Examination of the levels of structures in the thorax in multidetector computerized tomography images

Yıl 2020, , 784 - 789, 01.09.2020

Güneş Bolatlı , Nadire Ünver , Mustafa Koplay , Zeliha Fazlıoğulları , Ahmet Kağan Karabulut

https://doi.org/10.28982/josam.730332

Öz

Aim: Levels of the anatomical structures found in thorax and their relationships are particularly important in terms of surgical procedures. These levels are indicated with reference to the ribs and most are based on cadaver studies. The vertebral level of many structures is not specified. In this study, it was aimed to determine the level changes of some structures in the thorax according to age and gender by referring to the vertebrae. Methods: Multidetector computed tomography images of the thorax region in the PACS archives of Selcuk University Medical Faculty Hospital were used in the study. Images of 700 people, who did not undergo thoracic surgery, were studied in different age groups. The anatomical structures were evaluated with reference to the vertebrae on these images, and the findings were compared according to age groups and genders.
Results: Some of the levels of the investigations were different from the information in the classical books. It was seen that the entrance level of the aorta from the diaphragm was at Th10 level, the entrance level of superior vena cava to the right atrium was Th7 in the 0-9-year age group, Th6 level in the other age groups, and exit level of the pulmonary trunk from the right ventricle and the apex of the heart were Th7 and Th10, respectively.
Conclusion: Most of our current knowledge is based on cadaver studies rather than living human beings and the intercostal spaces are referenced in defining the levels of structures in the thorax. Age and gender distinctions have not been made in cases where most of the structures are not specified. Vertebral reference is important in terms of comparing superficial and deep structures. As the thoracic surgeon is needed in every age group, it is important that surgeons know these differences

Anahtar Kelimeler

Anatomy, Levels, MDCT, Thorax

Multidedektör bilgisayarlı tomografi görüntülerinde toraks’daki yapıların seviyelerinin incelenmesi

Öz

Amaç: Torakstaki anatomik yapıların düzeyleri ve aralarındaki ilişki cerrahi işlemler açısından çok önemlidir. Bu seviyeler genel olarak kaburgalar referans alınarak belirtilir ve çoğu kadavra çalışmalarına dayanır. Birçok yapının vertebral seviyesi belirtilmemiştir. Bu çalışmada torakstaki bazı yapıların yaş ve cinsiyete göre düzey değişiklikleri, vertebralar referans alınarak belirlenmek amaçlanmıştır.
Yöntemler: Çalışmada Selçuk Üniversitesi Tıp Fakültesi Hastanesi Pacs arşivindeki toraks bölgesi Çok Dedektörlü Bilgisayarlı Tomografi görüntüleri kullanıldı. Göğüs cerrahisi geçirmemiş farklı yaş gruplarında 700 kişinin görüntüleri incelendi. Bu görüntülerdeki anatomik yapılar omurlara göre değerlendirildi ve bulgular yaş gruplarına ve cinsiyetlere göre karşılaştırıldı.
Bulgular: Araştırmada tespit edilen bazı düzeyleri klasik kitaplardaki bilgilerden farklıydı. Aortun diyaframdan geçişi T10, vena cava süperior’un sağ atriyuma girişi 0-9 yaş grubunda T7, diğer yaş gruplarında T6, turuncus pulmonalis’in sağ ventrikül’den çıkışı T7 ve apeks kordis’in T10 seviyesinde olduğu görüldü.
Sonuç: Mevcut bilgimizin çoğu canlı insanlardan ziyade yapılan kadavra çalışmalarına dayanmaktadır ve genellikle interkostal aralıklar referans alınarak yapıların seviyeleri belirtilmiştir. Yapılan çalışmaların çoğunda yaş ve cinsiyet ayrımı yapılmamıştır. Vertebraların referans alınması yüzeysel ve derin yapıların karşılaştırılması açısından önemlidir. Göğüs cerrahisinde yaş grupları arasındaki seviye farklılıklarının bilinmesi cerrahlar için son derece önemlidir.

Anahtar Kelimeler

Anatomi, Seviyeler, MDBT, Toraks

Kaynakça

• 1. D'Antoni AV. Gray's Anatomy, the Anatomical Basis of Clinical Practice, 41st edition. Clin Anat. 2016;29(2):264-5. doi: 10.1002/ca.22677. PubMed PMID: WOS:000370613000022.
• 2. Drake L, Vogl A, Mitchell A. Gray's anatomy for students. 2016 Mar 15. 456- p.
• 3. Mirjalili SA, Hale SJ, Buckenham T, Wilson B, Stringer MD. A reappraisal of adult thoracic surface anatomy. Clin Anat. 2012;25(7):827-34. Epub 2012/05/12. doi: 10.1002/ca.22091. PubMed PMID: 22576938.
• 4. Badshah M, Soames R, Khan MJ, Ibrahim M, Khan A. Revisiting thoracic surface anatomy in an adult population: A computed tomography evaluation of vertebral level. Clin Anat. 2017;30(2):227-36. Epub 2016/12/10. doi: 10.1002/ca.22817. PubMed PMID: 27935171.
• 5. Shen XH, Su BY, Liu JJ, Zhang GM, Xue HD, Jin ZY, et al. A reappraisal of adult thoracic and abdominal surface anatomy via CT scan in Chinese population. Clin Anat. 2016;29(2):165-74. Epub 2015/06/03. doi: 10.1002/ca.22556. PubMed PMID: 26032163.
• 6. Keough N, Mirjalili SA, Suleman FE, Lockhat ZI, van Schoor A. The thoracic surface anatomy of adult black South Africans: A reappraisal from CT scans. Clin Anat. 2016;29(8):1018-24. Epub 2016/10/21. doi: 10.1002/ca.22776. PubMed PMID: 27571396.
• 7. Mirjalili SA, McFadden SL, Buckenham T, Stringer MD. A reappraisal of adult abdominal surface anatomy. Clin Anat. 2012;25(7):844-50. Epub 2012/06/30. doi: 10.1002/ca.22119. PubMed PMID: 22744875.
• 8. Drake RL. VA, Mitchell AWM. Gray's Anatomy for Student. New York: Elsevier; 2017.
• 9. Moore K, Dalley A. Clinically Oriented Anatomy: Lipincot; 2005. 114 p.
• 10. Connolly B, Mawson JB, MacDonald CE, Chait P, Mikailian H. Fluoroscopic landmark for SVC-RA junction for central venous catheter placement in children. Pediatr Radiol. 2000;30(10):692-5. Epub 2000/11/15. doi: 10.1007/s002470000297. PubMed PMID: 11075603.
• 11. Snell RS. Cninical Anatomy: Lipincot; 2013. 62 p.
• 12. Karwinski B, Svendsen E. Comparison of Clinical and Postmortem Diagnosis of Pulmonary-Embolism. J Clin Pathol. 1989;42(2):135-9. doi: 10.1136/jcp.42.2.135. PubMed PMID: WOS:A1989T235200005.
• 13. Goldhaber SZ, Visani L, De Rosa M, Icoper. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353(9162):1386-9. doi: 10.1016/S0140-6736(98)07534-5. PubMed PMID: WOS:000080020800010.
• 14. Pak N, Patel SG, Hashemi Taheri AP, Hashemi F, Eftekhari Vaghefi R, Naybandi Atashi S, et al. A reappraisal of adult thoracic and abdominal surface anatomy in Iranians in vivo using computed tomography. Clin Anat. 2016;29(2):191-6. Epub 2015/11/18. doi: 10.1002/ca.22669. PubMed PMID: 26575429.
• 15. Fischer NJ, Morreau J, Sugunesegran R, Taghavi K, Mirjalili SA. A reappraisal of pediatric thoracic surface anatomy. Clin Anat. 2017;30(6):788-94. doi: 10.1002/ca.22913. PubMed PMID: WOS:000407689500014.
• 16. Uzun C, Atman ED, Ustuner E, Mirjalili SA, Oztuna D, Esmer TS. Surface anatomy and anatomical planes in the adult turkish population. Clin Anat. 2016;29(2):183-90. Epub 2015/09/26. doi: 10.1002/ca.22634. PubMed PMID: 26403267.
• 17. Jutley RS, Shepherd DET, Hukins DWL, Jeffrey RR. Preliminary evaluation of the Sternum Screw: a novel method for improved sternal closure to prevent dehiscence. Cardiovasc Surg. 2003;11(1):85-9. doi: 10.1016/S0967-2109(02)00118-7. PubMed PMID: WOS:000180732800016.
• 18. Stahle E, Tammelin A, Bergstrom R, Hambreus A, Nystrom SO, Hansson HE. Sternal wound complications - Incidence, microbiology and risk factors'. Eur J Cardio-Thorac. 1997;11(6):1146-53. doi: 10.1016/S1010-7940(97)01210-4. PubMed PMID: WOS:A1997XK71400037.
• 19. Chukwuemeka A, Currie L, Ellis H. CT anatomy of the mediastinal structures at the level of the manubriosternal angle. Clin Anat. 1997;10(6):405-8. doi: 10.1002/(Sici)1098-2353(1997)10:6<405::Aid-Ca6>3.0.Co;2-N. PubMed PMID: WOS:A1997YF22100006.
• 20. Sebes JI, Salazar JE. The Manubriosternal Joint in Rheumatoid Disease. Am J Roentgenol. 1983;140(1):117-21. doi: 10.2214/ajr.140.1.117. PubMed PMID: WOS:A1983PW07900025.
• 21. Malempati S, Joshi S, Lai S, Braner DAV, Tegtmeyer K. Bone Marrow Aspiration and Biopsy. New Engl J Med. 2009;361(15). PubMed PMID: WOS:000270540000010.