Transcript Pelvis: CT axials, male & MRI Coronals, female

Unit 2
10 Transaxial CT Images of the Male Pelvic Cavity
12 Coronal MRI images of the Female Pelvic Cavity
There are no drawings with this unit
The images of the male pelvis start just below the iliac crest, several cm lower than
where the abdomen images left off. They continue in 1 cm increments through the
pelvic cavity.
The coronal images of the female pelvic cavity start posterior and continue
anterior.
First set of parenthesis, in bold, is page number for 3rd edition
Second set of parenthesis, not bold, is page number for 4rd edition
Unit 2
Reference
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Ala of Rt. ilium
Sacrum
Male Images 1 & 2
Sacroiliac joints
Psoas major muscles
Lt. common iliac artery (381)(401)
Lt. common iliac vein*
Small bowel (with barium)
Rt. iliacus muscle (478)(496)
9. Gluteus maximus muscle (476, 477)(494-495)
10. Gluteus medius muscle
11. Gluteus minimus muscle
12. Rt. common iliac vein**
13. Lt. ureter (with iodine contrast) (381)(401)
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11
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3.
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6.
7.
8.
* These pelvic sections begin below the aorta and IVC.
Compare the appearance of the Rt. and Lt. common
iliac vessels to plate 381 in Netter to appreciate
why they are in this position, e.g. the artery on the
right is medial to the vein, but on the left it is lateral.
** The elongated, apostrophe like shape of the Rt.
iliac vein at this level is due to anastomosis of the
internal and external iliac veins which are seen in
image 3.
Images 1-4
Reference
Images 3 & 4
1.
2.
3.
4.
Rt. external iliac artery (381-383)(401-403)
Rt. external iliac vein
Rt. internal iliac artery
Rt. internal iliac vein
5.
6.
7.
8.
9.
Body of bladder (348)(361)
Rectosigmoid junction* (374, 348)(393-361)
Rt. external iliac artery**
Lt. external iliac vein***
Branches of the internal iliac veins (383)(403)
& arteries****
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2
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4
* Identified by its position behind this full bladder
** Rt. external iliac vein is against, but behind
the artery
*** Lt. external iliac artery is against, but in
front of the vein.
****The internal iliac artery and vein are no longer
identifiable. Numerous branch vessels are
seen as spots or streaks.
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1
Images 5 & 6
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Reference
Bladder, with urine and iodine contrast
Body of the Rt. ilium (468)(486)
Rt. ureter* (348)(361)
Lt. external iliac artery
Lt. external iliac vein
Rt. iliopsoas muscle** (478)(398)
7. Roof of Rt. acetabulum
8. Rt. femoral artery
9. Rt. femoral vein*** (253)(262)
10. Rectum****
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*
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Seen as a streak, rather than a spot, because it
has turned anterior toward the bladder. The Lt.
ureter is not seen because at the moment in
time it was imaged no contrast happened to be
in it.
** The psoas major and iliacus muscles have
merged into the iliospsoas. On image 4 the two
can still be seen separately.
*** The external iliac vessels become femorals when
they pass through the inguinal canal, which is
not seen. However, the level of the top of the
acetabulum is close to the inguinal canal.
****The sigmoid colon crosses the top of the bladder,
but posterior to it becomes the rectum.
Images 5-8
Reference
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2.
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5.
6.
Greater trochanter of Lt. femur (469)(487)
Coccyx
Ureterovesical (ureterocystic) junctions
Rt. & Lt. ampulla of vas deferens (367)(384)
Rt. & Lt. seminal vesicle*
Rt. & Lt. spermatic cords
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1
4
5
7. Ischium bone
8. Pubic bone
9. Rt. & Lt. spermatic cords (241-243, 348)
(249-251, 361)
10. Rt. & Lt. femoral veins**
11. Greater trochanter of the Rt. femur
* Two spellings, vesicle (little bladder) and
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vesical, (bladder shape) are similar, though
“icle” is used for the seminal vesicles.
** Arteries are against, and anterior to the veins
Images 7 & 8
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7
Reference
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1. Pubic symphysis
2. Prostate gland (367)(384)
3. Rt. Gluteus maximus muscle
2
4. Rt. ischial tuberosity (468)(385)
5. Proximal shaft of Lt. femur
3
Images 9 & 10
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4
Images 9 & 10
MRI Coronal Images of
the Female Pelvis
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Reference
Adipose
tissue
Female Images 1 & 2
Rt. ilium
Rectum
Posterior wall of acetabulum*
Rt. & Lt. gracilis muscle (482, 487)(500, 505)
Greater trochanter of Lt. femur
Lesser trochanter of Lt. femur
Intertrochanteric crest of Lt. femur (470, 471)(488,489)
9. Posterior elements of lumbar spine
10. Sigmoid colon
11. Rt. femoral head**
12. Rt. internal iliac vein*** (373)(392)
13. Lt. internal iliac artery****
* Superior part is composed of ilium, inferior part is ischium
** Most posterior aspect
*** Artery is immediately below it
****Vein is immediately above it. See Netter’s plate 373 to
appreciate why the internal vein is superior to the internal
artery in these coronal sections.
Images 1-4
Reference
1.
2.
3.
4.
5.
Rt. & Lt. sacroiliac joints
Neck of the Rt. femur
Vertebral canal
Shaft of the right femur*
Sacral plateau
1
Images 3 & 4
* On image 3 & 4 the proximal shaft of the femur is seen to
be anterior to the distal shaft: muscle tissue is covering the
distal shaft on image 3. For this reason it is evident that as
the distal portion of the shaft appears it will be cortical bone
that first comes into the imaged plane. That is why the
distal shaft is dark. Cortical bone is dense and
contains little hydrogen, so no signal is returned.
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2
4
5
Reference
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2
3
1.
2.
3.
4.
Rt. pedicle of the 4th lumbar vertebra
Body
of the 5th lumbar vertebra
Images 5 & 6
Branches of the Lt. internal iliac artery*
Posterior wall of the vagina
5. Fundus of the uterus** (352)(365)
6. L4-L5 intervertebral disk material (space)
4
* See Netter’s plate 383 (403) to appreciate the
appearance of this streak in this coronal plane
**First seen in image 5
6
5
Images 5-8
Reference
1.
2.
3.
4.
Uterus
Urinary Bladder*
Lt. common iliac vein (381-383)(401-403)
Images 7 & 8
Lt. internal iliac artery
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1
2
4
5. Lt. external iliac vein**
6. Rt. iliopsoas muscle (478)(496)
7. Small bowel
* Depending on the position of the uterus (see plate 358) (374), the
amount of urine in the bladder, and the angle of the cut plane of
the scan, when the bladder appears it may be superior or inferior
to the uterus. The images seen here are similar to illustration B.
A
B
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6
**In image 7 #3, the Lt. common iliac vein appears. The dark spot,
#4, is the internal iliac artery which is unchanged from its first
appearance in image #2. Where the internal iliac artery crosses
the vein marks the spot where the common iliac vein becomes
the external iliac vein. See plate 381 (401).
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5
Images 9 & 10
Reference
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Urinary bladder
Neck of bladder and internal urethral orifice (353)(366)
Uterus
Rt. psoas muscle
Rt. iliacus muscle
Rt. iliopsoas muscle
Rt. internal iliac artery*
8. Rt. external iliac vein
9. Inferior vena cava**
10. Vestibule of the vagina (359)(377)
* Just the darker spot
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** Most proximal part, at the anastomosis of the Rt. & Lt.
common iliac veins.
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Images 9-12
2
Reference
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5.
Rt. & Lt. common iliac arteries
Inferior vena cava (381)(401)
Cecum of the colon
Lt. ovary (354-356)(369-371)
Lt. fallopian tube (oviduct)
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1
Images 11 & 12
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5
6. Rt. & Lt. external iliac artery
7. Rt. & Lt. femoral artery (superficial femoral)*
8. Abdominal aorta
9. Pubic symphysis
10. Labia majora (labium=singular)
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* On this image we see the origin of the deep femoral (profunda)
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where the various branches of the circumflex feed the
proximal femur. Compare the right side to plate 494 (512).
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