.7 +/-.24 cms

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DOMElement Object
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  RSPV

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  RSPV

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 1cms from ostia (cms)

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 1cms from ostia (cms)

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 ostia (cms)

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 ostia (cms)

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