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Radiological Anatomy of theRadiological Anatomy of the Pelvis, Walls and Viscera
Department of Radiology,p gy,Vancouver General Hospital
Dr. Savvas NicolaouDirector of ER/Trauma Radiology
B bl t id tif th f ll i t t l l i di h
Lecture Objectives
Pelvis Pelvis continued..
Be able to identify the following structures on a normal pelvic radiograph:
• Ilium
• Ischial spine
• Obturator foramen
• Sacro-iliac joints
• Pelvic inlet• Ischial tuberoses
• Pubis
S i bi
Pelvic inlet
• Anterior-superior iliac spine
• Superior pubic ramus
• Inferior pubic ramus
• Sacrum
Femur
• Head
N k• Sacrum
• Coccyx
• Pubic symphysis
• Neck
• Greater trochanter
• Lesser trochanterPubic symphysis
• Acetabulum
Lecture Objectives
• Bladder
Be able to identify the following anatomy on Pelvis CT:
• Bladder
• Uterus
• RectumRectum
• Prostate
• Seminal vesicle
A t R iAnatomy Review
3 Bones
Gross Anatomy of Pelvic Region
3 Bones1. Sacrum2. Hip/Pelvic Bone3. Coccyx
112
3
Pelvic inletinlet
3 Parts of Pelvic Bone
Gross Anatomy of Pelvic Bone
1. Ilium2. Ischium3. Pubis
1
2
3
2
Pelvis Bone - Anterior
1. Ischiopubic rami
Anterior
2. Obturator Foramen
3. Anterior superior Iliac Spine
4. Iliac Crest4. Iliac Crest
5. Iliac Fossa
6. Ischial Spine
7. Pubic Tubercle
8. Pubic Crest
9 P bi S h i9. Pubic Symphysis
10. Sacro-iliac joints
11. Ala of sacrum
Pelvis: Lateral View
1. Iliac Crest
2. Anterior superior iliac spinep p
3. Acetabulum
4. Superior pubic ramus
5. Inferior pubic ramus
6. Ischial spine
7 Ischial tuberosity7. Ischial tuberosity
8. Obturator foramen
9. Greater sciatic notch
10. Lesser Sciatic notch
Muscles of Pelvis
1. Piriformis 2. Obturator Internus 3. Levator Ani
11 1
22
23
Viscera and Vascular Review- Female
4 1. Rectum8
52. Uterus
3. Ovary
4. Aorta
1 36
4. Aorta
5. Common Iliac
Artery1
23 6. External Iliac
Artery
7 I t l Ili A t7. Internal Iliac Artery
8. Inferior Vena Cava
Female Pelvic Region – Sagittal View
Male or Female? Which View?
1. Uterus
2. Ovary
3. Bladder
1
25 63. Bladder
4. Rectum
5. Vesico-uterine pouch13 4
6. Recto-uterine pouch
Male Pelvic Region- Sagittal View
Male or Female? Which View?
1. Bladder
2. Prostate
3. Seminal vesicle
3 4. Rectum
5. Urethra
1
3
41
2
4What pouch is outlined in red?
Recto-vesical pouch
5
Femur
1. Femoral Head
2 Femoral Neck2. Femoral Neck
3. Greater trochanter
4. Lesser trochanter112 3
44
RADIOLOGY ATLAS
What view is this radiograph?What view is this radiograph?
AP view
What is this particular type of
radiograph called?radiograph called?
KUB – radiograph is focused on Kidneys, Ureter BladderUreter, Bladder
What is this
called again?called again?
Pelvic Inlet
1. Ilium2. Sacrum
4. Ischium5. Pubic bone2. Sacrum
3. Coccyx5. Pubic bone
L Ili C tAla of sacrum
R Anterior superior
L Iliac Crest
superior iliac spine
L Ili FL Iliac Fossa
R acetabulum L Sacroiliac joint
R Ischial Spine
Pubic Tubercle
R superiorR superior pubic ramus R inferior pubic ramus
R ischialtuberosity
RectumR femoral head
Pubic Symphysis
R femoral neck
L Obturatorfforamen
Is this Right or Left?
Right hip and femurg p
1. Femoral Head
2 Greater Trochanter of femur
12. Greater Trochanter of femur
3. Intertrochanteric Crest
4. Femoral Neck
24
5. Obturator foramen3 5
Is this Right or Left?
Right hip and femur
8
g p
6. Lesser Trochanter of femur
7 Acetabulum7
8
7. Acetabulum
8. Hip Joint
9. Ischial Tuberosityy
69
Coronal pelvic structures:G CXRGross vs CXR
L Iliac CrestAla of sacrumR Ischial SpineIlium
Sacrum
R Anterior superior
L Iliac Fossa
Ilium
superior iliac spine
L Sacroiliac joint
R acetabulumjoint
Coccyx
Pubic Tubercle
RectumR femoral head
R superiorPubic Symphysis
R femoral neck
L Obturatorf
Ischium
R superior pubic ramus R inferior pubic ramus
R ischialtuberosity
foramen
Pubic bone
Coronal pelvic structures: Gross vs CXR
11 112
2
1. Anterior Superior Iliac Spine2. Rectum
Coronal pelvic structures: Gross vs CXR
22
1
4
31
3
45
67
45 6
7
1. Ilium2. Iliac Crest3. Iliac Fossa
5. Superior Pubic Ramus6. Pubic Tuberosity7. Pubic Symphysis
4. Pubic bone
Coronal pelvic structures: Gross vs CXR
2
21
6
3
7
1
3
4
85 6
87
4
8
5
1. Ilium2. Iliac Crest3. Iliac Fossa4 I f i P bi R
1. Obturator Foramen2. Acetabulum3. Femoral Head4 F l N k4. Inferior Pubic Ramus 4. Femoral Neck
Coronal pelvic structures: Gross vs CXR
1
2
43 2
5
7
1
3
45
6 7
56
1. Ilium2. Iliac Crest3. Sacrum
5. Ischium6. Ischial Tuberosity7. Rectum
4. Sacroiliac Joint
Coronal pelvic structures: Gross vs CXR
12
4
1 2
34
3
1. Ilium2. Ala of Sacrum3. Ischium4. Ischial Spine
Coronal pelvic structures: Gross vs CXR
1
1
1. Coccyx
CT ATLAS OF PELVIS
Pelvis- Axial View
1. Bowel
2. Piriformis muscle
3. Gluteus muscles
4. Pubic bone1 4
4. Pubic bone2
3
1
2
4
23
Pelvis- Axial View
5. Sacrum7
6. Rectum
7. Bladder
56
7
56
Pelvis- Axial View
1. Rectus abdominus muscle1
2. Piriformis muscle
3. Gluteus muscles
4. Pubic bone4
4. Pubic bone2
3
11
2
4
23
Pelvis- Axial View
5. Sacrum7
8
6. Rectum
7. Uterus
8. Ovary
7
8. Ovary
56
788 8
6
5
Pelvis– axial view level of hip joints
1 12 2 53
56
36
7 74 34
1. Femoral Head 5. Pubic Bone
2. Bladder
3. Ischium
4 Ischial Spine
6. Acetabulum
7. Rectum
4. Ischial Spine
Pelvis– axial view level of hip joints
66 77
5 5
7
5. Gluteus muscles
6. Seminal Vesicle
7 Obturator internus muscle7. Obturator internus muscle
1
Pelvis– axial view at level of greater trochanter
1. Pubic Symphysis
2. Rectum
3. Prostate gland
4. Ischial spine23
4
1
23
4
Pelvis– axial view at level of greater trochanter
5. Femoral neck
6. Greater trochanter
7. Ischio-rectal fossa
8. Obturator internus muscle5
68
7
567
8
What plane is this? Male or female?
Male Pelvis– Sagittal view
1. Pubic Symphysis
2. Bladder
3. Prostate gland
4. Rectum
5. Seminal vesicle
6. Recto-vesical pouch5 6
23
4
13
What plane is this? Male or female?
Female Pelvis– Sagittal view
1. Pubic Symphysis
2 Bladder2. Bladder
3. Uterus
22
3
31 1
2
What plane is this? Male or female?
4. Rectum
5 Recto uterine pouch
Female Pelvis– Sagittal view
5. Recto-uterine pouch
6. Vescio-uterine pouch
56
44
56
6
Coronal view
What plane is this view in?
1 12 2
4 453 3
1. Ilium
2. Sacrum
4. Rectum
5. Obturator internus muscle
5
3. Ischium
1. Inferior Vena Cava2 Aorta
5. Left External Iliac Artery6 Left Internal Iliac Artery
Vascular Review- CT Coronal
2. Aorta3. Left Common Iliac Artery4. Right Common Iliac Artery
6. Left Internal Iliac Artery7. Right External Iliac Artery8. Right Internal Iliac Artery
11 2
12
373457
3
4 5
8
7
68
1. Inferior Vena Cava2 Aorta
5. Left External Iliac Artery6 Left Internal Iliac Artery
Vascular Review- CT Coronal
2. Aorta3. Left Common Iliac Artery4. Right Common Iliac Artery
6. Left Internal Iliac Artery7. Right External Iliac Artery8. Right Internal Iliac Artery
1 21 2
33
5768
4
68
8