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OF AN

Richard
L.Drake 1,
A.WayneVogl
AdamW.M.Mitchelt
Richard
M.Tibbitts
PaulE.Richardson
i

RichardL.Drake,PhD
Directorof Anatomy
Professorof Surgery
ClevelandClinicLernerCollege
of Medicine
Cleveland,Ohio,USA
A. WayneVogl,PhD
Professorof AnatomyandCellBiology
Directorof GrossAnatomy
Department andphysiological
of Cellular Sciences
Faculty
of Medicine
Universityof BritishColumbia
Vancouver, BritishColumbia,
Canada
AdamW. M. Mitchell,MBBS,FRCS,
FRCR
JointHeadof GraduateEntryAnatomy
lmperialCollege
University
of London
ConsultantRadiologist
Department of lmaging
Charing
CrossHospital
London,UK
lllustratedby

RichardM. Tibbitts
SaffronWalden,UK
PaulE.Richardson
Cambridge,
UK
Photographs
by
AnsellHorn
CHURCHILL
LIVINGSTONE
EISEVIER

1600JohnF.Kennedy
Blvd.
Ste1800
Philadelphia,
PA19103-2899

GRAY'SATLASOFANATOMY ISBN: -06721


978-0-443 -1

Copyrighto 2008by ChurchillLivingstone,an imprint of ElsevierInc.

All rights reserved.No partof this publicationmaybe reproduced or transmittedin anyform or by any
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u s e o f t h e m a t e r i a lc o n t a i n e di n t h i s b o o k .
ThePublisher

Libraryof CongressCataloging-in-Publication
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Gray'sAtlasof anatomy/ RichardL.Drake. . . let al.].- 1st eo.


p . ;c m .
Companionto: Gray'sanatomyfor students/ RichardL.Drake,WayneVogl,AdamW.M.Mitchell.2005.
Includes bibliographical
references
andindex.
lsBN978-0-443-067 21-1
1. Anatomy-Atlases.l. Drake,Richard1.,Ph.D. ll. Drake,Richard1.,ph.D.Gray'sanatomyfor
students. lll. Gray,Henry,1825-1861. Gray'sanatomy. lV. Title:Atlasof anatomy.
IDNLM: 1. Anatomy-Atlases. eS j7 G7842OOB]
QM25.G722008
611.0022'3-dc22 2007017928

Acquisitions Editor: William Schmitt


DeveIop m ental Editor: RebeccaGru liow
Publishing ServicesManager: Linda Van pelt
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Lastdigitistheprintnumber: 9 8 7 6 5 4 3 2 1
To my wifewho supportsme andto my parentswho arealwayswith me.
RichardL.Drake

To my family,to my professional and rolemodels,andto


colleagues
my students.
WoyneVogl

to Cathy,Maxand Elsa
Thanks,
Adam W.M.Mitchell

To my family- my inspiration, x
Evi,Zo€,andNicholas
RichordM.Tibbitts

andMajaandin memoryof AMRandJER


To Lesley
PaulRichardson
ACKNOWLEDGMENTS

The following reviewershelped enormouslywith their detailedcritiquesand suggestions


for everychapter.Theirassistance was invaluable.
Mark Hankin,PhD,Universityof Toledo Collegeof Medicine,Toledo,Ohio
MariosLoukas,MD, PhD,St.George'sUniversitySchoolof Medicine,Grenada
JamesJ. Rechtien,DO, PhD,MichiganStateUniversitySchoolof Medicine,EastLansing,
Michigan
WilliamA. Roy,PT,PhD,Touro University,Henderson,Nevada
SusanStandring,PhD,DSc,Professorof ExperimentalNeurobiologyand Head,Division
o f A n a t o m y ,c e l l a n d H u m a nB i o l o g yG , uy'sK
, i n g ' sa n d s t T h o m a s s' c h o o lo f B i o m e d i c a l
S c i e n c e sK, i n g ' sC o l l e g eL o n d o n ,L o n d o n
WilliamSwartz,PhD,LouisianaStateUniversityHealthSciencesCenter,BatonRouge,
Louisiana
Mark F.Teaford,PhD,JohnsHopkinsUniversitySchoolof Medicine,Baltimore,Maryland

we want to thank Dr. Brucecrawford for a radiographof the head and neckand Dr.
MurrayMorrisonfor laryngoscopicimagesof the larynx;Dr. JerryHealyfor three imagesin
the Abdomen section:the celiacartery,the bile duct system,and a three-dimensionalview
o f a b d o m i n a vl e s s e l sa;n d S i e m e n sM e d i c a S l o l u t i o n sU S Aa n d t h e f o l l o w i n gi n d i v i d u a l w
s ith
t h a t c o m p a n y :M o l l i eB e a v e rD, i r e c t o rC
, TC l i n i c aSl o l u t i o n sa, n d D r .L o u i s eM c K e n n aG , lobal
clinical MarketingManager,cT oncology,who supplied a syngoMulti-modalityworkplace,
w h i c h w a s u s e dt o a c q u i r et h e m a j o r i t yo f t h e c l i n i c ailm a g e s .
S t u a r tM o r r i s o nM
, D , h e l p e dw i t h a l l a s p e c t so f c o o r d i n a t i n gt h e c o l l e c t i o no f t h e
radiographicmaterial.Radiologicalassistance and imageswere contributedin each of the
following areas:

Back Mark Kayanja,MD, PhD


JeffreyS.Ross,MD
Thorax M a r i oG a r c i aM , D
A . M i c h a e l L i n c o fM
f, D
Abdomen N a m i t aG a n d h i ,M D
M i c h e l l eI n k s t e rM
, D,PhD
B r i a nR .L a n e .M D
A n a n d R a o ,M D
J a m e sS .W u , M D
Pelvis Matthew Barber,MD, MHS
T o m m a s oF a l c o n eM, D
J. StephenJones,MD
E u n i c eM o o n ,M D
J a m e s5 . N e w m a n ,M D , P h D
Extremities H a k a nl l a s l a nM
, D
BradfordJ. Richmond,MD
JoshuaPolster,MD
Headand Neck Todd W. StuItZ,DDS,MD
J . M a r t i nP a l o m aD
, D S ,M S D
C i n d yM c C o n n a u g h y
R o n a l dL e m m o .D D S

vl
A workingknowledge of anatomyis not an "optionalextra" modernimagingprocedures. Of course,anatomycannotbe
forhealthcareprofessionals - it isfundamental. Acquiringthat learnedfrom booksand interactiveDVDsalone,no matter
knowledgehasalwayschallenged eventhe mostmotivated how excellentthey may be. Anatomyis a practicalsubject,
students.Over many generations, learningmaterialsthat best learnedby gaininghands-onexperience of the body.
aid the processeffectively havebeenwarmlywelcomedby Students shouldspendasmuchtimeastheycanexamining
studentsand their teachers(and by patients,who are the cadavericdissections(if theydo not havethe opportunityto
ultimatebeneficiaries of that knowledge). I remembermy dissectthemselves) and shouldalwaysreadfrom screenor
own students'responsewhen | first includedillustrations pagewith the appropriate bonesin frontof them.Theyneed
from Gray'sAnatomyfor Studentsin a lecture-afterward,I to combineand correlate informationfrom a widevarietyof
wasaskedrepeatedly forthe sourceof the marvelous pictures. sourcesin orderto gainthe workingknowledgementioned
Lookingbeyondthe "wow"factorthat leaptfrom the pages earlier.
of the book,it wasclearthatan enormous amountof thought Thisatlaswillprovidea valuable companion to theirstudies,
andskillhadgoneinto producingthe artwork. and I am confident that it will remainin theirlibraries long
This atlas containsa seriesof additionaloutstanding aftertheyhavecompletedthe earlystagesof theirtraining.
piecesof anatomical art from the illustrative teamof Richard
Tibbittsand PaulRichardson that will complement thosein SusanStandring
Groy's Anatomy for Students, combined with relevant
clinical Division CellandHumanBiology
of Anatomy,
pictures,surfaceanatomy,and imagesfrom a range of King's London
College,

vtl
FOREWORD

We beganworking on Gray'sAtlasof Anotomyin 2005 resonanceimaging (MRl).Where appropriate,we have


followingthe publication of our textbook,Gray's Anatomyfor includedendoscopic, laryngoscopic,and laparoscopic views
Students.Wewantedto producean atlasthat wouldbuildon of the anatomy and have included examples of ultrasound
themesand conceptsestablished in the textbookand that images.In a numberof regions,we alsohavereconstructed
wouldcoupleartisticrenderings of "internal"grossanatomy the internalanatomyof patientsby abstractingspecific
with actual "living" anatomy,as visualizedwith modern information from multipleMRor CTimages, and we present
imagingtechniquesand with surfaceanatomy.We believe these reconstructions together with artwork of the same
thatthefinalatlaspresents a freshandintegrated to anatomy.Althoughthe artwork
approach was done independently of
anatomythat isaccessible to entry-level studentsin anatomy, the reconstructed images,the two types of representations
aswellasto studentsat moreadvanced levels. arestrikinglysimilar.
Because an atlasis usedin a much differentway than a Eachpageof thisatlaswasplannedpriorto beginningwork
textbook, we couldnotsimplyrepackage figuresusedin Groy's on the figures,andall of the artworkwasgenerated digitally.
Anotomyfor Studentsand putthemin the atlas.Consequently, Most of the figureswere createdfrom an extensive digital
mostof the figuresin the atlasare new and weredesigned database createdfor the textbook.Eachfigure was reviewed
to presentstructures in a morecompletecontextthan in the for accuracy andrevisedaccordingly.
textbook,eventhoughthe colorpalateand overalllook of We hope that the textbookand atlasusedtogetherwill
the figuresin both the atlasand textbookare similar.Also, providenew and powerfullearningtools for studentsof
figuresin the atlasprovideadditional detailnot includedin humangrossanatomy.
the textbook and directly correlate artisticrepresentations
of anatomy with computed tomography (CT)and magnetic TheAuthors

tx
CONTENTS

Meninges 48
Spinolcord:imaging 50
Anatomicalposition,terms,andplanes 2 Transversesection: thoracic region 52
Anatomicalplanesandimaging 3 Dermatomes andcutaneous nerves 53
Surfaceanatomy:anteriorview 4
Surfaceanatomy:posteriorview 5
Skeleton:onterior 6
Skeleton:posterior 7
Muscles:onterior 8 Surface anotomywith bones 56
Muscles:posterior 9 Bonyframework 57
vascuIar system: arteries 10 Ribs 59
Vascular system: veins 11 Articulations 60
Lymphatic system 12 Breast 62
Nervoussystem 13 Pectoralregion 64
Sympathetics 14 Thoracic wallmuscles 66
Parasympathetics 15 Diaphragm 67
Dermatomes 16 Arteriesof thethoracicwall 68
Cutaneous nerves 17 Veinsof thethoracicwall 69
Nervesof the thoracicwall 70
Lymphaticsof the thoracicwall 71
lntercostal nervesandarteries 72
PIeural cavitiesandmediastinum 73
::r:,i;;!11;,1...;1; Parietalpleura 74
Surface anatomy 20 Surfaceproiectionsof pleuralrecesses 75
Vertebralcolumn 21 Rightlung 76
Regional vertebrae 22 Leftlung 77
Cervicalvertebrae 23 Lunglobes:surfacerelationship 7B
Thoracicvertebrae 26 Lunglobes:imaging 79
Lumbarvertebrae 28 Bronchialtree BO
Sacrum 31 Bronchopulmonarysegments B1
Intervertebral foramina and di scs 32 Pulmonary vesselsandPlexus 82
Intervertebral discproblems 33 Pulmonary vessels:imaging 83
Jointsandligaments 35 Mediastinum B5
Backmusculature: surfaceanatomy 36 Pericardium 86
Superficial muscuIature 37 PericordiallaYers B7
IntermediatemuscuIature 39 Anteriorsurfaceof heart BB
Deepmusculature 40 Base anddiaphragmatic surfaceof heart B9
Backmusculature: section
transverse 42 Rightatrium 90
Suboccipitol region 43 Rightventricle 91
Spinalnerves 44 Leftatrium 92
Spinalcord 45 Leftventricle 93
Spinal cord vascu Iature 46 Aorticvalveondcardiacskeleton 94
Venous drainageof spinalcord 47 Cardiacchambers andheartvalves 95

xi
CONTENTS

Coronaryvessels 96 Arterialsupplyof viscera 147


Coronaryarteriesand variations 97 Stomach 148
Cardioc conduction system 99 Spleen 149
Auscultationpointsandheartsounds 100 Arteriesof stomachandspleen 150
Cardiacinnervation 101 Duodenum 152
Superiormediastinum: thymus 102 Smallintestine 154
Superiormediastinum:veinsand arteries 103 Largeintestine 156
Superiormediastinum: arteriesandnerves 104 lleocecaljunction ts8
Superiormediasti num: imaging 105 Gastrointestinaltract:imaging 159
Superiormediastinum:veinsand tracheo 106 Mesentericarteries 160
Mediastinum: imoging 107 Liver 162
Mediastinum:viewfromright 108 Vessels of theliver 164
Mediastinum:imaging- viewfromright | 09 Segments of theliver 165
Mediastinum:viewfromleft 110 Pancreas andgallbladder 166
Mediastinum: imaging-view fromleft 11| Vasculature ofpancreasandduodenum 169
Posteriormediastinum 112 Venous drainageof viscera 170
Mediastinum:imaging 114 Portosystemic anastomoses 172
Transversesection: WlII Ievel llB Posteriorwall 173
Dermatomes andcutaneous nerves 119 Vesselsof theposteriorwoll 174
Visceral
efferent(motor)innervationof theheart | 20 Diaphragm 175
Visceral
afferents 121 Kidneys 176
Grossstructureof kidneys 178
Kidneys: imaging 179
Renalvasculature 180
Branches of theabdominalaorta 182
Surfaceonatomy 124 lnferiorvenacava 183
Quadrants andregions 125 Abdominalaortaandinferiorvenacava:imoging l g4
Abdominalwall 126 Lumbarplexus 186
Muscles 128 Lumbarplexus:cutaneous distribution 187
Muscles: rectussheath 131 Lymphatics 188
Vessels
of theabdominalwall 132 Abdominalinnervation 189
Arteriesandlymphatics of theabdominalwall 133 Splanchnic nerves 190
Nervesof theabdominalwall 134 Visceral efferent(moto) innervationdiagram 191
Dermatomes andcutaneous nerves 135 Visceralofferent(sensory) innervotionand referred
lnguinalregion 136 pain diagram tg2
lnguinalcanal t38 Kidneyand uretervisceralafferent(sensory)
lnguinalhernias 140 diagram lg4
AnteriorabdominaI walI 141
Greateromentum 142
Abdominalviscera
PELVIS
ANDPERINEUM
143
Peritonealcavity 144 Surface anatomyandarticulated
pelvisin men lgg
Abdominal sagittal secti
on 145 Surface anatomyandarticulated
pelvisin women 200
Abdominalcoronalsection 146 Pelvicgirdle 202
xii
CONTENTS

Pelvicairdle:imaging 203 Pudendal nerve 251


Lumbosacral joint 204 VascuIatureof perineum 252
joint
Sacro-iliac 20s Nervesof perineum 253
Pelvicinletandoutlet 206 Lymphatics of pelvisandperineumin men 254
Orientationof pelvicgirdleandpelvicbrim 207 Lymphatics of pelvisandperineumin women 255
Pelvicvisceraandperineumin men 208 Lymphatics 256
Pelvicvisceraandperineumin men:imaging 209 Dermatomes 257
Pelvicvisceraandperineumin women 210 !nnervation systemin men
of reproductive 258
Pelvicvisceraandperineumin women:imaging 211 systemin women
lnnervationof reproductive 259
Lateralwallof pelviccavitY 212 lnnervationof bladder 260
Floorof pelviccavity:pelvicdiaphrogm 213 Pelviccavityimagingin men 261
Rectumand bladderin situ 216 Pelviccavityimagingin women 264
Rectum 217
218 ' -;8LOWERLIMB
Fe+.!n#C*
Bladderin men
Bladderin women 219 tWMa'
Reproductive systemin men 220 Surfaceanatomy 272
Prostate 221 Bonesof thelowerlimb 273
Prostateandseminalvesicles 223 Pelvicbonesandsocrum 274
Scrotum 224 Articulated Pelvis 275
Testes 225 Proximalfemur 276
Penis 226 Hipjoint 277
Reproductive systemin women 227 Hip joint:structureandarterialsupply 279
Uterusandovaries 228 Glutealregion:attochments andsuperficial
Uterus 229 musculature 280
Uterus:imaging 230 G!utealregion:superficial anddeepmuscles 281
Pelvicfascia 231 Glutealregion:arteriesandnerves 282
Arterialsupplyof pelvis 232 Distalfemurandproximaltibiaondfibula 284
Venous drainageof pelvis 233 Thigh:muscleattachments 28s
Vasculature of thepelvicviscera 234 Thigh: anterior superficial musculature 286
Vasculature of uterus 235 Thigh: posterior superficial muscuIature 287
Venous drainageof prostateandpenis 236 Thigh: anteriorcompartmentmuscles 288
Venous drainageof rectum 237 Thigh: medial comPartmentmu scles 289
Sacralandcoccygeal nerveplexuses 238 Femoraltriangle 290
Pelvicnerveplexus 239 Anteriorthigh:arteriesandnerves 291
Hypogastric plexus 240 Anterior thigh: arteries 292
Surface anatomyof theperineum 241 Thigh:posteriorcompartment muscles 293
Borders andceilingof theperineum 244 Posterior thigh:arteriesandnerves 294
Deeppouchandperinealmembrane 245 Transversesections:thigh 296
Muscles anderectiletissues in men 246 Kneejoint 298
tissuein men:imaging
Erectile 247 Ligaments of theknee 300
Muscles anderectiletissuesin women 248 Menisciand cruciateligaments 302
Erectiletissuein women:imaging 249 Knee:bursaandcaPsule 306
lnternalpudendalarterYand vein 250 Kneesurface:muscles, capsule,and arteries 307
xilt
CONTENTS

Poplitealfossa 308 Glenohumeral joint 356


Tibiaand fibula 309 Muscleattachments 358
Bones ofthefoot i t 0 Pectoralregion 360
Bonesandjointsof thefoot 3 1 3 Deeppectoralregion 361
Talusandcalcaneus 3 1 4 Wallsof theaxilla 362
Anklejoint 3 1 5 Thefourrotatorcuffmuscles 364
Ligaments of theanklejoint 3 1 6 Deepvessels andnervesof theshoulder 366
Leg: mu scle attachm ents 3 1 9 Axillaryartery 367
Posteriorleg:superficialmuscles 320 Brachialartery 368
Posteriorcompartment:deepmuscles 3 2 1 Brachialplexus 369
Posteriorleg:arteriesand nerves 322 Medialand lateralcords 370
LateraI compartment: mu scles 323 Posteriorcord 371
Anteriorleg:superficialmuscles 324 Distalendof humerusandproximalendof
Anterior comportment:mu scles 32s radiusand ulna 372
Anteriorleg:arteriesond nerves 326 Muscleattachments 373
Leg:cutaneous nerves 327 Anterior compartment:mu scles 374
Transversesections:Ieg 328 Anteriorcompartment: arteriesandnerves 376
Foot: mu scle attachme nts 330 Veinsof thearm 377
Foot:ligaments 3 3 1 Posterior compartment: mu scles 378
Dorsumof foot 3 3 3 Posteriorcompartment:arteriesand nerves 380
Dorsumof foot:arteriesandnerves 334 Lymphaticsof thearm 381
Plantaraponeurosis 336 Transversesections:arm 382
Plantarregion(sole)musculature:first layer 337 Anteriorcutaneousnervesof thearm 384
Plantarregion(sole)musculature: secondlayer 338 Posterior cutoneous nervesof thearm 385
Plantarregion(sole)musculature: thirdlayer 339 Elbow joint 386
Plantarregion(sole)musculature: fourthlayer 340 Elbowjoint:capsuleandligaments 388
Plantarregion(sole):arteriesand nerves 3 4 1 Cubitalfossa 390
Dorsalhoodand tarsaltunnel 343 Radiusand ulna 391
Superficialveins of thelowerIimb 344 Bonesof thehandand wristjoint 392
Lymphaticsof thelowerlimb 345 lmagingof thehandand wristjoint 393
Anteriorcutoneous nervesanddermatomes Bones ofthehand 394
of thelowerlimb 346 Jointsandligomentsof thehand 395
Posteriorcutaneousnervesand dermatomes Muscleattachmentsof forearm 396
of thelowerlimb 347 Anteriorcompartment of forearm:muscles 397
Anteriorcompartment of forearm:arteriesand
nerves 400
Posteriorcompartment of forearm:muscles 401
Surfaceanatomy 3s0 Posteriorcompartmentof forearm:arteriesand
Bonesof theupperIimb 351 nerves 403
Bonyframeworkof shoulder 352 Transversesections:forearm 404
Scapula 3 5 3 Carpaltunnel 406
jointsandligaments
Clavicle: 354 Muscleattachments of thehand 408
Proximalhumerus 3 5 5 Superficial palmarregion(patm)of hand 409
xiv
CONTENTS

410 lnnervationof thelacrimalgland 463


Tendonsheathsof hand
411 Musclesof theeYeboll 464
Lumbricalmuscles
of hand 412 lnnervationof theorbitandeyeball 465
lntrinsicmuscles
(palm) of hand:arteriesandnerves 414 Eyemovements 466
Palmarregion
416 of orbit
Vasculature 467
Arteriesof thehand
of thehand:medianond ulnarnerves 417 Eyeball 468
Innervation
418 Eyeimaging 469
Dorsumof hand
419 innervation
Earsurfaceandsensory 472
Dorsalhoods
420 Ear 473
Dorsumof hand:arteries
421 Middleear 474
Dorsumof hand:nerves
422 lnternalear 476
Anatomicalsnuffbox
of forearm 42i Earimaging 477
Superficialveins andlymphatics
nervesof forearm 424 Temporal ondinfratemporalfossae 478
Anteriorcutaneous
nervesof upperlimb 425 Bonesof thetemporalandinfratemporolfossoe 479
Posteriorcutaneous
Temporalandinfratemporal fossae 480
TemporomandibuIar ioint 482
Mandibulardivisionof thetrigeminalnerve[V] 483
428 ParasYmPatheticinnervation 484
Surface anotomywith bones
Bonesof theskull 429 andveinsof temporaland
Arteries
430 infratemPoralfossae 485
Skull:anteriorview
432 PterygoPalatinefossa 486
Skull:lateralview
434 Necksurfaceanatomy 488
Skull:posteriorview
435 Bonesoftheneck 489
Skull:superiorviewondroof
436 Compartments andfasciaof theneck 490
Skull:inferiorview
437 Superficialveinsofthe neck 491
Skull: cranialcavity
438 Muscles of theneck 492
Ethmoid,lacrimal bone,inferiorconcha,and vomer
439 Nervesin theneck 494
Maxillaandpalatinebone
440 Cranialnervesin theneck 495
SkuII: mu scle attachments
442 Cervicalplexusandsympathetictrunk 496
Scalpandmeninges
443 Arteriesof theneck 498
Duralpartitions
444 Rootoftheneck:arteries 500
Duralarteriesandnerves
445 of theneck
Lymphatics 502
Duralvenous sinuses
446 Pharynx 504
Brain
448 Musclesof thePharYnx 506
Brain:imaging
450 Innervationof thePharYnx 508
Cranialnerves
452 Vasculatureof thePharYnx s09
Arterialsupplyto brain
455 LarYnx sl0
Cutaneous distributionof trigeminolnerve[V]
456 LarYngealcavitY sl2
Facialmuscles
458 Musclesof thelarYnx 513
Vasculature, facialnerve[Vll]and lymphatics
459 lnnervationof thelarYnx 514
Deeparteriesand veinsof parotidregion
460 Thyroidgland 515
Bonyorbit
of eyelid 461 Vasculatureof thethyroidgland 516
throughorbitandstructures
Section
462 NoseandParanasal sinuses 518
andlacrimalaPParatus
Eyelids
xv
Nasolcavity: bones 519 Musclesond salivaryglandsof theoral cavity 530
NasaI cavity:mucosalIinings 520 Vessels
and nervesofthe tongue 531
Vasculature ond innervationof thenasalcavity 521 Tongue 532
Sinusimaging 522 Hardand softpalate 53i
Oralcavity:bones 524 Palate 534
Teeth 525 lnnervationof oral cavity 53s
Teeth:imaging 526 Craniolnerves 536
Anotomyof teeth 527 efferent(moto) pathwaysin thehead
Visceral 5i8
Vessels and neruessupplyingteeth 528
lnnervationof teethand gums 529 INDEX 541

xvl
.HE
CONTENTS
rcWw!:+1;8.'|::::,.t I :':'' : ::t .'
BODY
Anatomicalposition,terms,andplanes 2
Anatomicalplanesandimaging 3
Surfaceanatomy:anteriorview 4
Surfaceanatomy:posteriorview 5
Skeleton:anterior 6
Skeleton:posterior 7
Muscles: onterior B
Muscles:posterior 9
VascuIar system: arteries 10
Vascularsystem:veins 11
Lymphaticsystem 12
Nervoussystem 13
Sympathetics 14
Parasympathetics 15
Dermatomes 16
Cutaneous nerves 17
Sagittal plane Coronal plane

_ cranial

- caudal

Verticalor _ Medial
l o n g i t u d i n aal x i s
f -1u1"ru;

Proximal
Transverse
axis

Transverse,horizontal,
or axial plane

DistaI

D o r s u mo f h a n d

Dorsumoffoot

Plantarsurfaceoffoot - Inferior

2
Anatomicalplanes
andi

Sacralpromontory

T2-weightedMR image, in sagittal plane

S m a l il n t e s t i n e

Sigmoidcolon

CT image,with contrast,in coronal plane

Pectoralismajor Manubriumof sternum

vein
Left brachiocephalic
R i g h tb r a c h i o c e p h a lvi ce i n
trunk
Brachiocephalic

Trachea
Leftcommon carotidartery

Left subclavianartery

Esophagus

CTimage,with contrast,in axialplane


3
THE BODY . Surfoceanatomy:anteriorview

Sternocleidomastoid

Clavicle
J u g u l a rn o t c h
Acromion

Pectorali
major

Costal Areola
margrn Xiphoidprocess

Nipple
Breast

Cubitalfossa

Medialmalleolus Lateralmalleolus

Dorsumoffoot

4
Surfaceanatomy:posteriorview

Vertebraprominens Vertebraprominens
(spinousprocess (spinousprocess
of CVll) of CVll)

Acromion
S p i n eo f s c a p u l a Spinousprocess
ofTl
Deltoid

M e d i a lb o r d e r
of scapula

L a t i s s i m udso r s i

Spinousprocess
of TXll

S a c r adl i m p l ea t
posteriorsuperior
i l i a cs p i n e

Interglutealcleft

Glutealfold

Bicepsfemoristendon
Poplitealfossa Poplitealfossa Bicepsfemoristendon

Gastrocnemius

M e d i a lm a l l e o l u s
C a l c a n e a( A
l chilles)
tendon
THE BODY. Skeleton:anterior

Frontalbone

Zygomaticbone

CVII

R i bI
process
Clavicle
Acromion
Lessertubercle

Greatertubercle

Bodyof sternum

Xiphoidprocess
of sternum

Mediae
l picondyle
Trochlea
Lateralepicondyle
Capitulum

Radius llium
S a c r o - i l i aj oci n l
Ulna Sacrum

Pubis

P ub i c Greater
symphysis trochanter

Lesser
trochanter

6
Parietalbone

Occipitalbone
Externaloccipitalprotuberance
Mastoidprocess
Cl (atlas)
Cll(axis)
A n g l eo f m a n d i b l e
S p i n eo f s c a p u l a S u p e r i oar n g l eo f s c a p u l a
Acromion Clavicle

Greatertubercle Shoulderjoint

Humerus

Mediae
l picondyle

Lateralepicondyle

lliaccrest

Posteriorsuperior Radius
i l i a cs p i n e
Ulna
Sacrum
H i pj o i n t
Coccyx
Greatertrochanter

Wristjoint

lschial
tuberosity

l s c h i asl p i n e

M e d i ae
l picondyle Medialcondyle
Lateralepicondyle
Lateralcondyle
K n e ej o i n t -
Palpablebone
(posteriorview)

Anklejoint

Tuberosityof fifth metatarsal


Masseter

Sternocleidomastoid

Tr

Long head of bicepsbrachii(cut)


Deltoid
P e c t o r a l im
s inor
Pectoralismajor Shortheadof bicepsbrachii(cut)

Coracobrachialis
Externalintercostal
Serratusanterior
Internalintercostal
B i c e p sb r a c h i i
Brachialis
Rectusabdominis
Posteriorwall of rectussheath
Bicepsbrachiitendon (cut)
Pronatorteres
Supinator(superficial head)
B r a c h i o r ai a
dl i s Internaloblique (cut)
E x t e r n aol b l i q u e T r a n s v e r s uasb d o m i n i s

F l e x o cr a r p ir a d i a l i s Flexordigitorum profundus
P a l m a r ilso n g u s Flexop
r o l l i c i sl o n g u s
F l e x o cr a r p iu l n a r i s
lliopsoas
Tensorfascialatae
Pronatorquadratus

T h e n a rm u s c l e s ator externus

Hypothenarmuscles
Adductorbrevis

Sartorius

Rectusfemoris Pectineus
l l i o t i b i atlr a c t
A d d u c t o rm a g n u s

A d d u c t o rl o n g u s
Vastuslateralis

Gracilis
Vastusmedialis

Gastrocnemius
F i b u l a r ilso n g u s
E x t e n s odr i g i t o r u ml o n g u s
Soleus

T i b i a l i sa n t e r i o r E x t e n s ohr a l l u c i sl o n g u s

E x t e n s ohr a l l u c i sl o n g u s

Extensordigitorum longus

8
posterior
Muscles:

S e m i s p i n a lci sa p i t i s
Occipitalis

Sternocleidomastoid S p l e n i u cs a p i t i s
Spleniuscervicis
R h o m b o i dm i n o r
Rhomboidmajor
Trapezius
Levatorscapulae
Supraspinatus

Deltoid Infraspinatus

Teresminor
Infraspinatus Lateralhead oftriceps brachii(cut)
Teresmajor
Latissimusdorsi(cut)
Latissimus
dorsi Long head oftriceps brachii
Externalintercostal
Tricepsbrachii Medialhead oftriceps brachii
Erectorspinae

E x t e r n aol b l i q u e
Internaloblique
Extensorcarpiradialislongus
Supinator(deephead)
F l e x o cr a r p iu l n a r i s

Abductorpollicislongus
Extensordigitorum
Extensorpollicislongus
Extensorpollicisbrevis
G l u t e u sm a x i m u s
Extensorindicis

Piriformis
supeflor
l l i o t i b i atlr a c t Obturatorinternus

Gemellusinferior
Quadratusfemoris

Long headof bicepsfemoris Adductormagnus

Semitendinosus
Shorthead of bicepsfemoris
Semimembranosus
Gracilis Semimembranosus

Long head of bicepsfemoris(cut)


Plantaris
Plantaris(cut)

Popliteus

Soleus(cut)
Gastrocnemius

r i g i t o r u ml o n g u s
F l e x od
F i b u l a r ilso n g u s
Soleus
Flexoh
r a l I u c i lso n g u s

C a l c a n e at el n d o n

Fibularisbrevis(tendon)

9
THE BODY . Vascular
system:
arteries

5uperficialtemporalartery

Facialartery
Left internalcarotidartery
Vertebralartery
Leftexternalcarotidartery
Rightsubclavianartery
Leftcommon carotidartery
B r a c h i o c e p h atl ri cu n k Left subclavianartery

A x i l l a r ya r t e r y Arch of aorta
Internalthoracicartery
Anteriorcircumflexhumeralartery
Ascendingaorta

Thoracicaorta
Profundabrachiiartery

C e l i a ct r u n k

Commonhepaticartery

Brachialartery S p l e n i ca r t e r y
Left renalartery

Superiormesentericartery

Inferiormesentericartery
Ulnarartery

Left common iliacartery


Testicular/ovarian
artery
Left internaliliacartery
D e e pp a l m a ra r c h Leftexternaliliacartery

Superficialpalmararch

Transversebranchof lateral Femoralartery


circumflex femoralartery
Deeparteryofthigh
Descendingbranchof lateral
circumflex femoralartery

Poplitealartery

Anteriortibial artery

Posteriortibial artery

F i b u l aar r t e r y

Dorsalispedisartery

10
Vasculorsystem:

Supe16cial
temporalvein

F a c i avl e i n
Left externaljugularvein
A n t e r i o jru g u l a rv e i n
Left internaljugular vein
R i g h ts u b c l a v i avne i n
Left subclavianvein
R i g h tb r a c h i o c e p h a lvi ce i n

Left brachiocephalic
vein
C e p h a l i vc e i n Superiorvenacava

Azygosvein

B a s i l ivce i n lnferiorvenacava
B r a c h i avle i n s
H e p a t i cv e i n S p l e n i cv e i n

Portalvein

M e d i a nc u b i t a vl e i n
lnferiormesentericvein
Testicular/ovarian
vein
Suoeriormesentericvein
C e p h a l i vc e i n

B a s i l i vc e i n Leftcommon iliacvein
R a d i avl e i n

U l n a rv e i n Left externaliliacvein

Left internaliliacvein

D e e pv e i no f t h i g h Femoralvein

G r e a ts a p h e n o uvse i n

Poplitealvein
S m a l sl a p h e n o uvse i n

A n t e r i o rt i b i a lv e i n

P o s t e r i ot ri b i a lv e i n

Greatsaphenousvein
Posteriorfibularvein

S m a l sl a p h e n o uvse i n

Superficialveins -
D e e o v e i n st
Dorsalvenousarch

11
THE BODY. Lymphaticsystem

Pharyngealtonsil

S u b m a n d i b u l anro d e s P a l a t i n teo n s i l
L i n g u atlo n s i l

Thoracid
c uct
Cervicallymph nodes Left subclavianvein

Rightlymphaticduct

Rightsubclavianvein
Efferentlymphaticvessel
Axillarylymph nodes T h y m u sg l a n d

Tracheallymph nodes

Lymphaticvessels
o f t h e u p p e rl i m b
Thoracicduct
Cubitalnodes

Cisternachyli
S m a l il n t e s t i n e
Intestinallymph nodes
L y m p hn o d u l e si n
Largeintestine s m a l li n t e s t i n e
Appendix (Peyer'spatch)

lliaclymph nodes

Deep lymph nodes

Structureof a lymph node

I n g u i n ally m p h n o d e s
Femorallymph nodes

Bonemarrow

Popliteallymph nodes

D r a i n a g eo f t h e r i g h t
lymphaticduct

ofthe
Drainage
ffi thoracicduct

Principal
components
of the lymphaticsystem

12
Nervoussystem

Trigeminalnerve[V]

Brachialplexus

Axillarynerve

Musculocutaneon
ues rve

R a d i anl e r v e lntercostalnerves
Mediannerve

U l n a rn e r v e
C o n u sm e d u l l a r i s

C a u d ae q u i n a

Superficialbranchof radialnerve Lumbar plexus

Deepbranchof radialnerve
Femoralnerve

Sacralplexus
Mediannerve Lateralfemoral
curaneouSnerve
U l n a rn e r v e
Sciaticnerve

Lateralfemoralcutaneousnerve

Centralnervous
system(CNS)
Brain
Tibialnerve

S p i n acl o r d

Saphenousnerve

Deepfibularnerve

T i b i an
l erve

13
THE BODY . Sympathetics

o
a
a
o-

o
P r e g a n g l i o nsi cy m p a t h e t inc e r v e s o
follow somaticnervesto periphery
(glands,smooth muscle)

o
t
ts

o
o-
o
-o A b d o m i n avl i s c e r a
q

o
a
c

S y m p a t h e t igca n g l i o n

Sympathetictrunk

P r e g a n g l i o nsi cy m p a t h e t i c
Postganglionic
sympathetic
G a n g l i o ni m p a r

All sympatheticvisceralefferent(motor)nervesoriginatefrom
spinallevelsT1-12 and passinto the associated
spinalnerves
14
Parasympathetics

C i l i a r yg a n g l i o n

Pterygopalatine
ganglion

IIX]

O t i cA a n g l i o n S u b l i n g u agl l a n d

5 u m a n d i b u l agrl a n d
Submandibular
ganglion

o
a

s
F

Transitionfrom supply
by [X] to pelvicsplanchnics

Synapsewith nervecells
= of entericsystem
q
o
o

o
o
o
o

Erectiletissuesof penis
( o rc l i t o r i si n w o m e n )
P r e g a n g l i o np
i ca r a s y m p a t h e t i c
P o s t g a n g l i o npi ca r a s y m p a t h e t i c Pelvicviscera

visceralefferent(motor)nervesemergefrom the brainin


All paraympathetic
cranialnerveslll,Vll,lX,and X andfrom spinallevelsS2-S4
15
THE BODY. Dermatomes

H Trigeminal

Cervical

il Thoracic

t Lumbar

ffi Sacral

Dermatomemap
(cutaneous
distributionof nerves)

16
GreateroccioitalnerveC2

Supraclavicularnerve
Supraclavicular
nerves Third occipitalnerveC3 (from cervicalplexus)C3,4
(from cervicalplexus)C3,4 Posteriorcutaneous
branchesC4- Superiorlateral
LateralcutaneousnervesT3-T5 cutaneousnerveol arm
Superiorlateralcutaneous axillarynerve)C5,6
nerveof arm C5,6
cuTaneouS
M e d i a cl u t a n e o u s nerveof arm c5,6,7,8
nerveofarm C8,T1
Medialcutaneous
Anteriorcutaneous nerveof arm C8,T1
branchesof
Intercostobrachial
nerveT2 intercostal nerveT2
lntercostobrachial
nervesT2-T11
lnferiorlateralcutaneous lnferiorlateralcutaneous
nerveof arm C5,6 nerveof arm C5,6

Posteriorcutaneous
Posteriorcutaneous
M e d i a cl u t a n e o u s branchesT7-T12
nerveof forearmC5,6,7,8
nerveof forearmC8,T1

Lateralcutaneous Medialcutaneous
nervesT6-T11 nerveof forearmC8,T1
S u p e r i ocr l u n e anl e r v e s
Lateralcutaneous L 1- 1 3
nerveofforearm C5,6 Lateralcutaneous
M e d i a cl l u n e anl e r v e s
nerveofforearm C5,6
S1_S3
Lateralcutaneousbranch cutaneousbranch nerveLl
lliohypogastric
of subcostalnerve(T12) of subcostalnerve(T12)
SubcostalTl 2 lliohypogastricnerveL1
Superficialbranch
Femoralbranchof
r r a n c ho f m e d i a n
Palmab of radialC6,7,8
genitofemoralLl,2
Palmab
r r a n c ho f
lnferiorclunealnerves Dorsalbranchof
51-s3 u l n a rC 8 , T 1
Superficialbranch I n g u i n anl e r v eL 1
o f r a d i aC
l 7,8
Lateralcutaneous
of thigh 12,3
Median
MedianC6,7,8
c6,7,8
U l n a rC 8 ,T 1 Obturator12,3,4

Mediaal nd
intermediate Lateralcutaneousofthigh 12,3
cutaneousof Medialcutaneousofthigh 12,3
thigh12,3 Posteriorcutaneous
of thigh 12,3

Infrapatellarbranchof saphenous
Saphenous13,4
L a t e r acl u t a n e o u os f c a l fL 5 ,S 1 , 2
Lateralsuralcutaneousnerve
1 5 ,S 1 , 2

Saphenous13,4 S u r acl o m m u n i c a t i n bg r a n c h
of common fibular

fibular 14,5,S1
Superfrcial

S u r a1
l 5 ,5 1 , 2

Deepfibular
S u r aS
l 1,2

17
CONTENTS
Surfaceanatomy 20
Vertebralcolumn 21
Regionalvertebroe 22
Cervicalvertebrae 23
Thoracicvertebrae 26
Lumbarvertebroe 28
Socrum il
Intervertebralforamina and di scs i2
Intervertebral discproblems 33
JointsandIigaments 35
Backmusculature: surfaceanatomy 36
SuperficiaI muscuIature 37
IntermediatemuscuIature 39
Deepmusculature 40
Backmusculoture: tronsversesection 42
Suboccipitol region 43
Spinalnerves 44
Spinolcord 45
SpinaI cordvascuIoture 46
Venous drainageof spinalcord 47
Meninges 48
Spinalcord: imaging 50
Transverse section: thoracicregion 52
Dermatomes andcutoneous nerves 53
BACK . Surface
anatomy

L i g a m e n t u mn u c h a e

Vertebraprominens
(spinousprocessof CVll)
Acromionof scapula
S p i n eo f s c a p u l a

Inferiorangleof scapula

SpinousprocessofTXll

Sacraldimple at posterior
s u p e r i o irl i a cs p i n e

Interglutealcleft

Surfaceanatomy ofthe back

20
Anteriorview Posteriorview Lateralview

lntervertebraldisc

Thoracic
vertebrae

curvarure

lntervertebraldisc

Pro^on ory/

Sacrum- Sacral/coccygeal
curvarure

21
BACK . Regionalvertebrae

Vertebralforamen
Superiorarticularprocess

7 cervicalvertebrae
(cr-cvrD

Vertebralbody

process
Transverse
CVvertebra

Superiorarticularprocess

process
Transverse

Facetfor articulation
Vertebralforamen w i t h t u b e r c l eo f r i b V

Inferiorarticularprocess 12 thoracicvertebrae
Spinousprocess (Tr-TXil)

Demifacetfor articulation
Vertebralbody with headof rib V

Demifacetfor articulation
with headof rib Vl

TVvertebra

Vertebralforamen

5 lumbarvertebrae
(Lr-LV)

Sacrum
(5 fusedsacral
vertebrael-V)

Coccyx
(3-4 fusedcoccygeal
vertebrael-lV)
Llllvertebra

22
A n t e r i o tr u b e r c l e
of Cl(atlas)
P o s t e r i otru b e r c l eo f C l ( a t l a s )
II
l<F
Cl(atlas) A n t e r i o tr u b e r c l eo f C l ( a t l a s ) I
Lateral
atlanto-axial D e n so f C l l( a x i s ) Posterior
joint tubercle
of Cl (atlas)
C l l( a x i s ) B o d yo f C l l( a x i s )

Intervertebral Spni ous


disc Z y g a p o p h y s ijaoli n t process
of Cll (axis)
cill
S p i n acl o r d

ctv
Vertebra
Intervertebral
promrnens
foramen
Vertebralbody (spinous
CV of CVll processof
A n t e r i o rt u b e r c l e cvil)
of CVI
( c a r o t i dt u b e r c l e ) Spinous
processes
cvl regionof vertebralcolumn.
Cervical
T 1 - w e i g h t e dM R i m a g e i n t h e s a g i t t a lp l a n e
Foramen
transversail
um

Vertebrapromrnens
(spinousprocessof CVll)

Cervicalvertebrae lateralview

Posterior
A n t e r i o tr u b e r c l e tubercle
o f C l( a t l a s ) of Cl (atlas)
S p i n o u sp r o c e s s
of Clll Spinous
process
Vertebralbody of Cll (axis)
o f C l l( a x i s )

I n t e r v e r t e b rdails cs p a c e

V e r t e b r ap r o m i n e n s
( s p i n o u sp r o c e s o
s f CVll)

R i bI
Vertebra
promrnens
(sprnous
Vertebralbody of CVll rllllll!ill;ti processof
cvil))
regionof vertebralcolumn.
Cervical
R a d i o g r a p hA, P v i e w
Cervicalregion of vertebral column.
RadiograPh, view
lateral

23
BACK . Cervicolvertebrae

A n t e r i o tr u b e r c l e
Articularfacetfor dens
Tuberclesfor attachmentof
transverseligamentof atlas
L a t e r am
l ass Anteriorarch

S u p e r i oar r t i c u l afra c e t

Groovefor vertebralartery Transverse


process

Vertebralforamen
Posteriorarch Anteriortubercle

Posteriortubercle

Cl vertebra(atlas)superiorview Cl vertebra(atlas)anteriorview
Anteriorarticularfacet

Dens(odontoidprocess)

S u p e r i oar r t i c u l afra c e t Grooveon posteriorsurface


of densfor transverse
l i g a m e no
t f atlas Anteriorarticularfacet

Superiorarticularfacet
Facetsfor attachment process
Transverse
o f a l a rl i g a m e n t s Interarticularpart

Vertebralforamen
Spinousprocess
Inferiorarticularfacet
Body
Cll vertebra(axis)anteriorview

Body Uncinateprocess
F o r a m e nt r a n s v e r s a r i u m Anteriortubercle

Posteriortubercle

Groovefor
s p i n an
l erve

Superiorarticularfacet
Inferiorarticularprocess
Lamina Inferiorarticularfacet
Vertebralforamen Spinousprocess Spinous (bifid)
(bifid)

CVvertebrasuperiorview CVvertebraanteriorview
Uncinateprocess

joint
Zygapophysial of vertebra

J o i n tc a p s u l e

joint
Uncovertebral
Uncinateprocess
Intervertebral
disc

CV
joint
Uncovertebral
Inferiorarticularfacet
CIV/CVvertebraeanteriorview
24
. . .::..ti.l;,

Anterior

t Anteriortubercleof Cl (atlas)

joint
Medianatlanto-axial
s f Cl(atlas)
T r a n s v e r sper o c e s o
Densof Cll (axis)

ligamentof atlas
Transverse
Foramentransversarium

Posteriorarchof Cl (atlas)

Posteriortubercleof Cl (atlas)

Firstcervicalvertebra(atlas).
C T i m a g e i n a x i a lp l a n e
Posterior

Anteriorarch of Cl (atlas)

Densof Cll (axis) Posteriorarch of Cl (atlas)

Spinousprocessof Cll (axis)

Vertebralbody of Cll (axis)

lntervertebraldiscspace

vertebraeCl-Clll.
Cervical
view
lateral
Radiograph,

Anteriol

Vertebralbody
+
I

Anteriortubercle

Foramentransversarlum Posteriortubercle

Vertebralforamen Spinousprocess

Typicalcervicalvertebra.
C T i m a g e i n a x i a lP l a n e
Posteriol
25
BACK . Thoracicvertebrae

Vertebralbody of Tl

Z y g a p o p h y s ijaoli n t

Intervertebral
foramen

C S Fi n
Intervertebral
disc subarachnoid
space

S p i n acl o r d

S p i n o u sp r o c e s s

Vertebralbody ofTlX
(with compression
fracture)

Vertebralbody ofTXll

Thoracicregionof vertebralcolumn.
Thoracic
vertebraelateralview T 2 - w e i g h t e dM R i m a g e i n s a g i t t a lp l a n e ( c o m p r e s s i o n
f r a c t u r eT I X )

Body
S u p e r i oar r t i c u l apr r o c e s s
Vertebralforamen
S u p e r i ovr e r t e b r anl o t c h Superiorarticularfacet
Demifacetfor articulatton
w i t h h e a do f r i b l l l

Demifacetfor articulation
w i t h h e a do f r i b t l l Facetfor articulation
w i t h t u b e r c l eo f r i b l l l

Superiorarticularfacet
S p i n o u sp r o c e s s
Demifacetfor articulation
w i t h h e a do f r i b l V

Transverse
process Facetfor articulation
w i t h t u b e r c l eo f r i b l l l Inferiorarticularfacet
S p i n o u sp r o c e s s
lnferiorarticularprocess

Tlllvertebrasuperiorview Tlll vertebra lateral view

26
Superiorarticularfacet

process
Transverse

I n f e r i o ar r t i c u l apr r o c e s s
Vertebralbody
ofTV

S p i n o u sp r o c e s s

Tlll vertebraposteriorview

Thoracicaorta

Vertebralbody
ofTXll

Thoracicregion of vertebral column.


Radiograph,APview
S P i n o uP
s rocess

vertebrawith rib articulations.


Thoracic
C T i m a g e i n a x i a lP l a n e

Superiorarticularfacet
S u p e r i ovr e r t e b r anl o t c h

Costalfacet process
Transverse

S p i n o u sp r o c e s s
Vertebralforamen

S u p e r i oar r t i c u l a r
facet

lnferiorvertebralnotch
process
Transverse

lnferiorarticularfacet
InferiorarticularProcess

TXllvertebrasuperiorview TXllvertebralateralview

27
Lumbarvertebrae

V e r t e b r abl o d y S p i n o u sp r o c e s s

V e r t e b r abl o d yo f L l

S p i n o u sp r o c e s s

I n t e r v e r t e b rdails c

process
Transverse

Intervertebralforamen

Z y g a p o p h y s ijaoli n t
Intervertebral
disc Vertebralbody of LV

Lumbar vertebrae lateralview


Lumbarregionof vertebralcolumn.
T 1 - w e i g h t e dM R i m a g e i n s a g i t t a lp l a n e

Vertebral
body of Ll
S p i n anl e r v e
Vertebralbody of Ll

P e di c l e

I n t e r v e r t e b rfaol r a m e n
Intervertebra I
d i s cs p a c e
Intervertebral
foramen

I n f e r i oar r t i c u l apr r o c e s s
S u p e r i oar r t i c u l apr r o c e s s

I n t e r v e r t e b rdails c

Vertebral
body of LV
Vertebralbody of LV

Intervertebralforamina of lumbar region of vertebral column.


T1-weightedMRimagein sagittalplane

Lumbar region of vertebral column.


Radiograph, lateral
view
28
Lumbarvertebrae

Vertebralforamen

Mammillarp
y rocess

process
Transverse

LIVvertebrasuperiorview

process
Transverse

Inferiorarticularprocess

S u p e r i oar r t i c u l apr r o c e s s

I n f e r i o ar r t i c u l apr r o c e s s

S p i n o u sp r o c e s s

Articulationof lumbarvertebrae.
T 1 - w e i g h t e dM R i m a g e i n a x i a lp l a n e

29
BACK. Lumbar
vertebrae

Inferiorvertebralnotch

Spinousprocess

S u p e r i oar r t i c u l apr r o c e s s

M a m m i l l a r yp r o c e s s

Transverse
process

I n f e r i o ar r t i c u l apr r o c e s s S p i n o u sp r o c e s s

LIVvertebraobliqueview

Transverse
process

P a r si n t e r a r t i c u l a r i s S p i n o u sp r o c e s s

Lumbar region of vertebral column (,,Scottiedog,,).


Inferiorarticularprocess
Radiograph,obliqueview

30
Articularfacetfor pelvic
j oci n t )
b o n e( s a c r o - i l i a
Promontory

Lateral
sacralcrest
Posteriorsacralforamina
Median
sacralcrest
lntermediate
sacralcrest
S a c r ahl i a t u s
-Cornua

Sacrumand coccyxanteriorview Sacrumand coccyxposteriorview

S u p e r i oar r t i c u l apr r o c e s s
Vertebralbody of LV
Spinousprocess

Intervertebral
disc

Sacralregion of vertebral column. Sacrumand coccyx lateralview


T2-weighted
MRimagein sagittal plane

31
BACK . lntervertebralforamina
and discs

Intervertebral
disc

N u c l e u sp u l p o s u s

process
Transverse

Vertebralbody
S p i n o u sp r o c e s s

S p i n acl o r d

Intervertebral
disc

S u p e r i oar r t i c u l afra c e t
Anterior amus
Transverse
costalfacet

H y a l i n ec a r t i l a g e

Intervertebral
foramen

Inferiorcostalfacet
Intervertebral
disc
5uperior
Superiorcostalfacet
costotransverse
ligament

R a d i a t el i g a m e n t
joint Lateral
of costovertebral
co5IoIranSverSe
ligament

S y m p a t h e t itcr u n ka n d g a n g l i a

Vertebral
bodyof LV Sacrum G r a ya n d w h i t e r a m ic o m m u n i c a n t e s Rib Intercostalnerve

Intervertebraldisc in lower lumbar Intervertebralforamina and discsin the thoracic region


region of vertebral column.
T2-weighted MRimagein sagittalplane

32
IntervertebroI discproblems

S p i n acl o r d

Vertebralcanal C a u d ae q u i n a
c o n t a i n i n gC S F
a n d c a u d ae q u i n a

H e r n i a t i oo
nf
n u c l e u sp u l p o s u s

LIVvertebra D i s cp r o t r u s i o n

discprotrusionin lowerlumbar
Intervertebral
regionof vertebralcolumn,
T 2 - w e i g h t e dM R i m a g e i n s a g i t t a lp l a n e

V e r t e b r acl a n a cl o n t a i n i n gC S F
discprotrusion
Intervertebral
a n d c a u d ae q u i n a (midsagittalsection)

N u c l e u sp u l p o s u s

A n u l u sf i b r o s u s

H e r n i a t i oo
nf
n u c l e u sp u l p o s u s

Compression of
spinalnerveroots

C a u d ae q u i n a

D i s cp r o t r u s i o n

discprotrusionin lowerlumbar
Intervertebral
regionof vertebralcolumn. discprotrusion(superior
Intervertebral view)
T 2 - w e i g h t e dM R i m a g e i n a x i a lp l a n e

33
BACK o lntervertebral
discproblems

H e r n i a t i oo
nf n u c l e u s
pulposusof L4l15discnot
effectingLIVspinalnervebut
compressingLVand other
nervespassingto lower levels

Intervertebral
discprotrusion(posterior
view)

C5 Deltoid(biceps) ( b i c e p sp, e c t o r a l i s ) S h o u l d e ru, p p e rl a t e r aal r m c4-c5


c6 Wristextension ( b i c e p sb, r a c h i o r a d i a l i s ) l st and 2nd digits (lateralforearm) L)_LO

c7 Triceps Triceps T h i r df i n g e r LO-L/

c8 l n t r i n s i ch a n dm u s c l e s 4th and 5th digits (medialforearm) c7-r1

Clinically
importantnerverootsin the upperlimb

Dorsiflexionof foot at Dorsumoffoot, big toe


a n k l e( b i gt o e e x t e n s i o n ,
foot eversionand
lnverston

Lateralfoot. smalltoe. sole

Clinicallyimportant nerve roots in the lower limb

34
Jointsandli

A n t e r i o rl o n g i t u d i n al li g a m e n t

Externaloccipitalprotuberance
Lumbarvertebralbody

Superiorarticularprocess

S u p e r i oar r t i c u l a r
facet

(spinousprocessof CVll)

S u p r a s p i n o ul isg a m e n t

I n t e r s p i n o ul si g a m e n t

Intervertebral
disc

P o s t e r i ol ro n g i t u d i n a l
ligament

Ligamentaflava

Spinousprocess

Capsule of
joint
zygapophysial

I ransverseoroceSS Supraspinous
Ligamentumnuchaeand ligament
ligament(lateralview)
supraspinous

A n t e r i o rl o n g i t u d i n al li g a m e n t

S u p e r i oar r t i c u l apr r o c e s s
Interspinous
ligament

lnferiorarticularfacet

Inferiorarticularprocess
Ligamentaflava

Vertebralligamentsof the lumbarregion


Interspinous (posterior
obliqueview)
ligament

Supraspinous
ligament

P o s t e r i ol ro n g i t u d i n al li g a m e n t Inferiorarticularprocess

Ligamentaflava

35
BACK. Backmusculature:
surface
onatomy

L i g a m e n t u mn u c h a e
S p l e n i ucsa p i t i s

Levatorscapulae
S u p e r i oar n g l eo f s c a p u l a

R h o m b o i dm i n o r

Latissimus
dorsi

Erectorspinae
lliaccrest

Posterior
viewof maleshowingsurfaceprojections
of backmuscles

36
ialmusculature

S u p e r i onr u c h a l i n e Externaloccipitalprotuberance

Spleniuscapitis

S p i n eo f s c a p u l a AccessorynervelXll
R h o m b o i dm i n o r
Deltoid
Deep branchof transverse
cervicalartery(dorsal
Infraspinatus scapularartery)
Rhomboidmajor
Teresmajor

T r i a n g l eo f a u s c u l t a t i o n Inferiorangleof scapula

Humerus

L a t i s s i m udso r s i

Thoracolumbar
fascia

E x t e r n aol b l i q u e
L u m b a rt r i a n g l e

Superficial - trapeziusand latissimus


musculature dorsi

37
BACK . Superficiol
musculoture

S p l e n i u cs a p i t i s

Dorsalscapularnerve

5uperficialbranchof
transversecervicalartery
S p i n eo f s c a p u l a
Levatorscapulae

R h o m b o i dm i n o r( c u t )

Deepbranchof transverse
cervicalartery(dorsal
scapularartery)

Rhomboidmajor (cut)

Latissimus
dorsi

T e r e sm i n o r

Infraspinatus

E x t e r n aol b l i q u e
Teresmajor

S e r r a t uasn t e r i o r

R h o m b o i dm a j o r

Superficial - levatorscapulae
musculature and rhomboidmajorand minor

38
IntermediatemuscuIature

S e m i s p i n a lci sa p i t i s
S p l e n i ucsa p i t i s

L i g a m e n t u mn u c h a e

Levatorscapulae

Supraspinatus

Acromionof scapula Serratusposteriorsuperior

Teresminor Spleniuscervicis
Infraspinatus

Teresmajor

Posteriorlaverof thoracolumbarfascia

Serratusanterior

Serratusoosteriorinferior

lntermediate
musculature

39
BACK. Deepmusculature

i o i t a lb o n e

S u p e r i onr u c h a l i n e

S e m i s p i n a lci sa p i t i s
Spinousprocessof Cll (axis)

L o n g i s s i m ucsa p i t i s

Vertebraprominens lliocostalis
cervicis
(spinousprocessof CVll)

S p l e n i ucse r v i c i s

l l i o c o s t a l il su m b o r u m

T r a n s v e r s uasb d o m i n i s

P o s t e r i osru p e r i oirl i a cs p i n e

- erectorspinaemuscles
Deepgroupof backmuscles

40
Rectuscapitisposteriorminor

O b l i q u u sc a p i t i ss u p e r i o r
processof Cl (atlas)
Transverse

Rectuscapitisposteriormajor

O b l i q u u sc a p i t i si n f e r i o r

Vertebraprominens
(spinousprocessof CVll)

S e m i s p i n a ltihso r a c i s

Rotatoresthoracis
(long,short)

Levatorescostarum
(short,long)

Multifidus

Erectorspinae(cut)

- transversospinales
Deepgroupof backmuscles muscles
and segmental

41
BACK . Backmusculature:
transverse
section

T r a n s v e r s afl a
i ss c i a

Transversu
a sb d o m i n i s

Internaloblique

E x t e r n aol b l i q u e

Q u a d r a t ulsu m b o r u m

L a t i s s i m udso r s i

E r e c t osr p i n a e Transversospinales

Thoracolumbarfasciaand the deepbackmuscles


section- lumbarregion)
(transverse

T r a n s v e r s uasb d o m i n i s

I n t e r n aol b l i q u e
Psoasmajor
E x t e r n aol b l i q u e

Q u a d r a t u lsu m b o r u m
L a t i s s i m udso r s i

Transverse
process
F/a.t^/ cnin'a

Spinousprocess

Transversospi
nales
t

Lumbarregion(Llll)showingbackmusculature.
C T i m a o e i n a x i a lo l a n e

42
Suboccipital

T h i r do c c i p i t anl e r v e( p o s t e r i orra m u so f C 3 ) Rectuscaoitisoosteriorminor

S u p e r i obr r a n c ho f t h e o c c i p i t aal r t e r y S e m i s p i n a lci sa p i t i s( c u t ) Rectuscapitisposteriormajor

Greateroccipitalnerve O b l i q u u sc a p i t i ss u p e r i o r
(posteriorramusof C2)

S p l e n i ucsa p i t i s( c u t )

Occipitalartery

P o s t e r i orra m u so f C 1
Mastoidprocess
I n f e r i ob
r r a n c ho f t h e oftemporal bone
occipitalartery Transverse process
of Cl (atlas)
Vertebralartery
Posteriorramusof C2
O b l i q u u sc a p i t i si n f e r i o r

Transverse process
L o n g i s s i m ucsa p i t i s of Cll (axis)
S p i n o u sp r o c e s s
of Cll (axis)
I n t e r s p i n a lci se r v i c i s

Posteriorramusof C3 Multifidus

S p i n a l icse r v i c i s
S e m i s p i n a lci sa p i t i s( c u t )

(cut)
Sternocleidomastoid

S p l e n i u cs a p i t i s( c u t )

T r a p e z i u(sc u t ) S e m i s p i n a lci se r v i c i s

Suboccipitalregion

43
BACK . Spinalnerves

c1 Relationof spinalnerverootsto vertebrae


cl
\<}
c2 c S u b a r a c h n o si dp a c e
c3 c

Cervical
c4
ctv C e r v i c ael n l a r g e m e n t
nerves ( o f s p i n a cl o r d )
c5
CV C 1e m e r g e s
LO Cl (atlas) between
CVI s k u l la n d C l
C2-
Cll(axis)- vertebra
cvtl

c8

T1
C2- C7emerge
s u p e r i otro
T2 pedrcles

T3
TIV cvl
r4 C7- C8 emerges
cvll inferiorto
pedicleof CVll
T5 C8- - Vertebra
tvl

T6
Thoracic
nerves T7
will
T8
TIX Nomenclature
of spinalnerves
r9 (posteriorview)

Pedicleof vertebra

L u m b o s a c r a l e n l a r g e m e nLt4
(of spinalcord)
LV-

C o n u sm e d u l l a r i s

E n do f d u r a l / a r a c h n osi da c

Sacraland coccygeal
nerves F i l u mt e r m i n a l e
Sacraland coccygeal nerves
(duralpart)
(posterior view - vertebral arches removed)
- Coccyx

44
Spinalcord

Spinalcordand spinalnervesin vertebralcanal

Centralcanal
Anteriorhorn

Anteriormedian

Pediclesof Posteriorrootlets
vertebrae

Posteriorramus

Posteriormediansulcus

Posteriorintermediatesulcus

Posterolateral
sulcus

Recurrentmeningealbranchesof
s p i n an
l erve
G r a yr a m u sc o m m u n i c a n s

of the spinalcord(thoracicregion)and basic


Features
organization of a spinalnerve(posterior
view)

Vertebralbody Sympatheticganglion

Grayand white rami


communtcanreS

Spinalnerve

Anteriorramus

F i l u mt e r m i n a l e

45
BACK . Spinalcord
vasculoture

Anteriorspinalartery

Anteriorradiculararterv

S e g m e n t aml e d u l l a r y
arteries

Vertebralartery
Ascendingcervicalartery
Deepcervicalartery
Costocervical
trunk

Segmentalspinalartery
Posteriorradiculararterv
Thyrocervical
trunk
Segmentalspinalartery
Subclavianartery Rightposteriorspinalartery
Left posteriorspinalartery
Posteriorradicularartery

S e g m e n t aml e d u l l a r ya r t e r y
Left posterior
intercostalartery
Segmental supplyof
spinalcord(anteriorview)
Segmentalspinalartery Rightposteriorspinalartery
Left posteriorspinalartery
s e g m e n t am
l e d u l l a r ya r t e r i e s
(branchfrom segmentalspinal
artery)
Sulcal(central)
Posteriori ntercostalartery branchesto spinalcord

Posteriorradicularartery

Segmentalspinalartery
Anteriorspinalartery
Arteryof Adamkiewicz
(branchfrom
segmental Posteriorradicularartery
spinalartery)
Anterior
radicularartery
Anterior
radicularartery Segmental
spinalartery
P i aa r t e r i apl l e x u s
Segmental
spinalartery

Anastomoticloopsto
posteriorspinalarteries

Segmental
medullaryartery

Segmental
Lateralsacralartery m e d u l l a r ya r t e r y
Anteriorspinalartery
Rightposterior
intercostalarteries

Left posterior
Arteriesthat supplythe spinalcord intercostalarteries
(anteriorview) Segmental
spinalartery

46
of spinalcord

A n t e r i o ri n t e r n avl e r t e b r aol l e x u s

Anteriorexternal
vertebralplexus

Posteriorinternalvertebralplexus

Accessoryhemiazygosvein

Posteriorramus

Anterior amus
Veinconnectingto Posterior
externalvenousplexus(not shown)

Basivertebral A n t e r i o rs p i n a vl e i n

l o n g i t u d i n al li g a m e n t

Anteriorinternalvertebralplexus

r a d i c u l avr e i n
r a d i c u l avr e i n

Extraduralfat

Posteriorsulcal(central)vein Veinsthat drainthe sPinalcord


(transversesection)
Posteriorinternalvertebralolexus Posteriorspinalvein

47
BACK . Meninges

S u b a r a c h n o si dp a c e

Subarachnoid
space

Intervertebral
foramen

Cord and meninges at thoracic level

Endof spinalcord
a t v e r t e b r a eL l - L l l

C a u d ae q u i n a F i l u mt e r m i n a l e

Caudaequinaand meningesat lumbarlevel

F i l u mt e r m i n a l e( d u r a p
l art)

Nerve roots and meninges at sacrallevel

48
Meninges

Anteriorspinalartery Subarachnoidspace

Arachnoidtrabeculae

Anteriorroot

S p i n anl e r v e

Recurrentmeningealbranches
of spinalnerve

Meningescovering parts of the thoracic region of the spinal cord (posteriorview)

49
BACK . Spinalcord:imaging

Vertebralbody ofCll (axis)

C e r e b r o s p i nfal ul i d i n
s u b a r a c h n o isdp a c e

Cervicalenlargement
of spinalcord

Vertebraprominens
Vertebralbody of CVll (spinousprocessof CVll)

Intervertebraldisc

Cervical
and upperthoracicvertebralcolumnshowing
upperand middleportionsof spinalcord.
T 2 - w e i g h t e dM R i m a g e i n s a g i t t a lp l a n e

50
Spinalcord:

Spinousprocessof
thoracicvertebra
Vertebralbody of
thoracicvertebra
S p i n acl o r d

fluid
Cerebrospinal

lntervertebraldisc

Lumbosacralenlargement
Vertebralbody of Ll
C o n u sm e d u l l a r i s

Thoracicand upperlumbarvertebral
columnshowingmiddleand lowerportions C a u d ae q u i n a
of spinalcordand itstermination.
T2-weighted MR image in sagittal plane
RoshanKetab 02I-669 50 639

S p i n acl o r d

C o n u sm e d u l l a r i s

Vertebralbody of Ll

C a u d ae q u i n a

lntervertebraldisc Spinousprocessof
lumbarvertebra

Endof dural/arachnoidsac

Lumbarand sacralvertebralcolumnshowing
terminationof spinalcordand continuation
andterminationof dural/arachnoidsac.
T2-weighted MR image in sagittal plane

51
BACK . Transverse
section:thoracicregion

L a t i s s i m udso r s i Posteriorintercostalartery Thoracicaorta

Vertebralbody

Externalintercostal

I n t e r n ailn t e r c o s t a l

I n n e r m o sitn t e r c o s t a l
S y m p a t h e t iAc a n g l i o n

W h i t ea n d g r a yr a m ic

S p i n an
l erve

--
rsceral
f P l e ur a
Parietal-J

Spinousprocess
P o s t e r i ocru t a n e o u sb r a n c ho f
I n f r a s pnia t u s p o s t e r i orra m u so f s p i n a nl erve

E r e c t osr p i n a e

R h o m b o i dm a j o r

Transverse section through thoracic region of vertebral column

Thoracicaorta

Thoracicregion of back.
CTimagein axialplane

52
andcutaneousnerves
Dermotomes

GreateroccipitalnerveC2
ThirdoccipitalnerveC3

dorsi
Latissimus

Posteriorcutaneous
branchesT7 - Tl 2

SuperiorclunealnervesLl - L3

lliohypogastricnerveLl

M e d i a cl l u n e a nl e r v e s5 1 - 5 3

lnferiorclunealnerves
5 1- 5 3

Dermatomes nervesofthe back


and cutaneous

53
CONTENTS THORAX
Surface anatomywith bones 56 Cardiacchambers andheartvalves 95
Bonyframework 57 Coronaryvessels 96
Ribs 59 Coronary arteriesand variations 97
Articulations 60 Cardiac conduction system 99
Breast 62 Auscultationpointsandheartsounds 100
Pectoralregion 64 Cardiacinnervation 101
Thoracic wollmuscles 66 Superior media stinum: thYmus 102
Diaphragm 67 Superior mediastinum: veinsand arteries 103
Arteriesof thethoracicwall 68 Superior mediastinum: arteriesandnerves 104
Veinsof the thoracicwall 69 Superiormediastinum:imaging 105
Nerves of thethoracicwall 70 Superior mediastinum: veinsand trachea 106
Lymphatics of thethoracicwoll 71 Mediastinum: imaging 107
lntercostal nerves andarteries 72 Mediastinum: viewfromright t0B
Pleuralcovitiesand media stinum 73 Mediastinum: imaging- viewfromright 109
Parietalpleura 74 Mediastinum: viewfromleft 110
Surfaceprojectionsof pleuralrecesses 75 Mediastinum: imaging-view fromleft 111
Rightlung 76 Posteriormediastinum 112
Leftlung 77 Mediastinum: imaging 114
Lunglobes:surfacerelationship 7B Transversesection: WIII level 118
Lunglobes:imaging 79 Dermatomes andcutaneous nerves 119

Bronchioltree 80 Visceralefferent(motor)innervation of theheart 120


BronchopuImonory segments 81 afferents
Visceral 121
Pulmonary vesselsandplexus 82
PuImonary vessel s:imaging 83
Mediastinum 85
Pericardium 86
Pericardiallayers B7
Anteriorsurfaceof heart BB
Baseanddiaphragmatic surfaceof heart 89
Rightatrium 90
Rightventricle 91
Leftatrium 92
Leftventricle v5

Aorticvalveondcardiacskeleton 94
THORAX. Surface
anatomv
with bones

J u g u l a rn o t c h

joint
Acromioclavicular
Coracoidprocess

of sternum
angle

Anteriorchestwall in a woman

Jugularnotch

Coracoidprocess

M a n u b r i u mo f s t e r n u m
S t e r n aal n g l e

Bodyof sternum

Fourthintercostalspace

Xiphoidprocessof sternum

Costalmargin

Anteriorchestwall in a man

56
S u p e r i otrh o r a c i ca p e r t u r e
(indicated VertebraTl
VertebraTl b y r e dl i n e )

5 c ap u l a
S p i n eo f s c a p u l a

I n f e r i o ar n g l e
of scapula

X i p h o i dp r o c e s s
of sternum

l n f e r i o trh o r a c i c
apefture
(indicated b y r e dl i n e )

Bonyframeworkof thorax Bony framework of thorax


(anteriorview) (posterior view)

Trachea

Aorticarch

P u l m o n a r tyr u n k

R i g h ta t r i u m

Leftventricle

R i g h td o m e o f d i a p h r a g m Leftdome of diaPhragm

Costodiaphragmaticrecess

in chest.
of structures
Positioning
R a d i o g r a P hA, P v i e w
57
THORAX.B onyframework

S u p e r i oar r t i c u l apr r o c e s s

C o s t o v e r t e b rjaoli n t Demifacetfor articulation


S u p e r i oar r t i c u l afra c e t
w i t h h e a do f r i b l l

Facetfor articulation
w i t h t u b e r c l eo f r i b l l

process
Transverse

Demifacetfor articulation
Intercostalspace
w i t h h e a do f r i b l l l
Inferiorarticularfacet
S p i n o u sp r o c e s s
Inferiorarticularprocess

Tll vertebralateralview
S t e r n o c o s tjaoli n t
J u g u l anotch
r

| ,-'.
A r t i c u l asr i t e
for clavicle

Attachment
sitefor rib I M a n u b r i u mo f s t e r n u m

Costalcartilage

S t e r n aal n g l e
Articulardemifacets (manubriosternaI
for rib ll joint)

Sternum
Transverse
ridges

F l o a t i n gr i b s

C o s t am
l argin

Articularfacetsfor
r i b sl l l - V l

Superior process
Superiorarticularfacet Demifacetfor articulation
w i t h h e a do f r i b X Articularfacetsfor j ol i n t
Xiphisterna
r i bV l l
Facetfor articulation
with tubercleof rib X S u p e r i oar r t i c u l apr r o c e s s Xiphoidprocess
of sternum
Transverse
process
Demifacetfor articulation
Superiorarticularfacet
with headof rib Xll

Transverse
process
Inferiorarticularfacet

Inferiorarticularprocess
Spinousprocess
TXvertebralateralview
S p i n o u sp r o c e s s
Inferiorarticularfacet

TXll vertebra lateral view


58
Headwith articularfacet

Articular facet for transverse


orocessof vertebra

Headwith
Areafor attachmentof
articularfacet posteriorscalene

Areafor attachmentof
m i d d l es c a l e n e
Articular facet for
Groovefor subclavianartery vertebral body

Scalenetubercle(attachment
of anteriorscalene)

Groovefor subclavianvein Areasfor attachmentof


serratusanterlor
lnferiorsurface
RibI posteriorview
Articularfacetsfor
vertebralbody

lnternalsurface

Tubercle
Costalcartilage

Costalgroove

Articular facets for vertebral body

Articularfacet for transverse


processof vertebra
Non-articularsurface

Costalcartilage RibV anteriorview


lnternalsurface

Costalgroove

RibV posteriorview

Costalcartilage

Articularfacetfor
vertebralbody

59
THORAX . Articulations
:::.j:,:

S u p e r i ocr o s t afl a c e t
S u p e r i oar r t i c u l apr r o c e s s

Costalfacetof
t r a n s v e r sper o c e s s
M a n u b r i u mo f s t e r n u m

S t e r n aal n g l e

Bodyof sternum

S u p e r i ocr o s t o t r a n s v e r lsi q
eament

R a d i a t el i g a m e n t

C o s t acl a r t i l a g e

X i p h o i dp r o c e s s
of sternum

Costovertebral joints
and sternocostal

C o s t acl a r t i l a g e Sternum

i n t r a - a r t i c u l lai g
r ament
P a i r e ds y n o v i aj o
l ints
Costovertebraljoints
(lateralview)

R a d i a t el i g a m e n t

T u b e r c l eo f r i b Scapula
of thoracicvertebra

Bodyof thoracic
vertebra
L a t e r a lc o s t o t r a n s v e r s el i g a m e n t
Articulation of rib with thoracic vertebra (TlV). S y n o v i a lj o i n t c a v i t i e s

CTimage,withcontrast, C o s t o t r a n s v e r sl ieg a m e n t
in axialplane
joints
Costovertebral
(superior
view)
60
Articulations

F i b r o c a r t i l a g i n oj u
o si n t

C o s t o c h o n d rjauln c t i o n s S y n o v i aj ol i n t
(two compartments)
andintra-articula l i rg a m e n t

S t e r n aal n g l e M a n u b r i o s t e r njaoli n t
(symphysis)

R a d i a t es t e r n o c o s t a l
ligaments

Sternum
C o s t o c h o n d rjauln c t i o n j ol i n t s
lnterchondra

joints
and interchondral
Sternocostal

vertebra
Thoracic

Articulation of costalcartilagewith sternum.


CTimage,withcontrast, in axialplane

61
THORAX. Breost

Axillaryprocess

Anteriorview

Lateralview

Intercostalmuscles

Lactiferousducts

Secretorylobulesof mammarygland

Sagittalsection

62
Left parasternallymphaticvessel
Left subclavian(lymphatic)trunt
Pectoralbranchof
t h o r a c o a c r o m ia rl t e r y l x i l l a r yn o d e s
A p i c aa

Axillaryartery

Lateralthoracicartery Centralaxillarynodes

Pectoralismajor Lateralaxillary
nooeS

A x i l l a r yp r o c e s s S u b s c a p u l a rx i l l a r y
Secondthoracic
nodes
intercostal nerve
Pectoralaxillarynodes
F o u r t ht h o r a c i c
intercostalnerve Drainsto oppositeside

D r a i n si n t o a b d o m i n a l
lymphatics
Parasternal nodes
S i x t ht h o r a c i ci n t e r c o s t anle r v e

Mammarybranchesof
i n t e r n atlh o r a c i ca r t e r y Lymphaticdrainageof breast
Arteriesand innervationof breast

Loterol(axillo) Heod(superior)

Pectoralis
maJor

Retromammary
space

Nippleprofile

Mediolkternum) Feet(inferior)
Mammography. Craniocaudal(cc)view of a normal right Mammography. Mediolateraloblique (mlo) view of a normal right
breast showing a heterogeneouslydense appearance breast showing a heterogeneouslydense appearance

63
THORAX. Pectoral
region
i. ,: :

S u b c l a v i aanr t e r y

Thoracoacromial
artery
Coracoidprocess

Lateralpectoral
nerve

Pectoralismajor
M e d i a lp e c t o r a l
nerve

Clavipectoral
fascia

P e c t o r a l im
s inor
R i g h th u m e r u s
Left humerus

Lateralthoracicartery

S e r r a t uasn t e r i o r
Cut edge of pectoralismajor
Externalintercostal

Externalintercostalmembrane

Pectoralismajor muscleand related deep structures

Pectoralismajor

Internalthoracicartery
P e c t o r a l im
s inor

S e r r a t uasn t e r i o r

Pectoralis
majorand minormuscleson anteriorthoracicwall.
C T i m a g e ,w i t h c o n t r a s t ,i n a x i a lp l a n e

64
Pectoralregion

Coracoidprocess

Subclavius

P e c t o r a l im
s inor

S e r r a t uasn t e r i o r

Externalintercostal

Serratusanterior

lnternalintercostalmusclecovered
bv externalintercostalmembrane

Pectoralis
minorandthe anteriorthoracicwall
(pectoralismajor removed) Externalintercostal

Musclesof the lateralthoracicwall


(pectoralismajor removed)
Vertebraprominens
(spinousprocessof CVll)

Serratusposteriorsuperior

S p l e n i ucse r v i c i s

r Lonqissimus
Posteriorlayerof
thoracolumbarfascia --l I
coveflng I
lliocostalis

Externalintercostal

Serratusoosteriorinferior

E x t e r n aol b l i q u e

of the posteriorthoracicwall
Muscles

65
THORAX. Thoracic
wallmuscles

lnternalintercostal

Intercostalvein
Intercostalartery

Intercostalnerve M a n u b r i u mo f s t e r n u m

Externalintercostal

Bodyof sternum

Xiphoidprocess
of sternum

Costalcartilage

Intercostal
muscles

Transversus
thoracismusclesof the
anteriorthoracicwall

66
Diaphragm

C e n t r atle n d o no f d i a p h r a g m
Sternum
C a v aol p e n i n g
Centraltendon of diaphragm Cavalopening

Costalpart of
diaphragm

L u m b a rp a r to f d i a p h r a g m \ hiatus
Esophageal
Aortic hiatus

Diaphragmsuperiorview

E s o p h a g e ah li a t u s

Lateral
arcuate
ligament
crus Diaphragmwithinthe rib cage
Median
arcuate
ligament
Mediaal rcuate
ligament Aortichiatus

R i g h tc r u s

Inferiorvenacava

R i g h td o m e
R i bV

that passthroughthe diaphragm


Majorstructures of diaphragm
Features

67
THORAX. Arteries
of thethoracicwall

Left costocervical
trunk
Rightsupremeintercostalartery
Leftsubclavianartery
Rightcostocervical
trunk

R i g h ts u b c l a v i aanr t e r y Leftcommon carotidartery

Rightcommon carotidartery

Arch of aorta

Ascendingaorta

Thoracicaorta

Posteriorintercostalarteries
Internalthoracicarteries

terior perforating
orancnes

Collateralbranchof
posteriorintercostalartery

Anteriorintercostalartery

Collateralbranchof
anteriorintercostalartery

M u s c u l o p h r e nai cr t e r y R i g h ts u p e r i oer p i g a s t r iac r t e r y

Abdominalaorta
Arteriesof the thoracic wall

Headof rib
Ascendingaorta
S u p e r i ovr e n ac a v a
P u l m o n a r tyr u n k

Internalthoracicartery

Thoracicvertebra

Posteriorintercostalarteries-

R i g h ta t r i u m
R i g h tv e n t r i c l e
Arteriesof the thoracicwall.
Volume-rendered right lateralview Thoracicaorta
o f s t r u c t u r e si n t h e t h o r a x u s i n g
m u l t i d e t e c t o rc o m p u t e d t o m o g r a p h y

68
Veinsof thethoracicwoll

Left superiorintercostalvein

Leftsuoremeintercostalvein

L e f ti n t e r n ajlu g u l a rv e i n

R i g h ti n t e r n ajlu g u l a rv e i n Leftsubclavianvein

R i g h ts u b c l a v i a n vein
Left brachiocephalic
R i g h tb r a c h i o c e p h a lvi e
c in

Accessory
hemiazygosvein
R i g h ts u p e r i o irn t e r c o s t avle i n

lnternal
Posteriorintercostal thoracicveins

Anteriorintercostalvein

R i g h ts u p e r i o r
intercostalvein

Hemiazygosvein

Left superior R i g h ts u p e r i oer p i g a s t r ivce i n


intercostalvein
R i g h tm u s c u l o p h r e nvi ce i n

lnferiorvenacava
Accessory
hemiazygosvein
Left subcostalvein

Veinsof the thoracicwall

Right
s u b c o s t avle i n

l u m b a rv e i n

Azygossystemof veins

69
THORAX. Nerves
of thethoracicwall

Posteriorbranchof lateral
cutaneousnerve
Lateralcutaneous
b r a n c ho f
intercostalnerve

Anteriorbranch
of lateral
cutaneousnerve

S m a l cl o l l a t e r abl r a n c h
of intercostal

Posteriorramus

Anterior amus
(intercostalnerve)

Smallcollateralbranch

M e d i a cl u t a n e o u sb r a n c h
of posteriorramus

Lateralcutaneousbranch
of posteriorramus

Posteriorbranchof
lateralcutaneousnerve

Nerves of the thoracic wall

Intercostalnerve(anteriorramusof
thoracicspinalnerve)

S m a l cl o l l a t e r abl r a n c h

A n t e r i o rc u t a n e o u sb r a n c h
of intercostalnerve

Lateralcutaneous
branchof intercostal
nerve M e d i a lb r a n c ho f
anteflor cutaneousnerve
Anteriorbranchof
lateralcutaneousnerve

Lateralbranchof
anteriorcutaneousnerve
Intercostal nerves and branches

70
phaticsof the thoracicwall

Thoracicduct
R i g h ti n t e r n ajlu g u l a rv e i n

R i g h t j u g u l atrr u n k

R i g h ts u b c l a v i avne i n

R i o h tb r o n c h o m e d i a s t i nt raul n x
R i g h ti n t e r n ajlu g u l a rv e i n
Leftjugulartrunk R i g h ts u p e r i o r
R i g h tj u g u l a r
tracheobronchial nodes
R i g h ts u b c l a v i atnr u n k Leftsubclaviantrunk
R i g h ts u b c l a v i avne i n
Leftsubclavianvein
R i g h tb r o n c h o m e d i a s t i n a l
t r u nk Left bronchomediastinal
B r a c h i o c e o h an
l io
cdes trunk
lnferior
tracheobronchial
nodes
Left parasternal
Thoracicduct
Rightparasternal lymphaticvessel
lymphaticvessel
Lymphnodesand
vesselsof the trachea

Parasternal
nodes

Thoracicduct

Intercostal
nodes

D i a p h r a g m a t inco d e s

C i s t e r n ca h y l i

R i g h ti n t e r n a l j u g u l a r Left internaljugular vein


Leftjugular trunk
R i g h tj u g u l a r
Lateralaorticnodes
Leftsubclaviantrunk
R i g h ts u b c l a v i atnr u n k

R i g h ts u b c l a v i avne i n Leftsubclavianvein

R i g h tl y m p h a t i cd u c t Left bronchomediastinal
trunk
Majorlymphaticvessels and nodes R i o h tb r o n c h o m e d i a s t i nt raul n k
of the thoracicwall Thoracicduct

Superiorvenacava

of the lymphatictrunks
Termination
71
THORAX. lntercostal
nervesandarteries

Lateralcutaneousbranch Posteriorramusof soinalnerve


Externalintercostal

Internalintercostal

W h i t er a m u sc o m m u n i c a n s
( l r a vr a m u sc o m m u n t c a n s
lntercostalnerve

Innermosl lnternalintercostal Sympathetictrunk


intercostal membrane
Posteriorbranchof
Spinalnerve
lateralcutaneousnerve

lntercostalnerves
Lateralcutaneousbranch
of intercostalnerve

Parietalpleura
Transversus
thoracis

Anteriorcutaneousbranchof intercostalnerve
-:
:.".,:_,..,,1"",:
Anteriorbranchof
lateralcutaneousnerve

Lateralbranchof anteriorcutaneousnerve Medialbranchof anteriorcutaneousnerve

Posteriorbranchof posteriorintercostalartery
Externalintercostal

Internalintercostal

Thoracicaorta
l n t e r n ailn t e r c o s t a l
memorane

Intercostal
arteries

Internalthoracicartery
Anteriorintercostalartery

Transversus
thoracis

Anteriorperforatingbranch

72
Pleuralcavitiesandmediastinum

A p e xo f r i g h tl u n g

R i g h tm a i nb r o n c h u s
Left pleuralcavity

P l e u r acl a v i t y V i s c e r apl l e u r a

Mediastinum

P a r i e t apl l e u r a Mediastinum
( o nt h o r a c i cw a l l )

Costomediastinal
recess

recess
Costodiaphragmatic

R i g h tl u n g L e f tl u n g Pleuralcavities

H e a r ti n m e d i a s t i n u m Rightlung Mediastinum L e f tl u n g

R i g h tl u n g Left lung R i g h td o m e o f d i a p h r a g m Leftdome of diaphragm


Organizationof the thoracic cavity. Organizationof the thoracic cavity.
in axialplane
CTimage,with contrast, in coronalplane
CTimage,withcontrast,

73
pleura
THORAX. Parietal

Costalpleura

Spacefor root of lung

P u l m o n a r lyi g a m e n t

Costalpleura(cut)

Parietalpleuralreflections
and recesses

Costomediastinal
recess

Costodiaphragmatic
recess

74
Surfaceprojections
of pleuralrecesses

Horizontalfissure

Costomediastinal
recess

O b l i q u ef i s s u r e

R i bv i l l Costodiaphragmatic
recess

R i bX

P a r i e t apl l e u r a

Surfaceprojections
of the pleuraand lungs(anteriorview)

S p i n o u sp r o c e s o
s fTlV

R i bV
Costodiaphragmatic
recess
R i bV I

Ribvill

Costodiaphragmatic
recess
R i bX
Surfaceprojections
of the pleuraand lungs(posterior
view)

Surface projections of the


pleura and right lung (lateralview)

75
THORAX.Ri

S u p e r i olro b e
S u p e r i olro b e

Horizontalfissure

Horizontalfissure

Lobesof the rightlung(anteromedial


view)

Rightcommon carotidartery

Rightsubclavianartery

R i g h ti n t e r n ajlu g u l a rv e i n

R i g h ts u b c l a v i avne i n
Brachiocephalic
trunk

Rightbrachiocephalic
vein Arch of azygosvein
Costalcartilageof rib I

Left brachiocephalic
vein
Obliquefissure

Bronchusto suoeriorlobe
Superiorvenacava

Bronchialarteries

B r o n c h u tso m i d d l e
and inferiorlobes
Hilum

Esophagus

Azygosvein

P u l m o n a r lyi g a m e n t

Obliquefissure

Diaphragmaticsurface

Inferiorvenacava Inferiorborder

(medialview)
Rightlungand relatedstructures

76
Leftlung

5 u p e r i o lro b e

Lobesof the left lung (anteromedialview)

Leftsubclavianartery

Leftlung (lateralview)
L e f ti n t e r n ajlu g u l a rv e i n

Left brachiocephalic
vein

Costalcartilageof rib I

Leftcommon carotidartery
O b l i q u ef i s s u r e B r a c h i o c e p h atl ri cu n k

Arch of aorta

Accessoryhemiazygosvein

Pulmonaryartery

Bronchialarteries
Hilum

P u l m o n a r vy e i n s

C a r d i a ci m p r e s s i o n

Esophagus

P u l m o n a r yl i g a m e n t
Cardiacnotch

Thoracicaorta

Hemiazygosvein

Diaphragmaticsurface
Inferiorborder

Left lung and related structures (medial view)

77
THORAX.Lu Iobes:surfacerelation ship

Superiorlobe of right lung Superiorlobe of left lung

Horizontalfissure
R i bI V Rib IV
Middle lobe of right lung
R i bV

Obliquefissure Obliquefissure

Inferiorlobe of right lung Inferiorlobe of left lung

Surfaceprojectionsof the lobesand fissuresof the lungs(anteriorview)

Superiorlobe of left lung Superiorlobe of right lung

R i bV
Obliquefissure Obliquefissure
R i bV I

Inferiorlobe of left lung Inferiorlobe of right lung

R i bX

Surfaceprojectionsof the lobesand fissuresof the lungs(posteriorview)

78
3

nl#

Superiorlobe of left lung

S u p e r i olro b eo f r i g h tl u n g

O b l i q u ef i s s u r e

Obliquefissure

I n f e r i o lro b eo f r i g h tl u n g Inferiorlobe of left lung

arevisible.
superiorand inferiorlobes.Theobliquefissures
Rightlungand left lung demonstrating
C T i m a g e ,w i t h c o n t r a s t ,i n a x i a lp l a n e

S u p e r i olro b eo f r i g h tl u n g
Superiorlobe of left lung

M i d d l el o b eo f r i g h t l u n g

Obliquefissure

I n f e r i o lro b eo f r i g h tl u n g Inferiorlobe of left lung

with the left lungis visible.


superiorand inferiorlobes.Theobliquefissureassociated
C T i m a g e ,w i t h c o n t r a s t ,i n a x i a lp l a n e

Superiorlobe of left lung


M i d d l el o b eo f r i g h tl u n g

O b l i q u ef i s s u r e
O b l i q u ef i s s u r e

Inferiorlobe of left lung


I n f e r i o lro b eo f r i g h tl u n g

Rightlung demonstrating middleand inferiorlobesandthe left lungdemonstrating


superiorand inferiorlobes.Theobliquefissuresarevisible.
C T i m a g e ,w i t h c o n t r a s t ,i n a x i a lp l a n e

79
THORAX. Bronchialtree

S u p e r i otrh y r o i dn o t c h

Superiorhorn of thyroid cartilage

R i g h tl a m i n ao f t h y r o i dc a r t i Left laminaof thyroid cartilage

Inferlorhorn of Trachealmucosa
Cricothyroidligament thyroid cartilage
Arch of cricothyroidcartilage
Cricothyroidarticularcapsule
L o n g i t u d i n af ol l d so f m u c o s a
posteriorw a l l
Fibromuscular
C r i c o t r a c h elai gl a m e n t
Trachealcartilage(cut) i,--L^-l
I rolr rEdr
-^-+:l^-^-
Lor uro9s5

C u te d g eo f m u c o s a
Trachealcartilages

A n n u l a rl i g a m e n t so f t r a c h e a

Trachealmucosa Trachealbifurcation Trachea


Left main bronchus
(anteriorview) (posterior view)

R i g h tm a i nb r o n c h u s

B r a n c h eosf
r i g h ts u p e r i o r
lobar bronchus
Branchesof left superior
l o b a rb r o n c h u s

Branchesof
r i g h tm i d d l e
l o b a rb r o n c h u s

Bronchialcartilages

Branchesof
right inferior
l o b a rb r o n c h u s
Branchesof left inferior
l o b a rb r o n c h u s

Tracheaand bronchialtree

80
Bronchopulmon

Apicoposteriorsegment(5 | & ll)


Apicalsegment(5 l)
Posteriorsegment(5 ll)
Superiorlobe
Superiorlobe
Anteriorsegment(Slll)
Anteriorsegment(5 lll)
Superiorsegment(SVl)

Superiorsegment(SVl)
Superiorlingular
segment(s lv)
Medialsegment
(sv) lnferior lobe
lingular
lnferior lobe Posteriorbasal
segment (5 V)
Middle lobe segment(5

Anteriorbasal
M e d i a lb a s a l segment(SVlll)
segment(SVll)
Medialbasalsegment(5 Vll)
Anteriorbasalsegment(SVlll) Lateralbasalsegment(SlX)
Lateralbasalsegment(SlX)

Rightlung (medialview) Left lung (medialview)

Apicoposteriorsegment(5 l& ll)

Anteriorsegment(5 lll)

Apicalsegment(S

Superiorlingularsegment(SlV)
Anteriorsegment(Slll)
Superior
segment(5 Vl)
Lateralsegment(SlV) lingularsegment(SV)
Medialsegment(SV)
Superior
Anteriorbasalsegment(SVlll)
Anteriorbasalsegment(SVlll) segment(SVl)
Posteriorbasal
segment(5 X) basalsegment(SlX)
Lateralbasalsegment(SlX)
Medialbasal
segment(s vll)

Apicalsegment(Sl) Posteriorbasalsegment(5 X) Apicoposteriorsegment


(sr&rD
Superiorlobe Superiorlobe
Posteriorsegment(Sll)
Anteriorsegment(Slll)
Anteriorsegment(Slll)
Superiorsegment
(svr)
S u p e r i olri n g u l a r
Superiorsegment segment(s lv)
(svl)
Middle lobe Inferiorlingular
segment(S lnferior lobe
Medial
lnferior lobe segmenr
(sv) Posteriorbasal
segment(s x)
Posteriorbasal Anteriorbasal
segment(SX) segment(s vlll)

Lateralbasalsegment(5 lX)
(s lx)
segment
Right lung (lateralview) Left lung (lateralview)
segments
Bronchopulmonary
81
THORAX. Pulmonary
vessels
and

Trachea
Rightcommon carotidartery Leftcommon carotidartery

A p e xo f r i g h tl u n g Apex of left lung

R i g h ts u b c l a v i aanr t e r y Leftsubclavianartery

B r a c h i o c e p h a tl ircu n k b r a c h i o c e p h a lvi e
c in

C u ts u r f a c e
o f r i g h tl u n g
Cut surfaceof left lung
5uperiorvenacava
Arch ofaorta
R i g h ts u p e r i o r Left pulmonaryartery
l o b a rb r o n c h u s Leftsuperiorlobar
R i g h tp u l m o n a r ya r t e r y bronchus
Left superiorlobar
R i g h tm i d d l e
bronchus
l o b a rb r o n c h u s ( l i n g u l ad i v i s i o n )
R i g h tp u l m o n a r yv e i n s Left pulmonaryveins
Left inferiorlobar
DroncnuS
R i g h ti n f e r i o r
l o b a rb r o n c h u s
Thoracicaorta

Diaphragmatic
surface Esophagus

Pulmonary
vessels Leftcervicalcardiacnervesfrom
v a g u sa n d s y m p a t h e t itcr u n k
Rightcervicalcardiacnervesfrom
v a g u sa n d s y m p a t h e t itcr u n k
Firstthoracicsympatheticganglion
Rightrecurrentlaryngealnerve
Left sympathetictrunk
R i g h ts y m p a t h e t itcr u n k
Leftcommon carotidartery

Leftsubclavianartery

Leftvagusnerve
Arch of aorta
Left recurrentlaryngealnerve
R l g h tv a g u sn e r v e Branchto left plexusfrom
recurrentlaryngealnerve
B r a n c h etso c a r d i a ca n d p u l m o n a r yp l e x u s e s
C a r d i a cp l e x u s
A n t e r i o rp u l m o n a r yp l e x u s Anteriorpulmonaryplexus

R i g h tp u l m o n a r ya r t e r y
Left pulmonaryartery
R i g h tm a i nb r o n c u s
Left main bronchus

F i f t ht h o r a c i cs y m p a t h e t igca n g l i o n Posteriorpulmonaryplexus
Esophagus
Leftvagusnerve
R i g h tv a g u sn e r v e Thoracicaorta

Pulmonaryplexus
82
imaging
vessels:

Ascending
aorta
P u l m o n a r tyr u n k

f s u p e r i o vr e n ac a v a
Left pulmonaryartery
R i g h tm a i nb r o n c h u s Left main bronchus

Esophagus Thoracicaorta

Ascending
aorta P u l m o n a r tyr u n k

S u p e r i ovr e n ac a v a Left pulmonaryartery


R i g h ts u p e r i o pr u l m o n a r yv e i n Leftsuperiorpulmonaryvein

R i g h tp u l m o n a r ya r t e r y
R i g h tm a i nb r o n c h u s L e f tm a i nb r o n c h u s

Esophagus Thoracicaorta

Ascending
aorta P u l m o n a r tyr u n k

S u p e r i ovr e n ac a v a

R i g h ts u p e r i o pr u l m o n a r yv e i n Leftsuperiorpulmonaryvein

Left main bronchus


R i g h tp u l m o n a r ya r t e r y
R i g h tm a i nb r o n c h u s Left pulmonaryartery

Esophagus Thoracicaorta

A throughC - Relationships pulmonaryveins,and bronchiin the mediastinum.


of the pulmonaryarteries,
. i t h c o n t r a s t ,i n a x i a lp l a n e
C Ti m a o e s w

83
PuImonaryvessel
s:imaging

t
R i g h tv e n t r i c l e
Ascending
aorta

S u p e r i ovr e n ac a v a

R i g h ts u p e r i o pr u l m o n a r yv e i n L e f ts u p e r i o pr u l m o n a r yv e i n

R i g h tp u l m o n a r ya r t e r y
R i g h tm a i nb r o n c h u s L e f tm a i nb r o n c h u s
Left pulmonaryartery
Esophagus Thoracicaorta

' **i
I Ascending
aorta R i g h tv e n t r i c l e

R i g h ta t r i u m

Leftatrium Leftventricle

R i g h ts u p e r i o pr u l m o n a r yv e i n Leftsuperiorpulmonaryvein
R i g h tp u l m o n a r ya r t e r y

R i g h tm a i nb r o n c h u s Bronchi
Left pulmonaryartery
E s o p h augs

Thoracicaorta

R i g h tv e n t r i c l e

R i g h ta t r i u m

Leftventricle

Leftatrium
Left inferiorpulmonaryvein

E s o p h augs

Thoracicaorta

D throughF - Relationships
of the pulmonaryarteries,
pulmonaryveins,and bronchiin the mediastinum.
, i t h c o n t r a s t ,i n a x i a lp l a n e
C Ti m a g e s w

84
Mediastinum

R i g h tc o m m o nc a r o t i da r t e r y Leftcommon carotidartery

R i g h ti n t e r n ajlu g u l a rv e i n L e f ti n t e r n ajlu g u l a rv e i n

R i g h ts u b c l a v i aanr t e r y

R i g h ts u b c l a v i avne i n

R i g h tb r a c h t o c e p h a lvi e
cin Left brachiocephalic
vein
B r a c h i o c e p h atl ri cu n k
Arch of aorta
S t e r n aal n g l e
Left pulmonaryartery
Branchesof right
p u l m o n a r ya r t e r y

Structures
of the mediastinum
asthey relateto the surface

Middle
mediastinum

Posterior
mediastinum

5ubdivisions
of the mediastinum
(transversesection)

85
Trachea

Leftcommon carotidartery
Rightcommon carotidartery
C e r v i c apl a r i e t apl l e u r a
C e r v i c apl a r i e t apl l e u r a
R i g h tp h r e n i cn e r v e Left phrenicnerve

R i g h ts u b c l a v i aanr t e r y Leftsubclavianartery

R i g h ti n t e r n atlh o r a c i ca r t e r y
Left internalthoracicartery
R i g h tb r a c h i o c e p h a lvi ce i n
Left brachioceohalic
vein
B r a c h i o c e p h atl ri cu n k
Arch of aorta
S u p e r i ovr e n ac a v a
L i g a m e n t u ma r t e r i o s u m

B r a n c h eosf r i g h t Left pulmonaryartery


p u r m o n a r ya r t e r y

Right
p e r i c a r d i a c o pr ehn i c
vessels Left
pericardiacophrenic
vessels
R i g h tp h r e n i c
n e r v ea n d F i b r o u sp e r i c a r d i u m
p e r i c ar d i a c o p rhe n i c
a r t e r ya n d v e i n

costalpleura

Diaphragm
Esophagus

Pericardium
with nervesand vessels

B r a c h i o c e p h atl ri cu n k
R i g h tb r a c h i o c e p h a lvi ce i n L e f tb r a c h i o c e p h a lvi e
c in

Arch of aorta

S u p e r i ovr e n ac a v a
P u l m o n a r tyr u n k

Ascending
aorta

R i g h ta t r i u m

Leftventricle

Mediastinal
structures
and lungs.
C T i m a g e ,w i t h c o n t r a s t ,i n c o r o n a lp l a n e

86
. ,ij.ti

Junctionbetweenfi brous
pericardium
a n da d v e n t i t i a
nf nre:t vo<<el<

Pericardial
cavity Trachea

Viscerallayerof serous
Aorta
F i b r o u sp e r i c a r d i u m pericardium (epicardium)
Myocardium
Pulmonaryartery

pericardialsinus
Transverse

O b l i q u ep e r i c a r d i asli n u s

Leftatrium

Endocardium
Parietallayerof serous I Subepicardial fat
pericardium Esophagus
Pericardial
cavity

Leftventricle

Diaphragm Thoracicaorta

Inferiorvena cava

Superiorvenacava

Arch of aorta

Left pulmonaryartery
pericardialsinus
Transverse
Ascendingaorta

B r a n c h eosf r i g h t
pulmonaryartery

Left pulmonaryveins

R i g h tp u l m o n a r yv e i n s
C u te d g eo f p a r i e t apl l e u r a

Cut edge of O b l i q u ep e r i c a r d i asli n u s


m e d i a s t i n apll e u r a

Cut edge offibrous


pericardium and
parietallayerof
s e r o u sp e r i c a r d i u m prominence
Esophageal

Cut edge of fibrous


pericardium and
parietallayerof
Diaphragm
serouspericard;um

Inferiorvenacava

Pericardialsacwith heart removed

87
THORAX . Anteriorsurfaceof heart

C u t e d g eo f p e r i c a r d i u m

Arch of aorta

S u p e r i ovr e n ac a v a Ligamentum
arteriosum

Ascending
aorta Branchesof left
p u l m o n a r ya r t e r y

P u l m o n a r tyr u n k
B r a n c h eosf r i g h t
p u r m o n a r ya r t e r y p u l m o n a r yv e i n s

R i g h ta t r i u m Leftauricle

A n t e r i o ri n t e r v e n t r i c u l a r
branchof left coronaryartery
pulmonary
Right *,"r-L ( l e f ta n t e r i o d
r escending)
G r e a tc a r d i a cv e i n
C o r o n a r sy u l c u s A n t e r i o ri n t e r v e n t r i c u l a r
R i g h tc o r o n a r ya r t e r y s u l c u s( c o n t a i n i n vge s s e l s )

Leftventricle

O b t u s em a r g i n

S m a l cl a r d i a cv e i n

I n f e r i ovr e n ac a v a Apex
R i g h tv e n t r i c l e I n f e r i om
r argin

Anterior surfaceof the heart

Ascending
aorta
P u l m o n a r tyr u n k

R i g h ta u r i c l e

R i g h ta t r i u m
A n t e r i o ri n t e r v e n t r i c u l b
aranch
of left coronaryartery
( l e f ta n t e r i o d
r escending)
R i g h tc o r o n a r ya r t e r y
Leftventricle

R i g h tv e n t r i c l e

Anteriorviewof the heart.


V o l u m e - r e n d e r e da n t e r i o rv i e w u s i n g m u l t i d e t e c t o rc o m p u t e d t o m o g r a p h y

88
Arch of aorta
Left pulmonaryartery Leftatrium
Pericardial
reflections Left pulmonaryveins R i g h tp u l m o n a r ya r t e r y

R i g h tp u l m o n a r yv e i n

Left pulmonaryartery S u p e r i ovr e n ac a v a

Leftsuperior
p u l m o n a r yv e r n

Left atrium

Left inferior
pulmonary
vetn
R i g h ta t r i u m

Right
p u l m o n a r yv e t n s
Leftventricle R i g h ta t r i u m
R i g h tv e n t r i c l e
viewof the heart.
Posterior
V o l u m e - r e n d e r e dp o s t e r i o rv i e w u s i n g
S u l c u st e r m i n a l i s m u l t i d e t e c t o rc o m p u t e d t o m o g r a p h y

Arch of aorta

lnferiorvenacava
ApeX -

Leftventricle R i g h tv e n t r i c l e
S u p e r i ovr e n ac a v a
C o r o n a r ys i n u s Left pulmonaryartery

Baseof the heart

R i g h tp u l m o n a r ya r t e r y

L e f tp u l m o n a r yv e i n s

G r e a tc a r d i a cv e i n R i g h tp u l m o n a r yv e i n s

Leftatrium
R i g h ta t r i u m
Circumflexbranchof
left coronaryartery
lnferiorvenacava

C o r o n a r ys u l c u s

C o r o n a r ys i n u s S m a l cl a r d i a cv e i n

Leftventricle
P o s t e r i oi rn t e r v e n t r i c u l a r
branchof right coronaryarterY
( r i 9 h tp o s t e r i odr e s c e n d i n g )

Diaphragmaticsurfaceof the heart P o s t e r i oirn t e r v e n t r i c u l sa ur l c u s


( c o n t a i n i n vge s s e l s )
R i g h tv e n t r i c l e
Apexj M i d d l ec a r d i a cv e i n

89
THORAX. Rightatrium

Arch of aorta

R i g h ta u r i c l e
Superiorvenacava

T r i c u s p i vda l v e
L i m b u so f f o s s ao v a l i s

R i g h tv e n t r i c l e

Fossaovalis

Inferiorvenacava

Valveof inferiorvena cava O p e n i n go f c o r o n a r ys i n u s


V a l v eo f c o r o n a r ys i n u s

Internalviewof rightatrium

R i g h ta t r i u m

Leftatrium

Positioningof right atrium in relation to other cardiacchambers.


CTimage,with contrast,in axialplane
90
Rightventricle

S u p e r i ovr e n ac a v a
Arch of aorta

arteriosum
Ligamentum

R i g h ta u r i c l e

R i g h ta t r i u m

C o n u sa r t e r i o s u s

S e p t o m a r g i n tarla b e c u l a

A n t e r i o rp a p i l l a r ym u s c l e P o s t e r i opr a p i l l a r ym u s c l e

Internalview of right ventricle

of rightventriclein relationto othercardiacchambers.


Positioning
C T i m a g e ,w i t h c o n t r a s t ,i n a x i a lp l a n e

91
Arch of aorta

Leftventricle

P u l m o n a r vy e i n s

Valveof foramenovale

Leftatrium

M i t r a lv a l v e

Inferiorvenacava

Internal view of left atrium

R i g h ta t r i u m

Positioningof left atrium in relation to other cardiacchambers.


CTimage,with contrast, in axialplane
92
Leftventricle

Arch of aorta

G r e a tc a r d i a cv e i n
M i t r a lv a l v ep o s t e r i ocr u s p

M i t r a lv a l v ea n t e r i o cr u s p

C h o r d a et e n d i n e a e

P u l m o n a r vy e i n s

A n t e r i o rp a p i l l a r ym u s c l e

Leftatrium

T r a b e c u l acea r n e a e

P o s t e r i opr a p i l l a r ym u s c l e
lnternal view of left ventricle

Positioningof left ventricle in relation to other cardiacchambers.


CTimage,with contrast, in axialplane

93
THORAX . Aorticvalveandcardiacskeleton

Ascending
aorta

O p e n i n gf o r r i g h t I A o r t i cs i n u s Nodule
Aorticsinus
s e m i l u n acr u s p

Right
coronary
anery

Rightcoronaryartery Left coronaryartery

Lateralview of the Superiorviewof the


aortic valve in diastole aorticvalvein systole
R i g h ts e m i l u n acr u s p Left semilunarcusp

P o s t e r i osre m i l u n acr u s o

Anteriorview of the aorticvalve


(resectedand openedout)

F i b r o u sr i n go f p u l m o n a r yv a l v e

Leftcoronaryartery Rightcoronaryartery

Leftfibroustrigone

Left Right

Anteriorcuspof mitralvalve Fibrousring ofaortic valve

Anteriorcuspof tricuspidvalve

Leftatrioventricularring Atrioventricula
b ru n d l e

Coronarysulcus

Rightatrioventricularring
Posteriorcuspof mitralvalve

Coronarysinus
Posteriorcuspof tricuspidvalve

Rightfibroustrigone Septalcuspof tricuspidvalve

Posterior

Cardiacskeletonsuperiorview
(atriaremoved)

94
Cordiacchombersondheartvalves

Rightcommon carotidartery
Left common carotidarterv Left internaljugular vein
R i g h ti n t e r n ajlu g u l a rv e i n

Rightsubclavianartery Left subclavianarterv

Leftsubclavianvein

R i g h ts u b c l a v i avne i n

R i g h tb r a c h i o c e p h a lvi ce i n Left brachioceohalic


vein

Arch ofaorta

Pulmonary
trunk
P u l m o n a r vy a l v e

Superiorvenacava oeoxygenated
blood
I

Deoxygenotedblood Branchesof left


pulmonaryartery

Branchesof right
purmonary

pulmonaryveins

Leftauricle

\ Oxygenatedblood

R i g h tp u l m o n a r y Aorticvalve

Mitralvalve

Anteriorinterventricular
Oxygenatedblood sutcus

R i g h ta t r i u m Leftventricle

Coronarysulcus
Obtusernargin

Tricuspidvalve

Inferiorvenacava

Inferiormargin

Cardiacchambersand directionof bloodflow

95
THORAX . Coronary
vessels

Leftcoronaryartery
Ascending
aorta

C i r c u m f l ebx r a n c h
of left coronaryartery

R i g h tc o r o n a r ya r t e r y
G r e a tc a r d i a cv e i n

C o r o n a r ys u l c u s
A n t e r i o ri n t e r v e n t r i c u l a r
branchof left coronaryartery
( l e f ta n t e r i o d
r escending)
A n t e r i o rc a r d i a cv e i n s
A n t e r i o ri n t e r v e n t r i c u l vaer i n

S m a l cl a r d i a cv e i n

Marginalvessels

Cardiacvasculatureanterior view
C o r o n a r ys u l c u s
Leftatrium

T h o r a c i ca o r t a Rightpulmonary
artery Oblique
veinof
l e f ta t r i u m
G r e a tc a r d i a cv e i n
R i g h tc o r o n a r y
C i r c u m f l ebx r a n c h artery
of left coronary
artery

Posterior
c a r d i a cv e i n

C o r o n a r ys i n u s

S m a l cl a r d i a cv e i n

Posterolateral
branch R i g h ta t r i u m P o s t e r i oirn t e r v e n t r i c u l a r
of circumflex
b r a n c ho f r i g h tc o r o n a r y
C o r o n a r ys i n u s Thoracia
c orta a r t e r y( r i g h t
p o s t e r i odr e s c e n d i n g )

Posterior
viewof the heartshowingthe coronarysinus M i d d l e c a r d i a cv e i n
V o l u m e - r e n d e r e dp o s t e r i o rv i e w u s i n g m u l t i d e t e c t o rc o m p u t e d t o m o g r a p h y
Posteroinferiorview

96
Coronaryarteriesand variations

Ascending
aorta

Leftcoronaryartery

S i n u - a t r i anlo d a lb r a n c h
of right coronaryartery Leftauricle

Circumflexbranch
of left coronaryartery

Left marginalbranch
of circumflex
R i g h tc o r o n a r ya r t e r y

Anteriorinterventricular
R i g h ta t r i u m branchof left
coronaryartery

R i g h tv e n t r i c l e Leftventricle

D i a g o n abl r a n c ho f
anteriorinterventricular

P o s t e r i oirn t e r v e n t r i c u l a r
branchof right coronarYartery

Coronaryarteries(rightdominantsystem)

P o s t e r o l a t e rbarla n c h e s Anteriorinterventricular Leftcoronary Circumflexbranch


Rightcoronaryartery of right coronaryartery branchof left coronaryartery artery of left coronaryartery

R i g h tm a r g i n abl r a n c h P o s t e r i oirn t e r v e n t r i c u l b
aranch branches
septalbranch Diagonal
Interventricular of branch
Leftmarginal
of right coronaryartery of right coronaryartery ofanteriorinterventricular ofcircumflex
anteriorinterventricular

Coronaryangiography (right dominant system). Coronaryangiography (right dominant system).


obliqueprojection,
Leftanterior cranialangulation,
of rightcoronary
artery Leftanteriorobliqueprojection, of leftcoronaryartery
cranialangulation,

97
THORAX . Coronary
orteries
andvariations

Ascendingaorta

Leftcoronaryartery

Leftauricle

C i r c u m f l ebx r a n c h
of left coronaryartery

L e f tm a r g i n abl r a n c h
of circumflex
Rightcoronaryartery

Anteriorinterventricular
R i g h ta t r i u m
branchof left
coronaryartery

Rightventricle Leftventricle

M a r g i n abl r a n c h
of right coronaryartery

Posteriorinterventricularbranchof
circumflex

Coronaryarteries(leftdominantsystem)

Anteriorinterventricular Leftcoronary Circumflexbranch


Rightcoronaryartery of left coronaryartery artery of left coronaryartery

R i g h tm a r g i n abl r a n c h P o s t e r i oi rn t e r v e n t r i c u l a r Posterolateralbranch Left maroinalbranch


of right coronaryartery branchof circumflex of circumflex of circumflex

Coronary angiography (left dominant system). Coronaryangiography (left dominant system).


L e f t a n t e r i o ro b l i q u e p r o j e c t i o n c, r a n i a la n g u l a t i o n ,o f r i g h t c o r o n a r ya r t e r y obliqueprojection,
Leftanterior cranial
angulation,
of leftcoronary
artery

98
Cardiacconductionsystem

P u l m o l a r yt r u n k

Superiorvena cava Conductionsystemofthe heart

S i n u - a t r i anlo d e

R i g h tb u n d l eb r a n c h

Septomarginal
trabecula

Inferiorvenacava
Rightchambers

Rightventricle

A n t e r i o rp a p i l l a r ym u s c l e

P u l m o n a r tyr u n k

Left bundle branch

A n t e r i o rp a p i l l a r ym u s c l e
P u l m o n a r vy e i n s

Posteriorpapillarymuscle

99
pointsandheartsounds
THORAX. Auscultotion

Auscultationposition Auscultationposition
for aorticvalve for pulmonaryvalve

Pulmonaryvalve

Mitralvalve

Auscultationposition
for mitralvalve

points
Auscultation

Closureof mitraland tricuspidvalves


II

Heart sounds
"lupp" "dubb" "lupp"
+SYSTOLE+<- DTASTOLE+ +SYSTOLE
+

Cardiacauscultaiion

100
Cardiacinnervation

Trachea

Rightcommon carotidartery Leftcommon carotidartery

R i g h ts y m p a t h e t itcr u n k Left sympathetictrunk

Leftvagusnerve
Rightvagusnerve

Left recurrentlaryngealnerve
Rightrecurrentlaryngealnerve

R i g h ts u b c l a v i aanr t e r y
Left subclavianartery

Rightrecurrentlaryngealnerve

T h o r a c i c a r d i a cb r a n c ho f v a g u sn e r v e Thirdthoracicsympatheticganglion

B r a c h i o c e p h atl ri cu n k Thoracic(sympathetic)cardiacbranches

T h o r a c i (cs y m p a t h e t i c )a r d i a cb r a n c h e s
Thoraciccardiacbranchof vagusnerve

Arch of aorta
D e e pc a r d i a cp l e x u s
5uperficialcardiacplexus
R i g h ts u p e r i o lro b a rb r o n c h u s Left recurrentlaryngealnerve
arteriosum

Left pulmonaryartery

Superiorvenacava Leftsuperiorlobar bronchus

Branchesof right
p u l m o n a r ya r t e r y Left pulmonaryveins

R i g h tp u l m o n a r yv e i n s

lnferiorvenacava

Esophagus

RoshanKeab O2I- 669 SO639


Cardiacplexusand nervesofthe heart

101
THORAX. Superior
mediastinum:
thymus

Esophagus

Rightcommon carotidartery
Left common carotidartery
R i g h ti n t e r n ajlu g u l a rv e i n
L e f ti n t e r n ajlu g u l a rv e i n

R i g h ts u b c l a v i aanr t e r y
subclavianartery

R i g h ts u b c l a v i avne i n Leftsubclavianvein
R i g h tb r a c h i o c e p h a lvi ce i n Left brachiocephalic
vein
Superiorvenacava Arch of aorta
Sternal
Left pulmonaryartery
B r a n c h eosf r i g h t Left main bronchus
pulmonaryartery
Thoracicaorta
Ascendingaorta

Surfaceprojections
of structures
in the superiormediastinum

Esophagus
Rightcommon carotidartery common carotidartery

R i g h ti n t e r n ajlu g u l a rv e i n Left internaljugularvein


R i g h ts u b c l a v i aanr t e r y Leftsubclavianartery

R i g h ts u b c l a v i avne i n Leftsubclavianvein

R i g h tp e r i c a r d i a c o p h r e n i c
pericardiacophrenic
artery

Superiorvenacava
Arch of aorta
T h y m u sg l a n d
R i g h ti n t e r n atlh o r a c i <
Left pulmonaryartery

Left internalthoracicartery
B r a n c h eosf r i g h t
p u t m o n a r ya r t e r y p u l m o n a r yv e i n s

R i g h tp u l m o n a r yv e i n s

C u te d g eo f m e d i a s t i n apll e u r a C u te d g eo f m e d i a s t i n apll e u r a

Thymusgland

102
Superiormediastinum: ondarteries

E s o p h augs
R i g h tc o m m o nc a r o t i da r t e r y Leftcommon carotidartery
L e f ti n t e r n ajlu g u l a rv e i n
R i g h ti n t e r n ajlu g u l a r
R i g h ts u b c l a v i aanr t e r y- Left subclavianartery

R i g h ts u b c l a v i avne i n Leftsubclavianvein

Inferiorthyroid vein

R i g h ti n t e r n atlh o r a c i cv e i n Left internalthoracicvein

Left pericardiacophrenic
vein
S u p e r i ovr e n ac a v a Arch of aorta
L i g a m e n t u ma r t e r i o s u m
R i g h tp e r i c a r d i a c o p h r e nv ieci n Left pulmonaryartery

B r a n c h eosf r i g h t
p u l m o n a r ya r t e r y
Left pulmonaryveins

Pericardium
R i g h tp u l m o n a r y

C u te d g eo f m e d i a s t i n apll e u r C u te d g eo f m e d i a s t i n apll e u r a

Veinsof the superiormediastinum

R i g h tb r a c h i o c e p h a lvi e
c in
vein
Left brachiocephalic

Superiorvenacava Arch of aorta

Left pulmonaryvein
Ascending
aorta P u l m o n a r tyr u n k

showingvenousand arterialchannels.
Anteriorviewof the superiormediastinum
V o l u m e - r e n d e r e da n t e r i o rv i e w u s i n g m u l t i d e t e c t o rc o m p u t e d t o m o g r a p h y

103
THORAX . Superior
mediastinum:
arteries
andnerves

Trachea

R i g h tr e c u r r e nIta r y n g e anl e r v e
Left recurrentlaryngealnerve
R i g h tc o m m o nc a r o t i da r t e r y Left common carotidartery

R i g h ts u b c l a v t aanr t e r y
Leftvagusnerve

Left subclavianartery
R i g h tv a g u sn e r v e

B r a c h i o c e p h atl ri cu n k C a r d i a cb r a n c h e s
(sympathetic)
C a r d i a cb r a n c h
of vagusnerve {{+ C a r d i a cb r a n c h e s
C a r d i a cb r a n c h e s of vagusnerve
(sympathetic)
Arch of aorta
Left recurrent
laryngealnerve
S u p e r i ovr e n ac a v a
L i g a m e n t u ma r t e r i o s u m
Left pulmonaryartery

B r a n c h eosf r i g h t
p u l m o n a r ya r t e r y
Left pulmonaryveins

R i g h tp u l m o n a r yv e i n s
Cut edge of
m e d i a s t i n apll e u r a

Crt aAaa at
Pericardium
mediastinalpleura

Arteriesand nervesof the superiormediastinum

104
Superiormediastinum: imagi

R i g h tb r a c h i o c e p h a lvi ce i n vein
Left brachioceohalic

Superiorvenacava P u l m o n a r tyr u n k

Ascendingaorta

Leftventricle
R i g h ta t r i u m

of venouschannelsin the superiormediastinum.


Positioning
C T i m a g e ,w i t h c o n t r a s t ,i n c o r o n a lp l a n e

Rightcommon carotidartery
common carotidartery

Left subclavianartery
Rightsubclavianartery
Arch ofaorta

B r a c h i o c e p h atl ri cu n k

Thoracicaorta

with the venous


Anteriorviewof the superiormediastinum
channels,pulmonarytrunk,and heartremoved.
V o l u m e - r e n d e r e da n t e r i o rv i e w u s i n g m u l t i d e t e c t o rc o m p u t e d t o m o g r a p h y

105
Left brachiocephalic
vein
Rightcommon carotidartery Leftcommon carotidartery

R i g h ti n t e r n ajlu g u l a rv e i Left internaljugular vein

R i g h ts u b c l a v i aanr t e r y Leftsubclavianartery

R i g h ts u b c l a v i avne i n Leftsubclavianvein

Leftsubclavianartery

Arch of aorta
Superiorvenacava Ligamentum
arteriosum

Left pulmonaryartery

Branchesof right
pulmonaryartery Left main bronchus

R i g h ti n f e r i o r Thoracicaorta
l o b a rb r o n c h u s
H i l u mi n
H i l u mi n m e d i a s t i n apll e u r a
m e d i a s t i n apll e u r a
Esophagus

Ctft aAaa al

m e d i a s t i n apll e u r a C u te d g eo f
m e d i a s t i n apll e u r a

Trachea
and structures
relatingto it in the superiormediastinum

106
Mediastinum:
imaging

B r a c h i o c e p h atl ri cu n k
Arch of aorta

S u p e r i ovr e n ac a v a P u l m o n a r tyr u n k

Ascendingaorta

R i g h ta t r i u m

Leftventricle

Positioning
of brachiocephalic in the superiormediastinum.
trunk in relationto otherstructures
C T i m a g e ,w i t h c o n t r a s t ,i n c o r o n a lp l a n e

Leftcommon carotidartery

Arch of aorta

R i g h tp u l m o n a r ya r t e r y

Leftventricle

Positioning in the superiormediastinum.


of left commoncarotidarteryin relationto otherstructures
C T i m a g e ,w i t h c o n t r a s t ,i n c o r o n a lp l a n e

Leftsubclavianartery

Arch of aorta

Left pulmonaryartery

Left main bronchus

Positioning arteryandthe bifurcationof the tracheain relation


of left subclavian
in the superiormediastinum.
to otherstructures
C T i m a q e ,w i t h c o n t r a s t ,i n c o r o n a lp l a n e

107
THORAX. Mediastinum:
viewfromright

R i g h ti n t e r n ajlu g u l a rv e i n
Rightcommon carotidartery

R i g h ts u b c l a v i um
s uscle
R i g h ts u b c l a v i aanr t e r y
R i g h ts u b c l a v i avne i n

R i g h ts u p e r i o r
R i g h tb r a c h i o c e p h a lvi ce i n
intercostalvein
R i g h tp h r e n i cn e r v e
R i g h tv a g u sn e r v e
T h y m u sg l a n d
Arch of aorta
Sympathetictrunk
P e r i c a r d i a c o p h r eanri tce r y
Bronchus andvein
C u te d g eo f m e d i a s t i n apll e u r a
Azygosvein
Branchesof right
TracheobronchiaI pulmonaryartery
lymph nodes
Pericardium
E s o p h a g e ap l e x u s
Posteriorintercostal R i g h tp u l m o n a r yv e i n s
arteryand vein

G r e a t esr p l a n c h n inc e r v e

Cut edge of costalpleura

Diaphragmcoveredby
d i a p h r a g m a t ipcl e u r a

Right side of mediastinum and right thoracic cavity

108
imaging- viewfrom
Mediastinum:

h t b r a c h i o c e p h a lvi e
c in

R i g h tp u l m o n a r y
artery R i g h tp u l m o n a r y
vetnS

View of mediastinalstructuresfrom the right side of the thorax.


Volume-rendered computed
viewfromthe rightsideusingmultidetector
lateral tomography

109
THORAX . Mediastinum:
viewfromleft

Leftvagusnerve

Clavicle
Subclavius
Leftsubclavianartery
Leftsubclavianartery
Left subclavianvein

B r a c h i o c e p h atl ri cu n k
Left brachiocephalic vein Left common carotidartery
T h y m u sg l a n d Left superiorintercostalvein
Arch of aorta
Sympathetictrunk
Left recurrentlaryngealnerve
L i g a m e n t u ma r t e r i o s u m
C u te d g eo f m e d i a s t i n apll e u r a
Left pulmonaryartery soryhemiazygosvein

Pericardium Bronchus

Left pulmonaryveins Thoracicaorta

Posteriorintercostal
Left phrenicnerveand
pericardiacophrenic arteryand vein
arteryand vein

E s o p h a g e ap l e x u s

Greatersplanchnicnerve

Cut edge of costalpleura

Diaphragmcoveredby
d i a p h r a g m a t ipcl e u r a

Left side of mediastinum and left thoracic cavity

110
imaging-view fromleft
Mediastinum:

Leftsubclavianartery

Leftcommon
carotrdartery

B r a c h i o c e p h atl ri cu n k Arch of aorta

L e f tp u l m o n a r yv e i n s
Leftpulmonary
artery

Leftventricle Cut edge of diaphragm Thoracicaorta

Viewof mediastinal from the left sideof the thorax.


structures
V o l u m e - r e n d e r e dl a t e r a lv i e w f r o m t h e l e f t s i d eu s i n g m u l t i d e t e c t o rc o m p u t e d t o m o g r a p h y

111
THORAX . Posterior
mediastinum

R i g h tv a g u sn e r v e Trachea
R i g h ts u p r e m ei n t e r c o s t aalr t e r y

Left common carotidartery


B r a c h i o c e p h atl ri cu n k Leftsupremeintercostalartery
(from left costocervical
trunk)
R i g h t h i r dp o s t e r i o r
intercostalartery
Posteriorintercostalvein Leftvagusnerve

Left recurrentlaryngealnerve

Left subclavianartery

Posterior
Intercostal Arch of aorta

R i g h tm a i n
pl exus
Esophagea
oroncnus
Left main bronchus
Posterior
v a g a lt r u n k Thoracicaorta

M e d i a s t i n ablr a n c h e s
of aorta
Intercostal
A n t e r i o rv a g a lt r u n k
nerve
E s o p h a g e ab lr a n c h e s
of aorta

A n t e r i o rv a g a lt r u n k

Stomach

R i g h t h i r dp o s t e r i o r
intercostalartery

R i g h tb r o n c h i a l
arlery

Diaphragm
Leftsubclavianartery

Arch of aorta

S u p e r i olre f t
b r o n c h i aal r t e r y

Structures
of the posteriormediastinum
Inferiorleft bronchialartery

L e f tm a i nb r o n c h u s

R i g h tm a i nb r o n c h u s

Thoracicaorta

112
mediastinum
Posterior

E s o p h augs
Rightcommon carotidartery Leftcommon carotidartery
R i g h ti n t e r n ajlu g u l a rv e i n

S y m p a t h e t itcr u n k i- trunk
SYmPathetic

Thoracicduct

R i g h ts u b c l a v i aanr t e r y Leftsubclavianartery

Leftsubclavianvein
R i g h ts u b c l a v i avne i n

R i g h tb r a c h i o c e p h a lvi e
c in

S u p e r i ovr e n ac a v a

Azygosvein Accessory
hemiazygosvein

lntercostalnerves
Posteriorintercostal
vetns

Thoracid
c uct
Hemiazygosvein

G r e a t esr p l a n c h n i c
nerve

L e s s esr p l a n c h n i c
nerve

L e a s st p l a n c h n inc e r v e Greatersplanchnicnerve
R i g h ts u b c o s t avle i n L e s s esr p l a n c h n ince r v e
(cut)
Diaphragm Leastsplanchnicnerve
C i s t e r n ca h y l i
Leftcrusof diaphragm
l u m b a rv e i n
Ascending

Inferiorvenacava

R i g h tc r u so f d i a p h r a g m

Structuresof the posteriormediastinum


(thoracic
aortaand esophagus removed)

113
Mediastinum:
imaging

R i g h tc o m m o nc a r o t i da r t e r y
R i g h tb r a c h i o c e p h a lvi e
c in Left brachiocephalic
vein

R i g h ts u b c l a v i aanr t e r y Leftcommon carotidartery

Left subclavianartery
Trachea
E s o p h augs

Left brachiocephalic
vein
R i g h tb r a c h i o c e p h a lvi e
c in
B r a c h i o c e p h atl ri cu n k

Trachea
Leftcommon carotidartery

Left subclavianartery

Esophagus

A through| - Thisis a seriesof imagesthat passthroughthe thoraxfrom superiorto inferior


showingthe variousmediastinal structuresandtheirrelationships
with eachother.
C Ti m a g e s w
, i t h c o n t r a s t ,i n a x i a lp l a n e

Thymus M a n u b r i u mo f s t e r n u m

L e f tb r a c h i o c e p h a lvi e
c in
R i g h tp h r e n i cn e r v e
Left phrenicnerve
R i g h tb r a c h i o c e p h a lvi e
c in

Leftcommon carotidartery
B r a c h i o c e p h aal irct e r y
Leftvagusnerve
Trachea
Leftsubclavianartery
R i g h tv a g u sn e r v e

Esophagus
Left recurrentlaryngealnerve
R i g h lt u n g

TIII Thoracid
c uct

Leftlung

Transversesectionthrough the superior mediastinum at the level of vertebra Tlll

114
Mediastinum:

Arch of aorta

Esophagus

M a n u b r i u mo f s t e r n u m

Left phrenicnerve
S u p e r i ovr e n ac a v a

R i g h tp h r e n i cn e r v e Arch of aorta
Archof azygosvein
R i g h tv a g u sn e r v e Leftvagusnerve
Irachea Left recurrentlaryngealnerve

Esophagus
Thoracid
c uct
R i g h tl u n g

TIV Left lung

Transversesectionthrough the superior mediastinum at the level of vertebra TIV

115
THORAX Mediastinum:
imaging

+
I

Ascendingaorta P u l m o n a rtyr u n k

S u p e r i ovr e n ac a v a
Left pulmonaryartery
R i g h tp u l m o n a r ya r t e r y
Left main bronchus
E s o p h augs
R i g h tm a i n

Thoracicaorta

Ascending
aorta
P u l m o n a r tyr u n k

S u p e r i ovr e n ac a v a

R i g h tp u l m o n a r ya r t e r y
Left pulmonaryartery

R i g h tm a i nb r o n c h u s
Left main bronchus
E s o p h augs
Thoracicaorta

M a n u b r i u mo f s t e r n u m

Left lung
Ascendingaorta
P u l m o n a r tyr u n k
R i g h tp h r e n i cn e r v e
Superiorvenacava Left phrenicnerve

R i g h tp u l m o n a r ya r t e r y Leftpulmonaryartery

R i g h tm a i nb r o n c h u s
Left main bronchus
R i g h tv a g u sn e r v e
Leftvagusnerve
Azygosvern Esophagus
R i g h lt u n g Thoracicduct

TV Thoracicaorta

Transversesectionthrough the superior mediastinum at the level of vertebra TV

116
imaging
Mediastinum:

+
I

Thoracicaorta

Thoracicaorta

Leftventricle

Thoracic aorta

A through| - Thisis a seriesof imagesthat passthroughthe thoraxfrom superiorto inferior


showingthe variousmediastinal structures with eachother.
andtheirrelationships
C T i m a o e s ,w i t h c o n t r a s t ,i n a x i a lp l a n e

117
F i b r o u sp e r i c a r d i u m
a n d p a r i e t alla y e r V i s c e r al al y e ro f s e r o u sp e r i c a r d i u m
ofserouspericardium (epicardium)

I n t e r v e n t r i c u lsaer p t u m
R i g h ti n t e r n atlh o r a c i cv e s s e l s Sternum
Costalcartilage Leftventricle
R l g h tv e n t r i c l e
Pleuralcavity Mitralvalve
Tricuspidvalve
Leftatrium

Pericardial Left phrenicnerveand


cavity
pericardiacophrenicvessels
R i g h ta t r i u m

R i g h tp u l m o n a r yv e i n

B r a n c h eosf r i g h t m a i n
bronchus Parietalpleura
R i g h tl u n g
Thoracicaorta
V i s c e r apl l e u r a
Esophagus
Left sympathetictrunk
Azygosvein Left lung
Hemiazygosvein
Thoracicduct Branchesof left main
bronchus
O b l i q u ep e r i c a r d i asli n u s

Transverse
sectionthroughthorax
(approximatelyTVll)

118
nerves
andcutaneous
Dermatomes

nerve
Medialsuoraclavicular

nerve
Intermediatesupraclavicular
nerve
Lateralsupraclavicular

C o s t am
l argin

Lateralcutaneousnerves
T3-T11

c u t a n e o u sb r a n c h e s
of intercostalnervesT2-T11

Lateralcutaneousbranch
of subcostalnerveT12

Anteriorcutaneousbranch
of subcostalnerveT12

nervesof the thoracicregion


and cutaneous
Dermatomes

119
THoRAx ' visceralefferent
(moto!innervation
of theheart

D o r s am
l o t o rn u c l e u so f v a o u sn e r v e

P r e g a n g l i o nsi cy m p a t h e t i c
- - P o s t g a n g l i o nsi cy m p a t h e t i c

P r e g a n g l i o npi ca r a s y m p a t h e t i c
- - P o s t g a n g l i o npi ca r a s y m p a t h e t i c

C e r v i c aal n d t h o r a c i c
c a r d i a cb r a n c h e o
s f vagus

Cervicalsympathetic
ganglion

W h i t er a m u s
communtcans
C e r v i c aal n d t h o r a c i c
C a r d i a cp l e x u s cardiacnerves

Visceralefferent(motor)innervationof the heart


(sympathetic and parasympathetic)

120
Visceralafferents

Nucleiof solitarytract

Visceralafferent(followingsympathetics)
Visceralafferent(followingparasympathetics)
- Inferiorvagal
Somaticafferent ganglion

Visceralafferentsfrom chemo-and
baroreceptorsin the aorticarchfollow
parasympathetics of CN X backto brain

S p i n agl a n g l i o n

Visceralafferentfiber
"pain"

Somaticafferentfiber
Visceralafferents(pain)follow sympathetics
backto Tl -T4 spinallevels.
Painis referredby CNSto somaticregions
innervatedby samespinalcord levels

Visceralafferentsfrom heart

121
CONTENTS ABDOMEN
Surfaceanatomy 124 Portosystemic anastomoses 172
Quadrants andregions 125 Posterior wall 173
Abdominalwall 126 Vesselsof theposteriorwall 174
Muscles 126 Diaphragm 175
Muscles: rectussheath 131 Kidneys 176
Vesselsof theabdominalwall 132 Grossstructureof kidneYs 178
Arteriesandlymphatics of theabdominalwall 133 Kidneys: imaging 179
Nerves of theabdominalwall 134 Renalvasculature tB0
Dermatomes andcutaneous nerves 135 Branches of theabdominolaorta 182
lnguinalregion 136 Inferiorvenacavo 183
lnguinalcanal 138 Abdominalaortaandinferiorvenacava:imaging 184
lnguinalhernias 140 Lumbarplexus 186
Anteriorabdominal walI 141 LumbarpIexus:cutaneous di stribution 187
Greater omentum 142 Lymphatics 188
Abdominalviscera 143 Abdominalinnervation 189
Peritoneal cavity 144 Splanchnicnerves 190
AbdominaI sagittaI section 145 efferent(motor)innervationdiagram
Visceral 191
AbdominaI coronaI section 146 afferent(sensory)
Visceral innervationand referred
paindiagram 192
Arterialsupplyof viscera 147
Stomach 148 Kidneyand uretervisceralafferent(sensory)
diagram 194
Spleen 149
Arteriesof stomachandspleen 150
Duodenum 152
Smallintestine 154
Largeintestine 156
junction
lleocecal 158
Gastrointestinal tract:imaging 159
Mesenteric arteries 160
Liver 162
Vesselsof theliver 164
Segments of theliver 165
Pancreas andgallbladder 166
Vasculature of pancreas andduodenum 169
Venousdrainageof viscera 170
ABDOMEN. Surface
anatom

Xiphoidprocess
of sternum

Costalmargin
of lineaalba

of a tendinous
intersectionof rectus
a b d o m i n i sm u s c l e
Positionof a semilunarline
crest

A n t e r i o rs u p e r i o irl i a cs p i n e

Pubicsymphysis

Anteriorabdominalwallsurfaceanatomy

124
Quadrantsandregions

Sagittal plane

Ascendingcolon

Anteriorsuperioriliacspine

I n g u i n alli g a m e n t

Pubictubercle

Abdominalquadrantsandthe positionsof majorviscera

Midclavicularplanes

Epigastri<region
-referredpainfrom foregut

Subcostalplane

Umbilical region
-referredpain from midgut
Intertubercular Plane

Pubic region
-referredpainfrom hindgut

Thenineregionsof the abdomen


125
ABDOMEN . Abdominol
woll

Anteriorwall of rectussheath Lineaalba

R e c t u sa b d o m i n i s
Posteriorwall of
rectussheath

E x t e r n aol b l i q u e

I n t e r n aol b l i q u e

T r a n s v e r s uasb d o m i n i s

Transversalis
fascia

Layersof the abdominalwall

126
R e c t u sa b d o m i n i s Lineaalba Posteriorwall of rectussheath
A o o n e u r o s iosf t r a n s v e r s uasb d o m i n i s

A p o n e u r o s iosf i n t e r n aol b l i q u e

A p o n e u r o s iosf e x t e r n aol b l i q u e Fattylayer


(Camper's)
fsuperficial
E x t e r n aol b l i q u e I l-tascia
| ^ " ^ - " , - - ^ . . -layer
Membranous ' ^ . . ^1
"
I n t e r n aol b l i q u e (5carpa's)

T r a n s v e r s uasb d o m i n i s

fascia
Transversalis
P e r i t o n e acla v i t y

Extraperitoneal
fascia

P a r i e t apl e r i t o n e u m

L a t i s s i m udso r s i
Psoasmajor

Q u a d r a t ulsu m b o r u m
Erectorspinae

l n f e r i o vr e n ac a v a A b d o m i n aal o r t a

sectionshowingthe layersof the abdominalwall


Transverse
(aboveumbilicus)

L i n e aa l b a

Aponeurosisof external
R e c t u sa b d o m i n i s oblique

E x t e r n aol b l i q u e
Aponeurosisof internal
oblique
I n t e r n aol b l i q u e
T r a n s v e r s uasb d o m i n i s Aponeurosisof transversus
abdominis

Layersof the abdominal wall.


in axialplane
CTimage,withcontrast,

127
ABDOMEN. Muscles

Serratusanterior

L i n e aa l b a

E x t e r n aol b l i q u e Externaloblique (cut)

Umbilicus I n t e r n aol b l i q u e

Aponeurosisof external Aponeurosisof internal


oblique oblique

A n t e r i o rs u p e r i o irl i a cs p i n e

l n g u i n al i g a m e n t

S u p e r fcii a li n g u i n a rl i n g

Lateralcrus
Spermaticcord

Externaland internalobliquemuscles

128
Xiphoidprocess
of sternum

R i g h tc o s t a m
l argin L i n e aa l b a

Externaloblique(cut)
Externaloblique (cut)

Anteriorwall of Internaloblique(cut)
rectussheath
Umbilicus
abdominis
Transversus

I n t e r n aol b l i q u e

Aponeurosisof internal
oblique Aponeurosisof transversus
abdominis

A n t e r i o rs u p e r i o irl i a cs p i n e

I n g u i n alli g a m e n t

Cremasteric
muscle

P u b i ct u b e r c l e

abdominismuscles
Internalobliqueandtransversus

129
ABDOMEN.Muscles
rrttii!,ri"lfiiJilil+# i:r'i:"1,!ii:rrf
;il;r:;i,i

o s t a lm a r g i n
Externaloblique (cut)

R i bX

Externaloblique (cut)

R e c t u sa b d o m i n i s o b l i q u e( c u t )

w a l lo f
Tendinousintersection rectussheath

I n t e r n aol b l i q u e Aponeurosisof internal


oblique
Aponeurosisof internal
oblique
Arcuateline

A n t e r i o rs u p e r i o irl i a cs p i n e

Transversalis
fascia
I n g u i n alli g a m e n t

Pyramidalis

Cremasteric
muscle

Rectusabdominisand pyramidalis
muscles

130
rectussheoth
Muscles:

Organization of the rectussheath.


sectionthroughthe upperthreequarters
A. Transverse ofthe rectussheath
sectionthroughthe loweronequarterofthe rectussheath
B.Transverse

fascia(fattylayer)
Superficial Rectusabdominis E x t e r n aol b l i q u e
Superficialfascia(membranouslayer)
I n t e r n aol b l i q u e
Anteriorwall of rectussheath
abdominis
Transversus
Aponeurosisof external
oblique

Posteriorwall of rectussheath fascia


Transversalis
Aponeurosisof internal Falciform
ligament fascia
Extraperitoneal
oblique
Parietalperitoneum
Aponeurosisof transversus
abdominis

fascia(fattylayer)
Superficial R e c t u sa b d o m i n i s E x t e r n aol b l i q u e
5uperficialfascia(membranouslayer)
I n t e r n aol b l i q u e
Anteriorwall of rectussheath
T r a n s v e r s uasb d o m i n i s
Aponeurosisof external
oblique

R i g h tm e d i a lu m b i l i c alli g a m e n t fascia
Transversalis

A p o n e u r o s iosf i n t e r n a l M e d i a nu m b i l i c a l fascia
ExtraDeritoneal
oblique ligament Parietalperitoneum
Aponeurosisof transversus
abdominis I n f e r i o er p i g a s t r ivce s s e l s Left lateralumbilicalfold

131
ABDOMEN . Vessels
of theabdominalwall

Lateralthoracicvein

Musculophrenic
artery

Superiorepigastricartery

S u p e r i oer p i g a s t r ivce i n s

Thoracoepigastric
vein
Rectusabdominis

Externaloblique (cut)
I n t e r n aol b l i q u e( c u t )

E x t e r n aol b l i q u e Transversus
abdominis

Deepcircumflexiliac
arteryand vein

Superficialcircumflex iliac
arteryand vein Inferiorepigastricarteryand vein

Superficialeptgastric TransversaIis
fascia
arteryand vein

Superficialexternalpudendal
arteryand vein

Femoralarteryand vein

Vasculatureof the anterior abdominal wall

132
Internalthoracicartery

lntercostalarteries

Superiorepigastricartery

M u s c u l o p h r e nai cr t e r y

Subcostalartery

Externaliliacartery

Superficialcircumflex
i l i a ca r t e r y

SuperFcial
epigastricartery

Superficialexternal
p u d e n d aal r t e r y

F e m o r aal r t e r ya n d v e i n

Arteriesof the anteriorabdominalwall

A x i l l a r yl y m p hn o d e s

S u p e r f r c i ianl g u i n a l y m p hn o d e s

lymphaticdrainageof the
Supefficial
abdominalwall
anterolateral
133
ABDOMEN . Nerves
of theabdominalwall

Serratusanterior

Lateralcutaneousbranches Externaloblique (cut)


of intercostalnervesT5-T11

Posteriorwall of rectussheath

Tl0 nerve

Rectusabdominis(cut)

Anteriorcutaneous
branchofTl 0
T r a n s v e r s uasb d o m i n i s
Lateralcutaneousbranch
of subcostalnerve(T12)
Subcostalnerve(T12)

Lateralcutaneousbranchof
iliohypogastricnerve(11)

lliohypogastricnerve(11)

l l i o - i n g u i n anl e r v e( 1 1)
I n g u i n alli g a m e n t

I n t e r n aol b l i q u e

Spermaticcord

Nervesof the anterolateral


abdominalwall

134
nerves
ondcutaneous
Dermatomes

C o s t am
l argin

Lateralcutaneousnerves
17-T11

Anteriorcutaneousbranches
of intercostalnervesT7-T11

Lateralcutaneousbranch
of subcostalnerve(Tl 2)

Anteriorcutaneousbranch
of subcostalnerve(T12)

I n g u i n alli g a m e n t
Anteriorcutaneousbranch
of iliohypogastricnerve(11)

Dermatomes
and cutaneous abdominalwall
nervesof the anterolateral

135
ABDOMEN. lnguinal
region
, -=,'

A p o n e u r o s iosf e x t e r n aol b l i q u e
A n t e r i o rs u p e r i o irl i a cs p i n e
D e e pi n g u i n a rl i n g
I n g u i n alli g a m e n t (in transversalis fascia)

I n g u i n acl a n a l S u p e r cf ii a li n g u i n a rl i n g
( i na p o n e u r o s iosf e x t e r n aol b l i q u e )

Femoralartery
Positionof pubic symphysis

Spermaticcord

I n g u i n arle g i o ni n a m a n

Aponeurosisof externaloblique

D e e pi n g u i n arl i n g A n t e r i o rs u p e r i oirl i a cs p i n e
(in transversalis fascia)
S u p e r 6 c i ai nl g u i n a rl i n g I n g u i n alli g a m e n t
( i na p o n e u r o s iosf e x t e r n aol b l i q u e )
I n g u i n acl a n a l

P o s i t i o no f p u b i cs y m p h y s i s Femoralartery

R o u n dl i g a m e n ot f u t e r u s

Inguinalregionin a woman

136
Inferiorvenacava

Left renalvein

Leftovarianvein
R i g h tt e s t i c u l avre i n
Left ureter
E x t e r n aol b l i q u e
Leftovarianartery
R i g h tt e s t i c u l aar r t e r y
A b d o m i n aal o r t a

Transversus
I n t e r n aol b l i q u e a b d o m i n i s( c u t )

T r a n s v e r s uasb d o m i n i s E x t e r n aol b l i q u e( c u t )

I n t e r n aol b l i q u e( c u t )

G e n i t abl r a n c ho f
g e n i t o f e m o r anle r v e G e n i t abl r a n c ho f
genitofemoralnerve

Rectum
S i g m o r dc o l o n
R i g h ti n f e r i o e
r pigastric
arteryand vern Uterus
Location of Uterinetube
deep inguinal ring Ovary
Ductus Transversalis
fascia
Cremasterm
icuscle Peritoneum(cut)

Femoralartery
a n dv e i n
lliacus

Psoasmajor

R o u n dl i g a m e n o
t f uterus

Genitalbranchof
genitofemoralnerve

Rectua
s bdominis

Bladder

P e n i si n s e c t i o n

Inguinalregionin men Inguinalregionin women

137
Parietalperitoneum

Femoralbranchof genitofemoralnerve
T e s t i c u l aarr t e r ya n d v e i n s

Genitalbranchof oenitofemoralnerve

Externaliliacarteryand vein

Rlghtinferiorepigastricarteryand vein

Externaloblique (cut)
Ductusdeferens
I n t e r n aol b l i q u e( c u t )
P u b i cv e s s e l s
abdominis(cut)
Transversus
Conjointtendon
Transversalis
fascia

Extraperitoneal
fascia

Cremasteric
vessels

L o c a t i o no f d e e pi n g u i n a rl i n g

I n g u i n alli g a m e n t

l l i o - i n g u i n anle r v e( 1 1 )

Femoralarteryand vein

C r e m a s t e rm
i cu s c l e

L a c u n alri g a m e n t

Superficia
i nl g u i n a rl i n g
Aponeurosisof
e x t e r n aol b l i q u e
S p e r m a t ic o r d

Genitalbranchof qenitofemoral

C r e m a s t e rm
i cu s c l e

Inguinal canal and spermaticcord

138
Parietalperitoneum

Extraperitoneal
fascia

Transversalis
fascia
L a t e r aul m b i l i c aflo l d

Left inferiorepigastricarteryand vein

Ductusdeferens

M e d i a lu m b i l i c alli g a m e n t
( o b l i t e r a t eudm b i l i c a l Externaloblique (cut)

M e d i a nu m b i l i c alli g a m e n (t u r a c n u s . l I n t e r n aol b l i q u e( c u t )

abdominis(cut)
Transversus

Aponeurosisof external
o b l i q u e( c u t )

Deepcircumflexiliacvessels
D e e pi n g u i n a rl i n g

Genitalbranchof qenitofemoralnerve

Testiculararteryand pampiniformplexusof veins

Externalspermaticfascia
(from aponeurosisof externaloblique)

C r e m a s t e rm i cu s c l e
( f r o mi n t e r n aol b l i q u em u s c l e )

Internalspermaticfascia
P y r a m i d a l (i sc u t ) (from transversalis
fascia)
R e c t u sa b d o m i n i s( c u t )

Ductusdeferens

P a r i e t al la y e ro f t u n i c av a g i n a l i s
H e a do f e p i d i d y m i s

V i s c e r al a
l y e ro f t u n i c av a g i n a l i s

ofthe spermaticcord
Inguinalcanaland structures

139
ABDOMEN. lnguinal
hernias

Inferiorepigastricvessels
Inferiorepigastricvessels

Indirectinguinalhernia Directinguinalhernia

D i r e c th e r n i a

Ductusdeferens

R i g h ti n g u i n a lt r i a n g l e .
Laparoscopic
viewshowingthe parietal peritoneum stillcovering
the area
(inside
the peritoneal cavitylookinganteroinferior)

140
', ':
Anteriorabdominal

Cut edge of
diaphragm

Falciform
ligament

C u te d g eo f d i a p h r a g m

R o u n dl i g a m e n t
of the liver
(Ligamentum teres)
C u te d g eo f e x t e r n a l
oblique

C u te d g eo f i n t e r n a l Posteriorwall of
oblique rectussheath

Cut edge of transversus


abdominis
transversalis
fascia
C u te d g eo f
transversalisfascia Umbilicus
Transversus
C u te d g eo f abdominis
p a r i e t apl e r i t o n e u m
R i g h tm e d i a l
u m b i l i c alli g a m e n t
M e d i a nu m b i l i c a l
fold
Arcuateline
Rightinferiorepigastric
Left lateral arteryand vein
u m b i l i c aflo l d I n g u i n alli g a m e n t
D e e pi n g u i n a rl i n g

Righttesticularvessels
G e n i t abl r a n c ho f
genitofemoralnerve
Psoasmajor
Femoralartery
C u te d g eo f
p a r i e t apl e r i t o n e u m F e m o r avl e i n

Inguinaltriangle
Bladder
( H e s s e l b a c ht'rsi a n g l e )
O b t u r a t o irn t e r n u s
L a c u n alri g a m e n t
Levator
Ductusdeferens

O b t u r a t o rm e m b r a n e
l s c h i o a n af ol s s a Prostategland

D e e pp e r i n e apl o u c h

P e r i n e aml e m b r a n e

Internal view of anterior abdominal wall in men

141
ABDOMEN. Greater
omentum

Xiphoidprocess
of sternum
Diaphragm
Left lobe of liver
Falciformligament

R i g h tl o b eo f l i v e r

Internaloblique (cut)
Transversus abdominis(cut)

Greateromentum

Greateromentum

142
Abdominalviscera

C u te d g eo f d i a p h r a g m

Falciform
ligament

R i g h tl o b eo f l i v e r Stomach

R o u n dl i g a m e n t
of liver

D e s c e n d i ncgo l o n
Gallbladder

colon
Transverse

C u te d g eo f I n t e r n aol b l i q u e( c u t )
p a r i e t apl e r i t o n e u m
Transversus
Ascending
colon a b d o m i n i s( c u t )

Left paracolicgutter
R i g h tp a r a c o l igc u t t e r

S m a l il n t e s t i n e

I n g u i n alli g a m e n t

P s o a sm a j o r

Obturatormembrane
O b t u r a t o cr a n a l

Abdominalviscera(greateromentumremoved)
143
ABDOMEN.Peritonealcavity

S u b p h r e n irce c e s s

Diaphragm

Lrver

Lesseromentum Lessersac(omentalbursa)

P a r i e t apl e r i t o n e u m Pancreas

Abdominalaorta
Stomach

Greatersac Duodenum

Transverse
mesocolon
Superiormesentericartery

Transverse
colon

Rectussheath

G r e a t eor m e n t u m

R e c t u sa b d o m i n i s

Smallintestine

Greatersac

Greaterand lessersacsofthe peritonealcavity

144
Abdominal sagittaI section

C e l i a ct r u n k
Abdominalaorta

S u p e r i om
r e s e n t e r iacr t e r y
Left renalvein

S m a l il n t e s t i n e

Portalvein
lnferiorvenacava
r e s e n t e r ivce i n
S u p e r i om

S u p e r i om
r e s e n t e r iacr t e r y

Arrangement of abdominal contents in peritoneal cavity.


CTimageswithcontrast, plane
in sagittal

145
. Abdominalcoronalsection

Diaphragm

H e p a t i cv e i n

Liver
Stomach
Han:ti. .l' '.t

Spleen
Hepaticarteryproper

Portalvein P y l o r i ca n t r u m

Transverse
colon
Gallbladder

Transverse
colon H e a do f p a n c r e a s
Duodenum

S u p e r i om
r esenteric
Ascending
colon
arteryand vein

J e Ju n u m
lleocolicartery
l l e o c o l i vc e i n

Mesentery
l l e o c e c aj ul n c t i o n

Cecum
l l i a cc r e s t

S i g m o i dc o l o n

Coronalsection

LIVCT
Stomach

Gallbladder Pancreas

Spleen
Pancreas
S u p e r i om
r esenteric
arrery
S u p e r i om
r esenteric
vetn
Duodenum
lleocolicartery l l e o c o l i vc e i n
Ascending
colon

l l i a cc r e s t

Bladder

Coronal section.
CTimagewithcontrast,
in coronalplane
146
Arterialsupplyof viscera
ii.+ilif']$

Shortgastricarteries
S p l e n i ca r t e r y

Esophageal
artery
Left hepaticartery
R i g h th e p a t i ca r t e r y

Cystic
Hepaticarteryproper

Commonhepaticartery
R i g h tg a s t r i c
Gastroduodenal
artery
Supraduodenal
artery

Duodenum

Rightgastro-omentalartery
Posteriorpancreaticoduodenaiartery
Superiormesentericartery
Anteriorpancreaticoduodenal artery
I n f e r i oo
r ancreaticoduodenal

Transverse
colon

Marginalartery
A b d o m i n aal o r t a

M i d d l ec o l i ca r t e r y
Marginalartery
R i g h tc o l i ca r t e r y Inferiormesentericartery

M a r g i n aal r t e r y
Left colicartery

lleocolicartery

D e s c e n d i ncgo l o n
Ascending
colon

Sigmoidarteries

Appendicular

Appendix
coton

rectalartery

147
. Stomach
ABDOMEN

A b d o m i n ael s o p h a g u s

Internaland externalfeatures
of the stomach

J u n c t i o no f g a s t r i ca n d
e s o p n a 9 e aml u c o s a

Cardiac

Gastricfolds (rugae)

Gastricanal
Pylorus
Pyloricorifice

A n g u l a ri n c i s u r e

Duodenum

Stomach

P y l o r i ca n t r u m
t

S u p e r i opr a r to f d u o d e n u m P y l o r i ca n t r u m

E s o p h augs

Inferior
venacava Thoracic
aorta Diaphragm
Positioningof the stomach.
CTimage,withcontrast,
in axialplane

D e s c e n d i npga r to f d u o d e n u m D u o d e n o j e j u n jaul n c t i o n

Surfaceprojection of the stomach Stomach. Double contrast radiograph using barium

148
I t,::

Diaphragm

Left lobe of liver


Stomach

Lesseromentum

ligament
Falciform

Spleen

G r e a t eor m e n t u m

D e s c e n d i ncgo l o n

Surfaceprojectionof the spleen(posterior


view)

s b d o m i n i sm u s c l e
Rectua
S u p e r i opr o l e G a s t r i ci m p r e s s i o n
S m a l il n t e s t i n e

Lateralviewof abdominal
cavitywith spleen

lnferiorborder Stomach
S h o r tg a s t r i cv e s s e l s

S p l e n o r e n al ilg a m e n t Pancreas

Splenicartery
Spleen

S p l e n i cv e i n
Splenic
Leftgastro-omental veln
arteryand vein
Left
kidney

C o l i ci m p r e s s i o n
I n f e r i op
r ole

Surfaces
and hilumof the spleen Locationof the spleen.
in coronalplane
CTimage,withcontrast,

149
ABDOMEN . Arteries
of stomachandspleen

H e p a t i cv e i n s Leftgastricartery

Diaphragm

P a r i e t apl e r i t o n e u m
short gastricarteries

lnferiorvenacava
C e l i a ct r u n k
R i g h ts u p r a r e n agll a n d
Stomach
Hepaticarteryproper
Gastroduodenal
artery S p l e n i ca r t e r y

Spleen
Posteriorsuperior Leftgastro-omentalartery
pancreaticoduodenaI
artery Rightgastricartery

Duodenum Commonhepaticartery
A n t e r i o rs u p e r i o r Left kidney
pancreaticoduodenal
arrery Rightgastro-omental
artery
R i g h tk i d n e y
Posteriorinferior
A n t e r i o ri n f e r i o r
pancreaticoduodenal
pancreaticoduodenaI
anery
arrery
Left ureter
Superior
mesentericvein
Inferior
R i g h tu r e t e r mesentericartery
Superior
mesentericartery

Distributionof the celiactrunk

R i g h tg a s t r i ca r t e r y C e l i a ct r u n k

Hepaticarteryproper

Gastroduodenal
artery

Supraduodenal
artery

S p l e n i ca r t e r y

Posteriorsuperior
pancreaticod
uodenalartery

Anteriorsuperiorpancreaticoduodenal
artery

Posteriorinferior Rightgastro-omentalartery
pancreaticoduodenalartery
A b d o m i n aal o r t a
Anteriorinferiorpancreaticoduodenal
artery Superiormesentericartery

of the gastroduodenal
Branches artery

150
Left hepaticartery Leftgastricartery

R i g h th e p a t i ca r t e r y H e p a t i ca r t e r yp r o p e r S p l e n i ca r t e r y

.t

)fjt.",' .r.;i:L
:::::'l:1.:::,;,::::::.::

l-.:,. tt:l

Cysticartery R i g h tg a s t r o - o m e n t a rl t e r y

G a s t r o d u o d e naarl t e r y C o m m o nh e p a t i ca r t e r y

of the celiactrunkand its branches


angiography
Digitalsubtraction

C e l i a ct r u n k P annccrreeaass Stomach Spleen

5uperior Right Inferior A b d o m i n aal o r t a L e f tk i d n e y


C e l i a ct r u n k A b d o m i n aal o r t a Spleen
mesenteric kidney venacava
artery

of the celiactrunk in relationto otherstructures.


Positioning of the celiactrunkfrom the abdominalaorta.
Branching
C T l m a q e ,w i t h c o n t r a s t ,i n c o r o n a lp l a n e C T i m a o e ,w i t h c o n t r a s t ,i n a x i a lp l a n e

151
'Duodenum
ABDOMEN

Neckof pancreas

P o r t avl e i n
R i g h ts u p r a r e n agll a n d
Duodenum
- s u p e r i o rp a r t colon (cut)
Transverse

R i g h tk i d n e y

colon (cut)
Transverse Bodyof pancreas

Left kidney
S u p e r i om
r e s e n t e r ivce i n
Superior
Duodenum mesentericartery
- d e s c e n d i n gp a r t
Duodenum
Headof pancreas - a s c e n d i n gp a r t
Duodenum
- i n f e r i o rp a r t Inferiormesentericartery

A b d o m i n aal o r t a Testicular(ovarian)
a r t e r ya n d v e i n
Ascending
colon D e s c e n d i ncgo l o n

Left ureter

Duodenum
insitu

D u o d e n acl a p P y l o r i cs p h i n c t eor f s t o m a c h

Duodenum
- s u p e r i o rp a r t

antrum of stomach

Duodenum
- d e s c e n d i n gp a r t

Duodenum
-inferior part

Double contrast radiograph showing the duodenal cap

152
Heoaticartervproper
' ' -
I GastroduodenalarterY
C o m m o nh e p a t i cd u c l
S u p r a d u o d e n a rl t e r y
C o m m o nh e p a t i ca r t e r Y
B i l ed u c t
C y s t i cd u c t

Superiorpart
(firstpart)

Gallbladder
Splenicarteryand vein

Transverse
colon

Duodenojejunalflexure

R i g h tk i d n e y

Descendingpart
(secondpart)

M i n o rd u o d e n apl a p i l l a

M a j o rd u o d e n a p
l apilla

lnferiorvenacava Inferior part Abdominalaorta


( t h i r dp a r t )

Partsofthe duodenumand relatedstructures

Liver

Pancreas

Duodenum
-superioa
r nddescending
parts

P an c r e a s

S u p e r i om
r esenteric
vetn

Duodenum
-inferior part

in the vicinity.
of duodenumto structures
Relationship
C T i m a g e ,w i t h c o n t r a s t ,i n c o r o n a lp l a n e
153
ABDOMEN . Smallintestine

Inferiorborderof liver
Left lobe of liver
Falciform ligament
R o u n dl i g a m e n o
t f liver Cardialnotch

Gallbladder

R i g h tl o b eo f l i v e r

C u te d g eo f d i a p h r a g m

L e s s eor m e n t u m
(Hepatoduodenal
ligament)

Omentalforamen

Duodenum

S u p e r i om
r e s e n t e r ivce i n

M i d d l ec o l i ca r t e r y( c u t )

R i g h tc o l i ca r t e r y
Ascending
colon

lleocolicartery

Cut edge of
parietalperitoneum

J e j u n aal n d i l e a l
arteriea s ndveins

Small intestinedisplacedto show superior mesentericvessels


154
Smallintestine

Mesentery

in the arterialsupplyto the jejunumand ileum


Differences

Mesentery

Stomach

J e j u n u ma n d i l e u m R a d i o g r a puhs i n gb a r i u ms, h o w i n gj e j u n u ma n di l e u m

155
ABDOMEN. Lo

Leftcolicflexure

R i g h tc o l i cf l e x u r e
Transverse
colon

Ascending D e s c e n d i ncgo l o n
colon

S e m i l u i r af o
r ld

O m e n t a al p p e n d i c e s
Haustraof colon

S i g m o i dc o l o n

Largeintestineanteriorview

Transverse
colon
Leftcolicflexure

R i g h tc o l i cf l e

Large intestine left lateralview Surfaceprojection of the large intestine


156
Largeintestine

Leftcolicflexure

Ascending
colon

D e s c e n d i ncgo l o n

usingbariumshowingthe largeintestine
Radiograph

colon
Transverse

S i g m o i dc o l o n

Transversecolon showing right and left colic flexures'


in coronalplane
CTimage,with contrast,

157
ABDOMEN . tleocecal
junction

Appendix

lleocecaljunction

lleocecal fold

Colonoscopyshowing ileocecalfold

Positionsof the appendix

158
Gastrointestinal tract:imaging

A Endoscopyand colonoscopyshowing
differentpartsof the gastrointestinal
tract.

A. Gastroesophagealjunction
B. Cardiacorifice and fundus of stomach-retroflexedview
C. Bodyofstomach
D P y l o r u so f s t o m a c ha n d p y l o r i cs p h i n c t e r
E. Duodenum
F . C e c u ms h o w i n g a p p e n d i c e aol p e n i n g .
-----{ G. Transversecolon
H . S i g m o i dc o l o n
l. Rectum-retroflexedview
J . P e c t i n a t el i n e

159
ABDOMEN . Mesenteric
arteries

Transverse
colon

Arteriarectae
(vasarecta)

Marginalartery

M i d d l ec o l i ca r t e r y A b d o m i n aal o r t a

Superior
mesentericartery

Duodenum

Inferior
mesenteflcanery
Rightcolicartery
Leftcolicartery

lleocolicartery Descendingcolon

Sigmoidarteries

Ascending
colon

Arteriarectae

Appendix S i g m o i dc o l o n
J e j u n aal n d i l e a la r t e r i e s
Rectum
Superiorrectalartery

Superiorand inferiormesenteric
arteries
Rightcolicartery Superiormesentericartery

Inferiormesenteric
arlery

lleocolia
c rtery Jejunalarteries

li"111..
Catheters

':
Distalsmall ":::t/'::''. :'::: Superiorrectalartery
a rtefles
l l e a la r t e r i e s

Digital subtractionangiography of the superior Digitalsubtraction


angiography of the inferior
mesentericartery and its branches mesenteric arteryand its branches
160
arteries
Mesenteric

Lrver

Superror
m e s e n t e r ivce i n

lnferiorvena cava

R i g h tk i d n e y

Diaphragm

Branching arteryfromthe abdominalaorta.


of the superiormesenteric
C T i m a g e ,w i t h c o n t r a s t ,i n a x i a lp l a n e

S u p e r i om
r e s e n t e r ivce i n Superiormesentericartery

Ascending
colon

Positioning arteryin relationto otherstructures.


of the superiormesenteric
C T i m a g e ,w i t h c o n t r a s t ,i n c o r o n a lp l a n e
161
ABDOMEN.

Location of the liver.


CTimage,with contrast,in coronalplane
Surface projection of the liver anterior view

Falciformligament Coronaryligament

Right riangular
L e f tt r i a n g u l a r
ligament
ligament

Inferiorborderof liver

R o u n dl i g a m e n o
t f the liver
(ligamentum t e r e sh e p a t i s )

Inferiorborderof liver

Anteriorsurfaceof liver

162
Caudatelobe
Falciform
ligament lnferior vena cava

S u p r a r e n ai m
l pression

L e f tt r i a n g u l alri g a m e n t

Anteriorcoronaryligament

Posteriorcoronaryligament

R i g h t r i a n g u l alri g a m e n t

Gastricimpression R e n ailm p r e s s i o n

Rightlobe of liver
Leftlobeof liver
Neck

Esophagea
iml pression
Body

F i s s u rfeo r l i g a m e n t u mv e n o s u m

Portahepatis

R o u n dl i g a m e n o
t f the liver

Colicimpression

F u n du s Fissurefor ligamentumteres(roundligament)

Body

Neck
Portahepatis

Left lobe of liver

Hepaticarteryproper Lefttriangularligament
Caudatelobe
Fissurefor ligamentumvenosum

Visceralsurfaceof liver

163
ABDOMEN . Vessels
of theliver

lnferiorvenacava

Left hepaticvein

Left branch
of portalvein

Rightbranch
of portal vein

Left branchof hepaticarteryproper

Hepaticarteryproper

C o m m o nh e p a t i cd u c t
Rightbranchof hepaticarteryproper

Anteriorsurfaceof liverwith hepaticveins,portalvein,and associated


vessels

Inferiorvenacava

H e p a t i cv e i n s

Thoracicaorta

Leftand right branches


of hepaticarteryproper

Hepaticarteryproper
Inferior
venacava
P o r t avl e i n
Hepaticveins entering the inferior vena cava
in the substanceof the liver. Arrangement
of the hepaticvenoussegments
CTimage,withcontrast, in axialplane

164
of theliver
Segments

PosteriormedialsegmentVlll MedialsegmentlV
(Anteriorsuperiorarea) (Medialsuperiorarea)

Lateralsegmentll
(Lateralsuperiorarea)
PosteriorlateralsegmentVll
(Posteriorsuperiorarea)

Leftanteriorlateralsegmentlll
(Lateralinferiorarea)

MedialsegmentlV
(Medialinferiorarea)

A n t e r i o rm e d i a ls e g m e n V
t
(Anteriorinferiorarea)
RightanteriorlateralsegmentVl MedialsegmentlV
(Posteriorinferiorarea) (Medialinferiorarea)

Leftanteriorlateralsegmentlll
(Lateralinferiorarea)

PosteriorlateralsegmentVll
(Posteriorsuperiorarea)

Lateralsegmentll
(Lateralsuperiorarea)

MedialsegmentlV
Posterior(caudal)segmentI (Medialsuperiorarea)

Segmentsof the liver shownon anteriorand visceralsurfaces

165
ABDOMEN . Pancreas
andgallbladder

Stomach

Inferiorvenacava

C e l i a ct r u n k Spleen
Portalvein
5 p l e n i ca r t e r y
T-il ^r ^-^--^--
r or ur Por rlrEd>
Gallbladder

Bodyof pancreas

R i g h tk i d n e y
Left kidney
B i l ed u c t
JeJunum
Duodenum

H e a da n d u n c i n a t e Superiormesentericartery
processof pancreas
Left ureter
R i g h tu r e t e r
A b d o m i n aal o r t a

Superiormesentericvein

Pancreatic
notch

U n c i n a t ep r o c e s s

Anteriorsurfaceof the pancreas

Stomach

S p l e n i cv e i n

T a i lo f p a n c r e a s
Aorta

Spleen

Pancreas.
in axialplane
CTimage,withcontrast,

166
ondgallblodder
Pancreas

R i g h th e p a t i cd u c t

Left hepaticduct

Cysticduct

Duodenum
-supenor part

Accessorypancreaticduct

M i n o rd u o d e n a p
l apilla
B i l ed u c t
Duodenum
-descendingpart

M a j o rd u o d e n a p
l apilla

Duodenum
H e p a t o p a n c r e aa
t im
c pulla -ascendingpart

M a i np a n c r e a t idcu c t

Duodenum
-inferior part

Bileand pancreatic
ducts

of the gallbladderin relationto otherstructures.


Positioning
C T i m a g e ,w i t h c o n t r a s t ,i n a x i a lp l a n e

167
. Pancreas
andgallbladder

Left hepaticduct C o m m o nh e p a t i cd u c t

R i g h th e p a t i cd u c t

Gallbladder

i'^'
h e p a t i cd u c t

| 6ft hahrii..l,,.i

II

Cysticduct
C o m m o nh e p a t i cd u c t
S p i r avl a l v e

B i l ed u c t M a i np a n c r e a t idcu c t

C y s t i cd u c t B i l ed u c t

Bileductsystem.
Sectionthrough gallbladderand bile ducts P e r c u t a n e o utsr a n s h e p a t i c h o l a n g i o g r a m

Pancreas I n f e r i ovr e n ac a v a P a n c r e a s S t o m a c h

Superior Superior
-inferior part mesentericvein mesentericartery

Positioning of the pancreas in relation to other structures. Relationshipof pancreasto the stomach and spleen.
C T i m a g e ,w i t h c o n t r a s t ,i n c o r o n a lp l a n e in coronalplane
CTimage,withcontrast,

168
Lefthepaticartery
S p l e n i cv e s s e lcsu t
(spleenremoved) Shortgastricarteries
Righthepaticartery

Leftgastricartery

Celiac Portalvein
Leftgastro-omentalartery t r un k
Cysticduct
Stomach artery
Gastroduodenal

Left gastro-omentalvein
Posteriorsuperior
pancreaticoduodenalartery
S p l e n i cv e i n B i l ed u c t
Leftgastro-omental D e s c e n d i npga r to f d u o d e n u m
Inferiorpancreaticartery Headof pancreas
I n f e r i om
r e s e n t e r ivce i n
Dorsalpancreaticartery

Superiormesentericartery
mesentericvein
Anteriorinferiorpancreaticoduodenal
artery Posteriorinferior
Uncinateprocessof pancreas pancreaticod uodenalartery

posteriorview
of the pancreas
Vasculature

R i g h th e p a t i ca r t e r y C o m m o nh e p a t i cd u c t

Left hepaticartery

Gallbladder
trcarteryproper
Commonhepaticartery

Liver C e l i a ct r u n k

Cysticartery
Leftgastricartery
Cysticduct
Gastroduodenal
artery
S p l e n i ca r t e r y

S p l e n i cv e i n
Rightgastricartery

Stomach

Headof pancreas

D e s c e n d i npga r to f d u o d e n u m SuperiormesentericarterY

Uncinateprocessof pancreas
S u p e r i om
r e s e n t e r ivce i n
A b d o m i n aal o r t a
lnferiorvenacava

of the commonhepaticartery
Distribution
169
ABDOMEN . Venous
drainageof viscera

Stomach(cut)

Gallbladder
S h o r tg a s t r i cv e i n s

Liver(retracted)

Spleen
Leftgastricvein

S p l e n i cv e i n
Inferiormesentericvein
Pancreas(cut) B r a n c ho f m i d d l ec o l i cv e i n
R i g h tg a s t r o - o m e n t vael i n Leftgastro-omentalvein
Left gonadalvein
P a n c r e a t i c o d u o d e vneailn
S u p e r i om
r e s e n t e r ivce i n
B r a n c ho f m i d d l ec o l i cv e i n
Superiormesentericartery
Duodenum

R i g h tc o l i cv e i n Left colicveins

Inferiorvenacava D e s c e n d i ncgo l o n

l l e o c o l i vc e i n

J e j u n aal n d i l e a vl e i n s
Ascending
colon

Ureter

S i g m o i dv e i n s

Cecum

Appendix S i g m o i dc o l o n

Venousdrainage of the abdominal portion of the gastrointestinaltract in situ

170
Venousdrainageof viscera

Left gastricvein
Shortgastricveins
R i g h tg a s t r i cv e i n

S p l e n i cv e i n

P o r t avl e i n

R i g h t g a s t r o - o m e n t vael i n

S u p e r i om
r e s e n t e r ivce i n
lnferiormesentericvein
P a n c r e a t i c o d u o d e vn ea il n
B r a n c ho f m i d d l ec o l i cv e i n

Leftgastro-omentalvein
B r a n c ho f m i d d l ec o l i cv e i n

R i g h t c o l i cv e i n
Left colicveins

l l e o c o l i vc e i n

J e j u n aal n d i l e a lv e i n s

Superiorrectalvein

S i g m o i dv e i n s

Venousdrainageof the abdominalportionof the gastrointestinal


tract

Stomach
Liver

Pancreas
Portalvein S p l e n i cv e i n
lnferiormesentericvein
S u p e r i om
r e s e n t e r ivce i n (enterssuperiormesentericvein
Pancreas just anteriorto this view)
Spleen
Duodenum
-inferiorpart Superiormesentericartery

Formationof the portalvein.


C T i m a g e ,w i t h c o n t r a s t ,i n c o r o n a lp l a n e

171
ABDOMEN . Portosystemic
anastomoses

Para-umbilical

Lrver Tributariesto azygosvein


Left gastricvein

Stomach
Portalvein
Leftgastricvein
S p l e n i cv e i n

E s o p h a g e a ln d
gastricveins
Inferiormesentericvein

Superficia vel i n so n
a b d o m i n awl all
Inferiorvenacava
S u p e r i om
r e s e n t e r ivce i n

C o m m o ni l i a cv e i n

S u p e r i orre c t a vl e i n

I n t e r n aill i a cv e i n
Middle rectalvein
E x t e r n ai l i a cv e i n
Internal
p u d e n d avl e i n
Rectum

Connectinw g ith
Inferiorrectalvein s u p e r f i c i av le i n s

Portosystemic
anastomoses

5 u p e r i om
r e s e n t e r ivce i n
Esophageal varices:
swollenconnectionsbetweensystemicand portal
systemas t inferioe
r ndofesophagus

Hemorrhoids:
swollenconnectionsbetweensystemicand portal
systemsat inferiorend of rectumand analcanal I n f e r i om
r e s e n t e r ivce i n

C a p u tm e d u s a e :
swollenconnectionsbetweensystemicand portal
systema s r o u n du m b i l i c u s I n t e r n apl u d e n d avl e i n

Swollenconnectionsbetweensystemicand portal
systemsat bareareaof liver
Inferiorrectalvein
Swollenconnectionsbetweenveinsassociatedwith
retroperitonealpartsof the gastro-intestinal
tract and
the body wall
Venous enlargement in portal hypertension(varices)

172
Posteriorwall

E s o p h a g e ah li a t u s

M e d i a na r c u a t el i g a m e n t
(aortichiatus)

Medialarcuateligament

Lateralarcuateligament

R i g h tc r u so f d i a p h r a g m Leftcrusof diaphragm

Transversus
a b d o m i n i s( c u t )

Transversus
abdominis

Q u a d r a t u lsu m b o r u m

Anteriorsuperior
i l i a cs p i n e

I n g u i n alli g a m e n t

P u b i ct u b e r c l e

of the posteriorabdominalwall
Muscles

173
ABDOMEN. Vessels
of theposterior
wall

E s o p h augs A o r t i ch i a t u sa n d m e d i a na r c u a t el i o a m e n t

H e p a t i cv e i n s

Diaphragm

Left suprarenalgland
R i g h ts u p r a r e n agll a n d

Inferiorvenacava C e l i a ct r u n k
Middle suprarenalartery
Left renalvein
Superior
mesentencartery Left kidney

R i g h tk i d n e y
Transversus
abdominis
A b d o m i n aal o r t a

Q u a d r a t u lsu m b o r u m
Inferiormesentericartery

Leftgonadalvessels
R i g h tg o n a d avl e s s e l s

Rightureter

Left ureter
R i g h tc o m m o ni l i a ca r t e r y

Psoasmajor

Mediansacralartery Left internaliliacartery

lliacus

Leftexternaliliacartery

Leftexternaliliacvein

Bladder

Vessels
and theirrelationship
to the posteriorabdominalwall
174
E s o p h a g e ah li a t u s Superiorepigastricartery
Centraltendon
Inferiorvenacava
Esophagus with anteriorand posterior
v a g a lt r u n k s

Left phrenicnerve
R i g h tp h r e n i cn e r v e

Left inferiorphrenic
arrery

G r e a t esr p l a n c h n i c
nerve

Hemiazygos
veln

L e s s esr p l a n c h n i c
nerve
L e a s st p l a n c h n i c
nerve

Lateralarcuateligament

l r c u a t el i g a m e n t
Mediaa
Leftcrus
processof Ll
Transverse
Sympathetictrunk
Thoracicduct

Psoasmajor

Q u a d r a t u lsu m b o r u m
Inferiorviewof diaphragm

Aorta

Spleen

Pleuralcavity

of the diaphragmin relationto otherstructures.


Positioning
C T i m a g e ,w i t h c o n t r a s t ,i n a x i a lp l a n e

175
ABDOMEN. Kidneys
"i: :1r:.

Inferiorvena cava

Esophagus

Diaphragm

Leftsuprarenalgland
R i g h ts u p r a r e n agll a n d

Portalvein
Pancreas(retroperitoneal)
Parietalperitoneum Attachmentof transverse
mesocoton
R i g h tk i d n e y
(retroperitoneal) Left kidney

Duodenum
Superiormesentericartery

Inferiormesentericvein
S u p e r i om
r e s e n t e r ivce i n (retroperitoneal)
Left ureter(retroperitoneal)
Inferiormesenteric
Cut edgesof peritoneum artery(retroperitoneal)
R i g h tu r e t e r A b d o m i n aal o r t a
(retroperitoneal) (retroperitoneal)
S i t eo f a s c e n d i n gc o l o n S i t eo f d e s c e n d i n cgo l o n

C o m m o ni l i a c a r t e r y
(retroperitoneal) Cut edgesof peritoneum

Externaliliacartery
(retroperitoneal)

Superiorrectalvessels

Peritoneum
and the retroperitoneal
positionof the kidneys

T r a n s v e r s uasb d o m i n i s
Peritoneum
I n t e r n aol b l i q u e
Inferiorvenacava
E x t e r n aol b l i q u e A b d o m i n aal o r t a

Renalfascia Renalarteryand vein


P e r i n e p h r ifca t
Renalpelvis
Kidney
P s o a sm a j o rm u s c l e
Transversalis
fascia
P a r a n e p h r fi ca t
Q u a d r a t u lsu m b o r u mm u s c l e

Organization
of fat andfasciasurrounding
the kidneys
176
Kidneys

R i bX I R i bx t l
Left kidney
R i g h tk i d n e y
Left ureter
Transverseprocesses
lliaccrest
of lumbarvertebrae

Surfaceprojectionof the kidneysand ureters(posteriorview)

Diaphragm

Leftkidney Rightkidney

Psoasmajor

Q u a d r a t u lsu m b o r u m

Structuresrelatedto the posteriorsurfaceof eachkidney

Stomach
R i g h ts u p r a r e n agll a n d L e f ts u p r a r e n agll a n d
Spleen

Pancreas
Rightkidney Leftkidnev
Left colicflexure

Descendingpart
of duodenum Descendingcolon
Rightcolicflexure

Jejunum

S m a l il n t e s t i n e

relatedto the anteriorsurfaceofeachkidney


Structures
177
ABDOMEN. Gross
structure
ofkidneys

S u p e r i opr o l e

Medialborder
F i b r o u sc a p s u l e

Lateralborder

Inferiorpole

Anteriorsurfaceof right kidney

Internalstructureof the right kidney

178
lnferiorvena cava Abdominalaorta lnferiorvenacava Abdominalaorta

R i g h tk i d n e y I P s o a sm a j o rm u s c l e Rightkidney I Psoasmajor muscle


Renalpelvis pelvis
Renal Leftkidney Rightureter Left ureter Left kidney

Renalpelvis. Locationof ureters.


in axialplane
CTimage,withcontrast, CT image, with contrast, in axial plane

Pathwayof ureterin relationto otherstructures.


Coronal view of 3-D urogram using multidetector computed tomography

179
ABDOMEN. Renal
vasculature

Rightsuperiorsuprarenalartery Inferiorphrenicarteries

Celiactrunk
Leftsuperiorsuprarenalarteries

R i g h ts u p r a r e n agll a n d Left suprarenalgland

R i g h ts u p r a r e n avle i n Left middle suprarenalartery

Rightmiddle suprarenalartery
Leftsuprarenalvein
Rightinferiorsuprarenalartery
Left inferiorsuprarenalartery
Rightrenalvein
Left renal artery
Rightrenalartery
Left renalvein
R i g h tk i d n e y
Superiormesentericartery

Left kidney
Inferiorvenacava

Abdominalaorta

Inferiormesentericarterv

Rightureter

Rightgonadalvessels Left gonadalvessels

Rightcommon iliacartery Left ureter

Superiorrectalartery Leftcommon iliacvein

Rightexternaliliacartery Left internaliliacartery

Rightexternaliliacvein

Rightinternaliliacartery
Left externaliliacartery

Leftexternaliliacvein

Vasculature
relatingto kidneys,suprarenal
glands,and ureters

180
Abdominalaorta

Liver Spleen

Left renalvein
lnferiorvenacava
R i g h tr e n a vl e i n Left renalartery
Rightrenalartery

R i g h tk i d n e y Left kidney

Renalvasculature,
C T i m a g e ,w i t h c o n t r a s t ,i n a x i a lp l a n e

Stomach
Spleen

A b d o m i n aal o r t a
Left renal artery

Left kidney

Psoasmajor

Renalarteries.
C T i m a g e ,w i t h c o n t r a s t ,i n c o r o n a lp l a n e

Leftgastricartery

Common hepaticartery Splenicartery

C e l i a ct r u n k

Superiormesentericartery
Left renalartery

Rightrenalartery

Abdominalaorta

Inferiormesentericartery

Renalarteries.
V o l u m e - r e n d e r e da n t e r i o rv i e w u s i n g m u l t i d e t e c t o rc o m p u t e rt o m o g r a p h y

181
ABDOMEN. Branches
of theobdominal
aorta

C e l i a ct r u n k
Esophagus

Diaphr

R i g h ts u p e r i o r
suprarenalarteries Left superior
Rightsuprarenal suprarenalarteries
Rightinferiorphrenicartery Left inferiorsuprarenalartery
Rightinferior Left inferiorphrenicartery
suprarenalartery middle suprarenalartery
R i g h tm i d d l e Left renalartery
suprarenalartery
Superiormesentericartery
Rightrenal
a t u sl u m b o r u m
Subcostalartery
R i g h tk i d n e y
Inferiormesentericartery

P s o a sm i n o r Lumbararteries

R i g h tt e s t i c u l a r
(ovarian)artery

Psoasmajor

Rightcommon iliacartery
Deepcircumflexiliacartery
l l i o l u m b aar r t e r y

Internaliliacartery
Externaliliacartery
Superiorglutealartery Mediansacralartery

Lateralsacralartery Deepcircumflexiliacartery
l l i ac u s
Inferiorglutealartery
Middle rectalartery Leftfemoralartery

Abdominal aorta and branches


182
lnferiorvenacovo

H e p a t i cv e i n s
Left inferiorphrenicvein

Hemiazygosvein

Azygosvein

Leftsuprarenalgland
R i g h ts u p r a r e n avle i n

Leftsuprarenalvein

R e n avl e i n s
Left renalvein

lnferiorvena cava

Ascendinglumbarveins

Testicular
(ovarian)veins

L u m b a rv e i n s

l l i o l u m b avr e i n s

Left ureter

i l i a cv e i n s
M e d i a ns a c r avl e i n

Leftexternaliliacvein

R i g h ti n t e r n aill i a cv e i n
Rightexternaliliacvein

R i g h ts u p e r i ogr l u t e a vl e i n

lnferiorvenacavaandtributaries
183
R i g h tc o m m o n Leftcommon
iliacartery i l i a cv e i n

R i g h tc o m m o n Leftcommon
i l i a cv e i n i l i a ca r t e r y

l l i a c us Psoasmajor

R i g h ts a c r o - i l i aj oc i n t Sacrum

Abdominalaortaand inferiorvenacava.
CTimagesw
, i t h c o n t r a s t ,i n a x i a lp l a n e

184
andinferior
Abdominalaorta

Stomach

Spleen

Abdominalaorta
lnferiorvenacava
Left common
i l i a ca r t e r y
R i g h tc o m m o n
i l i a ca r t e r y

R i g h te x t e r n a l Psoasmajor
i l i a ca r t e r y
l l i ac us Leftexternal
i l i a ca r t e r y
Bladder

Stomach

5pleen

A b d o m i n aal o r t a
R i g h tk i d n e y

lnferiorvena cava
Leftcommon
Leftcommon iliacartery
i l i a cv e i n

R i g h te x t e r n a l Psoasmajor
i l i a ca r t e r y
Left external
l l i a c us iliacartery

Bladder

of the abdominalaortaand inferiorvenacavain relationto otherstructures.


Positioning
C T i m a g e s ,w i t h c o n t r a s t ,i n c o r o n a lp l a n e

185
Diaphragm

Subcostalnerve
(T12)

T r a n s v e r s uasb d o m i n i s

lliohypogastricnerve
( 1 1)

l l i o - i n g u i n anle r v e l l i o - i n g u i n anle r v e
( 1 1)

Lateralcutaneous Genitofemoralnerve
(11,12)
nerveof thigh

l l i a cf o s s a Psoasmajor
P s o a sm i n o r
Genitofemoralnerve
Lateralcutaneous
Obturatornerve nerveof thigh (12,13)

Lumbosacra
t rlu n k
L u m b o s a c r at rlu n k
Femoralnerve (L4,Ls)
G e n i t abl r a n c h
l l i a c us
I n g u i n alli g a m e n t
Femoralbranch
Femoralnerve
(L2-14)

Obturatornerve Obturatornerve
(12-L4)

Obturatorforamen

Lumbarplexus
186
Lumbarplexus:cutoneous

T10
Tll

r12

Lateralcutaneousbranchof
iliohypogastricnerve(11)

Anteriorcutaneousbranchof
iliohypogastricnerve(Ll )

112
llio-inguinalnerve(Ll )

Femoralbranchof genitofemoral
Genitofemoralnerve(11,12)
nerve(11,12)

l l i o - i n g u i n anle r v e( L l)

Lateralcutaneousnerveof
Lateralcutaneousnerveof thigh (12-13)
thigh (12-13)

Cutaneousbranchof obturator
nerve (12-14)
Obturatornerve(12-14)

lntermediatecutaneous
nerve from femoral nerve

Medialcutaneousnerve
from femoral nerve

Femoralnerve(L2-L4)

Saphenousnervefrom
femoralnerve

Cutaneousdistributionof the nervesfrom the lumbarplexus

187
OMEN . Lymphatics

Diaphragm

C e l i a cn o d e s

Superiormesenteric
nooes
I n t e s t i n at rl u n k Left renalartery

Rightrenalartery Superiormesenteric
artery
Cisternachyli
Abdominalaorta
Pre-aorticnodes
R i g h tl u m b a rt r u n k
with lateralaortic
Inferiormesentericnodes
( l u m b a r n) o d e

Inferiormesenteric
artery Left lumbartrunk
Inferiorvenacava

Psoasmajor
C o m m o ni l i a cn o d e s
Psoasminor

E x t e r n ai l i a cn o d e s
I n t e r n aill i a cn o d e s

I n t e r n aill i a ca r t e r y

Rectum

Bladder

Abdominal lymphatics
188
Abdominalinnervation

Esophagus

Anteriorand posteriol
vagaltrunks

Greatersplanchnicnerve
C e l i a cg a n g l i o n
Lessersplanchnicnerve
Leastsplanchnicnerve
Rightkidney Aorticorenalganglion
Rightrenalartery
anoprexus Superiormesenteric
L u m b a rs p l a n c h n inc e r v e ganglion

S y m p a t h e t itcr u n k
andganglion Aortic plexus

A b d o m i n aal o r t a
Ureterand plexus lnferiormesenteric
ganglion
Testicular(ovarian)
arteryand plexus

Superiorhypogastric
prexus

I n t e r n aill i a ca r t e r y
Righthypogastricnerve

Externaliliacartery Pelvicsplanchnicnerves
(s2,3,4)

Inferiorhypogastricplexus

plexuses
Prevertebral trunks
and gangliawith sympathetic
189
l-Greatersplanchnicnerve
Thoracicsplanchnicnerves--.] Lessersplanchnicnerve-
(sympathetics and visceralafferents)
f reast splanchnicnerve
A n t e r i o ra n d p o s t e r i ovr a g a lt
G r e a t esr p l a n c h n i c

Thoraci<
ganglia

Leastsplanchnicnerve

Abdominalaorta

S u p e r i ohr y p o g a s t r ipcl e x u s

Righthypogastricnerve

Inferiorhypogastricplexus

L u m b a rs p l a n c h n inc e r v e s
(sympatheticsand visceralafferents)

S a c r asl p l a n c h n inc e r v e s
(sympathetics
and visceralafferents)
P e l v i cs p l a n c h n inc e r v e s
(parasympathetics
and visceralafferents)

Splanchnic nerves

190
Visceralefferent(moto) innervotion
l

Dorsalmotor nucleusof vaqus


Visceralefferentinnervationto the
abdominalgastrointestinal system

R i g h tv a g u s

T5-12
P r e g a n g l i o np
i ca r a s y m p a t h e t i c spinalcordlevels

P r e g a n g l i o n si cy m p a t h e t i c

Postganglionic
sympathetic

Posteriorvagaltrunk
(parasympathetic)

FOREGUT
A n t e r i o rv a g a lt r u n k
(parasympathetic)

I
Superior
mesenreflc
MIDGUT
anery

HINDGUT

I n t e r n aal n a ls p h i n c t e(rs m o o t hm u s c l e )
innervatedby parasympathetic (52,3,4)
(relaxation) and sympathetic(11,12)(contraction) Pelvicsplanchnicnerves
(parasympatheticS2,3,4)
Externalanal sphincter(skeletalmuscle)
innervatedby somaticefferentfibers(S2,3,4) lnferior
in the pudendalnerve(not shown) hypogastricplexus

191
ABDOMEN ' Visceralofferent
(sensory)
innervationondreferredpain diagram

c3,4,5
s p i n a lc o r d l e v e l s

Nucleiof solitarytract

R i g h tv a g u s

Somatic"pain" referredto
anothersomaticareaof
samespinalcordlevel

IntercostalnervesT(5)6-TlI

Posteriorvagaltrunk
t e r i o rv a g a lt r u n k

" l r r i t a t i o no" f d i a p h r a g m
b y l i v e ra n d g a l l b l a d d e r

I
Superior
MIDGUT mesenteflc
artery

HINDGUT

- Visceralafferent(followsparasympathetic) Visceralpainfibersmainlyaccompany sympathetic nerves


Visceralafferent(followssympathetic) backto the centralnervoussystem.Othertypesofvisceral
Somaticafferent
sensory(afferent)fibers(relatedto reflexactivities)follow
mainlyparasympathetic nerves
192
(sensory)
Visceralafferent pain diagram
innervationandreferred

Visceral"pain" referredto somaticarea


innervatedby samespinalcordlevel
ABDOMEN . Kidneyonduretervisceralafferent
(sensory)
diagrom

D o r s am
l o t o r n u c l e u so f v a g u s

"Pain"from kidneysreferredto somaticarea


innervatedby samespinalcordlevel

Posteriorvagaltrunk

R i g h tk i d n e y

Preganglionic
sympathetic

P o s t g a n g l i o nsi cy m p a t h e t i c

P r e g a n g l i o np
i ca r a s y m p a t h e t i c

P o s t g a n g l i o npi ca r a s y m p a t h e t i c

Visceralafferent

P e l v i cs p l a n c h n inc e r v e s
(parasympathetic 52,3,4)

194
Kidneyand uretervisceralafferent(sensory)
diogram

TlO-Ll dermatomes

Painfibersmainlyfollow sympatheticnervesto the centralnervoussystem(CNS). Thispain is


'referred'by the CNSto the somaticareainnervatedby the samespinallevels.Othertypesof
visceralafferent(sensory)fibers(relatedto reflexactivities)follow mainlyparasympathetic
nerves

195
UM
PELVISAND PERINE
coNrENrs i t'l.t:i'1".''. t'

Surface anatomyandarticulated pelvisin men 198 Venous drainage ofrectum 237


Surface anatomyandarticulated pelvisin women 200 Sacralandcoccygeal nerveplexuses 238
Pelvicgirdle 202 Pelvicnerve plexus 239
PelvicAirdle:imaging 203 Hypogastric plexus 240
Lumbosacral joint 204 Surfaceanatomyof theperineum 241
joint
Sacro-iliac 205 Borders andceilingof theperineunt 244
Pelvicinletandoutlet 206 Deeppouchandperinealmembrane 245
Orientation of pelvicgirdleandpelvicbrim 207 Muscles anderectiletissues in men 246
Pelvicviscera andperineumin men 208 tissuein men:imaging
Erectile 247
Pelvicviscera andperineumin men:imaging 209 Muscles anderectiletissues in women 248
Pelvicviscera andperineumin women 210 tissuein women:imaging
Erectile 249
Pelvicviscera andperineumin women:imaging 211 lnternalpudendalartery andvein 2s0
Lateralwallof pelviccavity 212 Pudendal nerve 251
Floorof pelviccavity:pelvicdiophragm 213 Vasculature of perineum 252
Rectumand bladderin situ 216 Nerves of perineum 253
Rectum 217 Lymphatics of pelvisandperineumin men 254
Bladderin men 218 Lymphatics of pelvisandperineumin women 255
Bladderin women 219 Lymphatics 256
Reproductive systemin men 220 Dermatomes 257
Prostate 221 lnnervation of reproductivesystemin men 258
Prostate andseminalvesicles 223 lnnervation of reproductivesystemin women 259
Scrotum 224 lnnervation of bladder 260
Testes 225 Pelviccavityimagingin men 261
Penis 226 Pelviccavityimagingin women 264
Reproductive systemin women 227
Uterusandovaries 228
Uterus 229
Uterus:imaging 230
Pelvicfascia 231
Arterialsupplyof pelvis 232
Venous drainageof pelvis 233
Vasculature of thepelvicviscero 234
Vasculature of uterus 235
Venous drainageof prostateandpenis 236
A n t e r i o rs u p e r i o irl i a cs p i n e A n t e r i o rs u p e r i o irl i a cs p i n e

A n t e r i o ri n f e r i o ri l i a cs p i n e

Inguinalligament

P u b i ct u b e r c l e P u b i ct u b e r c l e

Obturatorforamen

R a m u so f i s c h i u m

I n f e r i o pr u b i cr a m u s

Surfaceanatomywith bones(anteriorview)

P o s t e r i osru p e r i o irl i a cs p i n e
Ala of sacrum

Anteriorsuperior
i l i a cs p i n e

Anteriorsacralforamina

A n t e r i o ri n f e r i o ri l i a cs p i n e Arcuateline

l s c h i asl p i n e
Coccyx

Acetabulum

S u p e r i opr u b i cr a m u s

R a m u so f i s c h i u m
pubis
( p e c t i n e al iln e )
I n f e r i o pr u b i cr a m u s P u b i cs y m p h y s i s

Articulatedpelvis(anteriorview)

198
andarticulatedpelvisin men

P o s t e r i osru p e r i o irl i a cs p i n e

Posteriorinferioriliacspine

l s c h i asl p i n e

lschialtuberosity

anatomywith bones(posteriorview)
Surface

Obturatorforamen

S u p e r i opr u b i cr a m u s

lschialtuberosity
R a m u so f i s c h i u m Bodyof pubis

I n f e r i o pr u b i cr a m u i P u b i cs y m p h y s i s

Articulatedpelvis(posterior
view)

199
Umbilicus

l l i a cc r e s t

A n t e r i o rs u p e r i o irl i a cs p i n e A n t e r i o rs u p e r i o irl i a cs p i n e

A n t e r i o ri n f e r i o ri l i a cs p i n e

I n g u i n alli g a m e n t

P u b i ct u b e r c l e P u b i ct u b e r c l e

Obturatorforamen

R a m u so f i s c h i u m

I n f e r i op
r u b i cr a m u s

Surfaceanatomywith bones(anteriorview)

P o s t e r i osru p e r i o irl i a cs p i n e

Ala of sacrum

Anteriorsuperior
i l i a cs p i n e

Anteriorsacralforamina

A n t e r i o ri n f e r i o ri l i a cs p i n e

Coccyx

Acetabulum

S u p e r i opr u b i cr a m u s
S u b p u b i ca n g l e
R a m u so f i s c h i u m (800-85oin women)

P u b i cs y m p h y s i s
l n f e r i o rp u b i cr a m u s

Articulatedpelvis(anteriorview)

200
Surfaceanatomyandarticulatedpelvisin women

l l i a cc r e s t l l i a cc r e s t

S a c r adl i m p l e
( l o c a t i o no f p o s t e r i osr u p e r i o irl i a cs p i n e )

Interglutealcleft (natalcleft)

Glutealfold

anatomywith bones(posterior
Surface view)

Superiorarticularprocess

Posteriorsuperior
i l i a cs p i n e
Posteriorinferior
i l i a cs p i n e

Sacrum

S a c r ahl i a t u s

Sacralcornua

l s c h i asl p i n e

Obturatorforamen

S u p e r i opr u b i cr a m u s

hialtuberosity
R a m u so f i s c h i u m
B o d yo f p u b i s
I n f e r i op
r u b i cr a m u i P u b i cs y m p h y s i s

Articulatedpelvis(posterior
view)

201
PELVISAND PERINEUM.Pelvic
airdle

A n t e r i o sr u p e r i o r
i l i a cs p i n e

A r c u a t el i n eo f i l i u m
- Greater
Anteriorinferioriliacspine sciaticnotch

l l i o p u b i ce m i n e n c e

Pectenpubis (pectinealline)

S u p e r i opr u b i cr a m u s

P u b i ct u b e r c l e
Obturatorforamen

R a m u so f i s c h i u m

Inferiorpubic ramus
Pubicsymphysis

PelvicAirdlein men
with left pelvicbone removed
(anterolateral superiorview)

Arcuate
l i n eo f - Greatersciatic
ilium
notch

Anterior
inferior
i l i a cs p i n e

lliopubic l s c h i asl p i n e
emrnence
" Lessersciatic
Pectenpubis
( p e c t i n e al il n e ) notch
S u p e r i opr u b i c
ramus Obturatorforamen

P u b i ct u b e r c l e I n f e r i op
r u b i cr a m u s

Pubiccrest Bodyof pubis

P u b i cs y m p h y s i s Pelvicgirdle in women
with left pelvic bone removed
(anterolateralsuperior view)

202
S a c r o - i l i aj ocin t

Sacrum ts

Acetabulum
r"l]urlllllllt,.,.,,,
H e a do f f e m u r

S u p e r i opr u b i cr a m u s
P u b i cs y m p h y s i s
Obturatorforamen

lschialtuberosity
R a m u so f i s c h i u m

S u b p u b i ca n g l e I n f e r i op
r u b i cr a m u s
( s m a l l eirn m e nt h a n i n w o m e n )

Male bony pelvis.


Radiograph,
anterior-posterior
view

"'""',::,:,,1,:,),,),),,),,,,,,,,:',,'

S a c r o - i l i aj oci n t

llium

Sacrum tuullllllll

Acetabulum
H e a do f f e m u r

S u p e r i opr u b i cr a m u s

P u b i cs y m p h y s i s
Obturatorforamen

R a m u so f i s c h i u m lschialtuberosity

Femur

S u b p u b i ca n g l e l n f e r i o rp u b i cr a m u s
( l a r g e irn w o m e nt h a n i n m e n )

Femalebony pelvis,
Radiograph,
anterior-posterior
view

203
PELVISAND PERINEUM.Lumbosacral

A n t e r i o rl o n g i t u d i n al li g a m e n t Bodyof vertebraLV

l l i o l u m b alri g a m e n t

Anteriorsuperior
i l i a cs p i n e
Sacrum

Greatersciaticforamen

S a c r o s p i n o ul isg a m e n t l s c h i asl p i n e
Lessersciaticforamen Anteriorsacrococcygeal
ligaments
Coccyx

Sacrotuberous
ligament
Obturatorforamen

P u b i ct u b e r c l e P u b i cs y m p h y s i s

jointsand associated
Lumbosacral ligaments(anteriorview)

joint betweenLVand 5l
Zygapophyseal
l l i o l u m b alri g a m e n t Bodyof vertebraLV

L u m b o s a c r al i lg a m e n t

Posteriorsuperior
i l i a cs p i n e

Interosseous
sacro-iliac
ligament

Posteriorinferior
i l i a cs p i n e
Posteriorsacralforamina

Greatersciaticforamen

S a c r o s p i n o ul isg a m e n t Superficialposterior
sacrococcygeal ligaments
Deepposteriorsacrococcygeal
ligament
Lessersciaticforamen
l s c h i asl p i n e Sacrotuberous
ligament

Obturatorforamen

lschialtuberosity
Pubic
symphysis

Lumbosacraljoints and associatedligaments (posteriorview)


204
A n t e r i o rl o n g i t u d i n al li g a m e n t

joint betweenLVand Sl
Zygapophyseal

Intervertebraldisc
Posteriorsacro-iliacligament(cut)
( b e t w e e nL V a n dS l )

sacro-iliacligament(cut)
Interosseous
A n t e r i o rs a c r o - i l i al icg a m e n (t c u t )

Articularsurfaceof sacrum

I n g u i n alli g a m e n t
Greatersciaticforamen

L a c u n alri g a m e n t

S a c r o s p i n o ul isg a m e n t
O b t u r a t o cr a n a l
Coccyx

Obturatormembrane

l s c h i atlu b e r o s i t y l s c h i asl p i n e

jointsand associated
Sacro-iliac ligaments(lateralviewwith left pelvicboneremoved)

P u b i cs y m p h y s i s

Pubiccrest

Anteriorsacrococcygeal
ligaments l s c h i asl p i n e

A n t e r i o rs u p e r i o irl i a cs p i n e

A r c u a t el i n eo f i l i u m

A n t e r i o rl o n g i t u d i n a l S a c r o s p i n o ul isg a m e n t
ligament
sacrotuberousligament

Bodyof Sl

A n t e r i o rs a c r o - i l i al icg a m e n t

P o s t e r i osra c r o - i l i al icg a m e n t

joints(anterosuperior
Sacro-iliac view)
205
M . Pelvic
PELVISAND PERINEU inletandoutlet

Pubiccrest
P u b i cs y m p h y s i s
Pubictubercle S u p e r i opr u b i cr a m u s

Pectenpubis (pectinealline)
Anteriorinferioriliacspine

l l i o p u b i ce m i n e n c e
Anteriorsuperior
i l i a cs p i n e

l s c h i asl p i n e

Arcuateline
of ilium
lliaccrest

Sacral
promontory

Ala of sacrum
joint
Sacro-iliac

S a c r acl a n a l P o s t e r i osru p e r i o irl i a cs p i n e

Pelvicinlet(shownin red;anterosuperior
view)

P u b i cs y m p h y s i s
P u b i ct u b e r c l e

lschialtuberosity

Sacrotuberous
lioament

P o s t e r i osru p e r i o irl i a cs p i n e Coccyx

Pelvic outlet (shown in green; anteroinferior view)

206
Orientationof pelvicgirdleandpelvicbrim

A n t e r i o rs u p e r i o r
i l i a cs p i n e

A n t e r o s u p e r i omr a r g i n
o f p u b i cs y m p h y s i s

position(lateralview)
Pelvicorientationin anatomical

Sacralpromontory Ala ofsacrum

S a c r o - i l i aj oci n t
Anteriorsuperior
i l i a cs p i n e

A n t e r i o ri n f e r i o ri l i a cs o i n e
A r c u a t el i n eo f i l i u m

Obturatorforamen

I n f e r i op
r u b i cr a m u s
P u b i cs y m p h y s i s

Pelvicbrim (shownin red;anteriorview)

207
M . Pelvic
PELVfS AND PERINEU viscera
andperineumin men

Common
i l i a ca r t e r y
Common
i l i a cv e i n

Parietal
peritoneum S i g m o i dc o l o n
Externaliliacartery
Inferiorepigastric
a r t e r ya n d v e i n
E x t e r n ai l i a cv e i n

Ductusdeferens Visceralperitoneum

Urachus

Bladder

P u b i cs y m p h y s i s
Retropubic
(potential)space
S u s p e n s o rl yi g a m e n o
t f penis

Prostaticurethra
M e m b r a n o uus r e t h r a
Deeppart of
externalanal sphincter
Spongyurethra
Superficialpart of
e x t e r n aal n a ls p h i n c t e r

Cutaneouspart of
e x t e r n aal n a ls p h i n c t e r

I n t e r n aal n a ls p h i n c t e r

Externalurethralsphincter

B u l bo f p e n i s

Pelvicvisceraand perineumin menln situ(sagittalsection)

208
andperineumin men:imaging
Pelvicviscera

Prostatic
venousptexus

Prostate
Rectum

ic urethra

A n a lc a n a l

B u l bo f p e n i s

Corpuscavernosum
C o r p u ss p o n g i o s u m

Pelvicviscerain men.
T 2 - w e i g h t e dM R i m a g e i n s a g i t t a lp l a n e

209
M . Pelvic
PELVISAND PERINEU andperineum
viscera in women

Common
iliacartery I n t e r n aill i a cv e i n
Common Internaliliacartery
i l i a cv e i n S u s p e n s o rl yi g a m e n t
of ovary

lliacus Uterinetube
Ureter
Peritoneum
S i g m o i dc o l o n
Externaliliacartery
Inferiorepigastric
Vesicouterine
arteryand vein
poucn
Externaliliacvein
Ovary Uterosacral
R o u n dl i g a m e n t ligament
of uterus
Posteriorfornix
Bodyof uterus of vagina

Rectouterine
pouch

Cervixof uterus
Bladder
Externalos
of uterus
P u b i cs y m p h y s i s
Levatorani

Urethra Rectum
Deep part of
G l a n so f c l i t o r i s
externalanal
sphincter
L a b i u mm i n u s
Superficialpart of
L a b i u mm a j u s externalanal sphincter

Cutaneouspart of
externalanal sphincter

I n t e r n aal n a ls p h i n c t e r

E x t e r n aul r e t h r asl p h i n c t e r
Vaginalorifice

Pelvicvisceraand perineumin womenin situ(sagittalsection)

210
Pelvicvisceraandperineumin women:imaging

Sacralpromontory
VertebraSll

S m a l li n t e s t i n e

Bladder

Retropubic
( p o t e n t i a ls)p a c e

Urethra

P u b i cs y m p h y s i s

Pelvicviscerain women.
T 2 - w e i g h t e dM R i m a g e i n s a g i t t a lp l a n e

211
ANDPERINEUM . Lateralwallof pelviccavity
PELVIS

s u p e r i o irl i a cs p i n e

A n t e r i o rs u p e r i o r
i l i a cs p i n e

Greatersciaticforamen

S a c r o s p i n o ul isg a m e n t

Obturatorinternus

Obturatorcanal

P u b i ct u b e r c l e

P u b i cs y m p h y s i s

Obturatorinternusand piriformismuscles(obliquemedialview)

P o s t e r i osru p e r i o irl i a cs p i n e

Piriformis

l l i o f e m o r al il g a m e n t

Greatertrochanterof femur

lschiofemoralligament

O b t u r a t o irn t e r n u s

Tendonof obturatorinternus
Lessertrochanterof femur

Obturatorinternusand piriformismuscles(posterior
view)
212
Floorof pelviccavity:pelvicdiaph

S a c r o i l l i aj oci n t

P o s t e r i osru p e r i o irl i a cs p i n e

Ala of sacrum

A n t e r i o rs u p e r i o r
i l i a cs p i n e

Piriformis
( p a s s i no
gu t o f g r e a t e r
s c i a t i cf o r a m e n )

l s c h i asl p i n e

Fascia c o v e r i n gt h e
o b t u r a t o ri n t e r n u s

T e n d i n o u sa r c h
(of levatorani)

Obturatorcanal

Puborectalis
(part of levatorani)

- Analaperture

P u b i cs y m p h y s i s

lliococcygeus
(partof levatorani)
U r o g e n i t ahl i a t u s
Pubococcygeus
(Partof levatorani)

muscles(obliquesagittalview)
(coccygeus)
Levatorani and ischiococcygeus

213
PELVISAND PERINEU ofpelvic
M. Floor pelvicdiaphragm

symphysis
Urogenitalhiatus
Pubococcygeus
(partof levatorani)

A n a la p e r t u r e
Obturatorcanal

Obturatorinternus

Tendinoua s rch
(of levatorani)

lliococcygeus
(partof levatorani)

A n o c o c c y g e al i lg a m e n t

l s c h i asl p i n e

lschiococcygeus
(coccygeus) Sacrotuberous
ligament
Piriformis

Sacrospinous
ligament

Anterior
sacrococcygeal
ligament

S a c r acl a n a l Sacrum

Levator ani and ischiococcygeus (coccygeus) muscles (anterosuperior view)

llium

S m a l il n t e s t i n e

E p i p h y s i acla r t i l a g e
Rectum
O b t u r a t o irn t e r n u s
lschium
P e l v i cd i a p h r a g m
( l e v a t oar n i a n d i s c h i o c o c c y g e u s )

lschio-analfossa
A n a lr e g i o n

Pelvicdiaphragmin relationto otherstructures


in
the pelviccavityand perineum.
T 2 - w e i g h t e dM R i m a g e i n c o r o n a lp l a n e
214
I n f e r i op
r u b i cl i g a m e n t
P u b i cs y m p h y s i s
l s c h i o p u b irca m u s
U r o g e n i t ahl i a t u s
Pubococcygeus
(partof levatorani)
l s c h i atlu b e r o s i t y O b t u r a t o irn t e r n u s

Puborectalis
(partof
l e v a t o ra n i )
A n a la p e r t u r e

Tendonof obturator Piriformis


in t e r n u s

S a c r o t u b e r o ul isg a m e n t
Iliococcygeus
( p a r to f l e v a t o ra n i )

Coccyx

Levatorani muscle(inferiorview)

Bladder

H e a do f f e m u r

Vagina
G r e a t etrr o c h a n t e r

P u d e n d acl a n a l

Rectum

to otherpelvicstructures.
Obturatorinternusmuscleand its relationship
T 2 - w e i g h t e dM R i m a g e i n a x i a lp l a n e

215
PELVISAND PERINEU
M. Rectum
andbtadder
in situ

S i g m o i dc o l o n

I n t e r n aal n a ls p h i n c t e r
D e t r u s om
r uscle
A n a lc a n a l
Cutaneouspart of
e x t e r n aal n a ls p h i n c t e r
P u b i cs y m p h y s i s part of
e x t e r n aal n a ls p h i n c t e r

I n t e r n aul r e t h r asl p h i n c t e r Deeppart of externalanalsphincter


Deeptransverseperinealmuscle
Externalurethralsphincter
I
D e e pp e r i n e apl o u c h P e r i n e am
l embrane

Bladder,prostate,and rectumwithin pelviccavityin men(obliquesagittalview)

216
Bladder

Rectum Vagina
P u O l cs y m p n y s l s
Urethra A n a lc a n a l

Positioningof the rectumand analcanalin relation


to the other femalepelvicviscera'
T2-weighted MR image in sagittal plane

Surfaceprojectionof the rectumin women

C o m m o ni l i a ca r t e r y
C u t e d g eo f p e r i t o n e u m
muscleof rectum
C o m m o ni l i a cv e i n
m u s c l eo f r e c t u m
Rectalfascia Mucosaof rectum
Ductusdeferens
Ureter

Obturatorinternus

Tendinousarch
(of levatorani)
Middle transversefold lliococcygeus
of rectum (partof levatorani)

lliococcygeus
(partof levatorani) Bladder
lnferiortransversefold
Obturatorinternus of rectum
P u d e n d acl a n a w
l ith lschio-analfossa
vesselsand nerve
Pubococcygeus P u d e n d acl a n a li n
(part of levatorani) fasciaof obtuator
internus
Fatfilling ischio-analfossa
Puborectalis
(partof levatorani)
Anal valve

lnternalrectal
External anal sphincter
venousplexus
Anal crypt
Inferiorpubic ramus
A n a lc o l u m n s

ExternalrectalvenousPlexus
I n t e r n aal n a ls p h i n c t e r groove
Intersphincteric
A n a ls i n u s

Coronalsectionthroughrectumand analcanal(posteriorview)
217
M . Btadder
PELVISAND PERINEU in men

Deepperinealpouch

Inferiorpubic
ramus

Surfaceprojectionof the bladderin menflateralview)

Vesicalfascia

Urachus(cut)

Prostaticurethra
Capsuleof prostate

Externalurethralsphincter

Urinarybladderin men

218
Bladderin women

Rightureter

Left ureter

Vaginalopening

Deepperinealpouch
ligament
Pubovesical

Perinealmembrane

ligament
Pubovesical

Surfaceprojectionof the bladderin women (lateralview)

Uretericorifices
Left ureter

Acetabulum

lntrauretericfold

Externalurethralsphincter

Compressorurethrae

Sphincterurethrovaginalis

Urinarybladderand urethralsphincter Appearance and positioningof the bladderin relation


musclesin women(anteriorviewof posteriorwall) to other structuresin the femalepelviccavity.
T 2 - w e i g h t e dM R i m a g e i n c o r o n a lp l a n e

219
ANDPERINEUM . Reproductive
PELVIS systemin men

Inferiorvenacava

Leftcommon iliacvein

I n g u i n alli g a m e n t

Rightexternaliliacartery

Inferiorepigastricartery lschiococcygeus
Rightductusdeferens (coccygeus)
D e e pi n g u i n a rl i n g

A m p u l l ao f
R i g h te x t e r n aill i a cv e i n
ductusdeferens
I n g u i n acl a n a l
Left ureter
Obturatorarteryand vein
Leftductusdeferens
S u p e r cf ii a li n g u i n a rl i n g

Seminalvesicle

lliococcygeus

Ejaculatoryduct

Pubococcygeus
Spermaticcord
Prostate

B u l b o u r e t h r agl a n d

Deeptransverseperinealmuscle

D e e pp e r i n e apl o u c h
Corpusspongiosum B u l bo f p e n i s P e r i n e am
l embrane

S p o n g yu r e t h r a Dartosfascia
Superficial perinealfascia
H e a do f e p i d i d y m i s (Colles'fascia)
C o r p u sc a v e r n o s u m

M u s c u l o f a s c ipaol u c h
Navicularfossa
T u n i c av a g i n a l i (sp a r i e t aal n d v i s c e r al la y e r
enclosingcavityof tunicavaginalis)
G l a n so f p e n i s
C r e m a s t em
r uscle

Reproductive
systemin men(obliquesagittalview)

220
Uretericorifices

Trigone
Prostaticurethra

B l a d d e nr e c k
( i n t e r n aul r e t h r asl p h i n c t e r ) Levatorani muscle

stroma
Fibromuscular
Prostaticplexusof veins Glandularelementsof Prostate

P r o s t a t isci n u s
Openingsof prostaticducts
Capsuleof prostate
Prostaticutricle
S e m i n acl o l l i c u l u s

O p e n i n g so f e j a c u l a t o rdyu c t s
D e e pp e r i n e apl o u c h ExternalurethralsPhincter

Membranousurethra

Superficial perinealpouch P e r i n e am
l embrane

C o r p u ss p o n g i o s u m B u l bo f p e n i s

M i d l i n er a p h e B u l b o s p o n g i o s umsu s c l e

Coronalsecionthroughbladderand prostate(anteriorview)

Prostaticplexusof veins S e m i n avl e s i c l e


H e a do f f e m u r

lschium B u l bo f p e n i s
lschium Femur Prostate

and positioningof bladderand prostatein relationto


Appearance Appearance and positioningof ductusdeferens,
in the malepelvisand perineum'
otherstructures and seminal in relationto otherstructures
vesicles
T 2 - w e i g h t e dM R i m a g e i n c o r o n a lp l a n e in the malePelvisand Perineum.
T 2 - w e i g h t e dM R i m a g e i n c o r o n a lp l a n e

221
M . prostote
PELVISAND PERINEU

A m p u l l ao f d u c t u sd e f e r e n s

S e m i n avl e s i c l e

Ejaculatory
duct

C e n t r azl o n e
T r a n s i t i o n za ol n e
P e r i p h e r azlo n e

Anterior egion
(non-glandular)

A r e ao f s e m i n acl o l l i c u l u s

E x t e r n aul r e t h r asl p h i n c t e r

P e n i l eu r e t h r a
S e m i n avl e s i c l e P r o b ei n r e c t u m prostate

Rectalultrasoundimagingof the prostate,bladder,and


Zonalanatomyof the prostategland.
Mostcarcinomas seminalvesicle.Sagittalviewalsoshowingthe urethra
originatein the peripheralzone.
Benignprostatichypertrophy(BpH)
affectsmainlythe transitional
zone

P e r i p h e r azlo n e P u b i cb o n e C e n t r azl o n e Prostaticvenousplexus

P r o b ei n r e c t u m
I
B o u n d a r i eosf p r o s t a t e I Prostate Probein rectum
Rectalultrasoundimagingof the prostate. Rectalultrasoundimagingof the prostate.
Axialviewshowingthe centraland peripheralzones Axialviewshowingthe surroundingplexusof veins
222
Prostateond seminaI vesicles

Peripheralzone Centralzone Urethra

Probein rectum
Boundariesof prostate S e m i n acl o l l i c u l u s P r o b ei n r e c t u m

Rectalultrasoundimagingof the prostate. Rectalultrasoundimagingof the prostate.


Sagittalview showingthe centraland peripheralzones Axialviewshowingthe urethraand seminalcolliculus

Transverse
vesicalfold

U r i n a r yb l a d d e r

Ductusdeferens

Ductusdeferens

S e m i n avl e s i c l e
A m o u l l ao f d u c t u sd e f e r e n s

Beginningof ejaculatoryduct

Bladderand prostate(posteriorview)

223
PELVISAND PERINEUM.Scrotum

Superficial
fascia:Scarpa'slayer A p o n e u r o s iosf e x t e r n aol b l i q u e
A p o n e u r o s iosf i n t e r n aol b l i q u e

S u p e r cf ii a li n g u i n a rl i n g

Superficial
epigastric
arteryand vein

l l i o - i n g u i n anle r v e

Femoralartery

Femoralvein I n g u i n alli g a m e n t

Superficialexternal
pudendal Cremastermuscle
arteryand vein
F u n d i f o r ml i g a m e n t
G r e a ts a p h e n o uvse i n of penis

D e e pe x t e r n apl u d e n d a l
arteryand vein

Deepfasciaof penis(Buck'sfascia)
Superficialdorsalvein of penis
piniformplexusof veinsand testicularartery
Deepdorsalvein and dorsalarteriesof
Genitalbranchof genitofemoralnerve
C o r p u sc a v e r n o s u m
Ductusdeferens
C o r p u ss p o n g i o s u m
P a r i e t al la y e ro f t u n i c av a g i n a l i s
Externalspermaticfascia
o f t u n i c av a g i n a l i s

C r e m a s t em
r uscle A p p e n d i xo f e p i d i d y m i s

A p p e n d i xo f t e s t i s
Dartosfascia
S k i no f s c r o t u m / S e p t u mo f s c r o t u m

Contentsof the scrotum(anteriorview)

Ductusdeferens

Dartosfascia Testicularartery
p l e x u so f v e i n s
Pampiniform

B o d yo f e p i d i d y m i s
Parietallayer

T u n i c av a g i n a l i s Cavity

Viscerallayer

Lobulesof testis
Internalspermaticfascia

Externalspermaticfascia

C r e m a s t em
r uscle

Transverse
sectionthroughthe scrotumandtestes

224
Femoralvessels

Testis Testis Testis Testis

Spermatic and positioningin a youngmale.


cordappearance
T 1 - w e i g h t e dM R i m a g e si n c o r o n a lp l a n e

Ductusdeferens(andarteryof ductusdeferens)

L i g a m e n t o urse m n a n to f p r o c e s s uvsa g i n a l i s
Testicularartery

Pampiniformplexusof veins

S e m i n i f e r o ut u
sbule

H e a do f e p i d i d y m i s

Efferentductules

Retetestisin mediastinumtestis
Parietallayer

T u n i c av a g i n a l i s Cavity

Viscerallayer B o d yo f e p i d i d y m i s

Septum
S t r a i g httu b u l e

Capsu le
( t u n i c aa l b u g i n e a )
T a i lo f e p i d i d y m i s

structures
Testisand surrounding

22s
PELVIS
AND PERINEUM.Penis

P e n i l es k i n
Superficialfasciaof pents C o r p u sc a v e r n o s u m
t f penis
S u s p e n s o rl yi g a m e n o
Deepfasciaof penis(Buck'sfascia)
Fundiformligamentof penis
T u n i c aa l b u g i n e ao f c o r p u sc a v e r n o s u m

C o r p u ss p o n g i o s u m

G l a n so f p e n i s

obturator internus
Externalurethral
orifice

Prepuceof penis

Perinealmembrane Frenulum
of prepuce
Superficial
Transverse
p e r i n e am
l uscle
Perinealbody

Structureofthe penis

Lowerpart of trigone

Corpuscavernosum

T u n i c aa l b u g i n e a

Deeparteryof penis
Corpuscavernosum
( d i s p l a c efdr o m g l a n s ) gland
duct

C r u so f p e n i s

Crusof penis

O p e n i n g so f
bulbourethral
G l a n sp e n i s ducts
B u l bo f p e n i s
Openingto membranouspart of urethra

Structureof the penis Roofof spongyurethra(inferiorview)

226
systemin women
Reproductive

lschiococcygeus
(coccygeus)

Ovary

Uterinetube

R o u n dl i g a m e n t
of uterus

Bodyof uterus

O b t u r a t o irn t e r n u s Posteriorfornix
of vagina
t
Round Iigament -------------{
l Cervixof uterus
of uterustraversing
i n g u i n acl a n a l
Externalos of uterus

Urachus
Rectum
Bladder
Levatorani

P u b i cs y m p h y s i s

Vagina

Deep perinealpouch

G l a n so f c l i t o r i s P e r i n e am
l embrane

G r e a t evr e s t i b u l agr l a n d
C r u so f c l i t o r i s
B u l bo f v e s t i b u l e

systemin women(obliquesagittalview)
Reproductive

227
M . IJterus
PELVISAND PERINEU andovaries

F u n d u so f u t e r u s U t e r i n et u b e
Suspensory
ligamentof ovary
R o u n dl i g a m e n o
t f uterus
Uterinetube
Infundibulum

Fimbriae
C o r p u sa l b i c a n s
luteum
L i q a m e n t oo
f v a r' v! . . .
Left ovary Ligamentof ovary FOiltCte
Rightovary
booy oI urerus
Myometrium
Endometrium
l n t e r n aol s

Cervixof uterus
Cervicalcanalwith oalmatefolds

Vaginalcervix

Lateralfornix of vagina

Externalos
Vagina

V a g i n aw
l all

Surfaceprojectionof the uterus

Structureof the uterus and ovaries(posteriorview)

U t e r i n et u b e

F o l d so f u t e r i n et u b e

S u s p e n s o rl yi g a m e n t
of ovary

Atreticfollicle
Secondary(antral)follicle
P r i m o r d i af o
l llicles

P r i m a r yf o l l i c l e

Ligamentof ovary Fimbriae

Surfaceepitheliumof ovary Ovarianvessels

Oocyteat ovulation
C o r p u sa l b i c a n s
R u p t u r e df o l l i c l e
T u n i c aa l b u g i n e a
Tertiary(Graafi
an)follicle
R e g r e s s i ncgo r p u sl u t e u m Activecorpusluteum

Structureof the uterine tube and ovary (posteriorview)

228
Suspensory
ligamentof ovary ligamentof
Suspensory
Mesosalpinx Uterinetube
of broad ligament

Fimbriae

Rightovary
Mesovariumof
broad ligament
Mesometriumof
broad ligament
Roundligamentof uterus
Cut edge of Mesometrium
peritoneum
(mesometrium) Rightureter
Uretericfold

Uterosacral
ligament

Uterosacral
ligament
Rectouterinepouch

Cervixof uterus

Vagina

Vaginalwall

Uterusand broad ligament (posteriorview)

Uterinetube

ligamentof ovary

Uterinetube and ovary (posteriorview)

229
PELVISAND PERINEUM.tJterus:
i

Bladder
H e a do f f e m u r
Cervixof uterus

Rectum Obturatorinternus
O b t u r a t o irn t e r n u s
lschialtuberosity

G l u t e u sm a x i m u s

H e a do f f e m u r

Uterus

Rightovary

Rectum

Pubicsymphysis

S m a l il n t e s t i n e

llium
R i g h tu t e r i n et u b e
Left uterinetube
Uterus

Rectum

Appearance
ofcervixof uterus,uterus,ovaries,and uterinetubes
in relationto otherpelvicstructures.
T 2 - w e i g h t e dM R i m a g e si n a x i a lp l a n e

230
Inferiorvesicalvein

Inferiorrectalvein

(coccygeus)
lschiococcygeus

Superior
vesicalvein
lliococcygeus

Rectum

P u b i cs y m p h y s i s
Prostate
Puboprostaticligament

Leftdorsal
arteryof penis
Rectovesical
septum
Prostaticfascia
Prostaticplexusof veins
D e e pd o r s a vl e i no f p e n i s
Rectouterinepouch
Pelvicfasciaand relatedstructures
in men

Uterosacral
ligament

Transverse
cervicalligamenl

Pubocervicalligament Cervixof uterus

Vesico-uterine
pouch
Rectum

Levatorani

canal

Rectovaginal
septum
P e r i n e am
l embrane
Pelvicfasciaand relatedstructures
in women

231
PELVISAND PERINEUM.Arterialsupply
ofpelvis

R i g h tc o m m o ni l i a ca r t e r y

Deepcircumflexiliacartery l l i o l u m b aar r t e r y

trunk (14,5)
Lumbosacral

glutealartery

Lateralsacralarteries

Internaliliacartery

A s c e n d i n gb r a n c ho f
deep circumflex Mediansacralartery
iliacartery

Externaliliacartery

Externaliliacvein

U m b i l i c aal r t e r y
Inferiorepigastricartery
Piriformis
Inferiorepigastricvein

Superiorvesicalartery Inferiorgluteal
arTery
Pubicbranch
of inferior I n t e r n apl u d e n d a l
epigastricartery artery
Pudendalnerve
Obturatornerve

Obturatorartery lschiococcygeus
(coccygeus)

Middle rectalartery

M e d i a lu m b i l i c a l
l i g a m e n (t o b l i t e r a t e d
umbilicalartery)
o b t u r a t o ri n t e r n u s Inferiorrectalartery

Dorsalarteryof penisor clitoris

(partof levatorani)
lliococcygeus
Inferiorvesicalartery
(in men or vaginalarteryin women)
(partof levatorani)
Pubococcygeus

Arterialsupplyto the pelvis


(rightsidesagittalview)

232
of pelvis

R i g h tc o m m o ni l i a cv e i n

R i g h tc o m m o ni l i a ca r t e r y

Lumbosacra
t rlu n k

S u p e r i ogr l u t e a vl e i n

Lateralsacralvein

I n t e r n aill i a cv e i n
M e d i a ns a c r avl e i n

Externaliliacartery

Externaliliacvein

Inferiorepigastricartery

Inferiorepigastricvein Piriformis
Inferiorvesrcalvein
Inferiorgluteal
S u p e r i ovr e s i c avl e i n
vetn
Obturatornerve
Middle rectalvein
Obturatorvein
I n t e r n apl u d e n d a l
P u b i ct r i b u t a r yt o
vetn
the inferior
epigastricvein
lschiococcygeus
(coccygeus)

Medialumbilical
ligament(obliterated
umbilicalartery)

Obturatorcanal Inferiorrectalvein

Obturatorinternus

Vesicalplexusof veins
(partof levatorani)
lliococcygeus
P e r i n e avle i n
(partof levatorani)
Pubococcygeus

Veinsof the pelvis


(rightsidesagittalview)

233
S u p e r i orre c t a al r t e r ya n d v e i n
from inferiormesentericvessels

l l i o l u m b avr e i n
l l i o l u m b aar r t e r y
Lateralsacralvein
Lateralsacralartery
S u p e r i ogr l u t e a vl e i n
S u p e r i ogr l u t e a a
l rtery

Left internaliliacvein
R i g h ti n t e r n a l
illacartery
Middle rectalvein

R i g h tu r e t e r
Left ureter

Middle rectal Rectum


artery

Note:
uterineartery
crossesureter U t e r i n ev e i n

Uterineartery

U m b i l i c aal r t e r y S u p e r i ovr e s i c avl e i n

V a g i n aal r t e r y

Obturatorartery

Superiorvesicalartery

of the pelvicviscerain women(superior


Vasculature view)

Superiorrectalarteryand vein
from inferiormesentericvessels
l l i o l u m b avr e i n

l l i o l u m b aar r t e r y Lateralsacralvein

Lateralsacralartery
S u p e r i ogr l u t e a vl e i n

Superiorglutealartery
L e f ti n t e r n aill i a cv e i n

R i g h ti n t e r n aill i a c
artery M i d d l er e c t a vl e i n

R i g h tu r e t e r
Left ureter

I n f e r i o gr l u t e a l Rectum
artery

S u p e r i ovr e s i c avl e i n
Middle rectalartery

Inferiorvesicalvein
Inferiorvesicalartery

U m b r l i c aal r t e r y
Obturatorvein
Obturatorartery

of the pelvicviscerain men(superiorview)


Vasculature
234
Vasculature
of uterus

Ovarianarteryand vein in
suspensoryligamentof ovary
U t e r i n et u b e
M e s o s a l p i noxf b r o a dl i g a m e n t F u n d u so f u t e r u s T u b a lb r a n c ho f u t e r i n ea r t e r va n d v e i n

Fimbriae

Rightovary

Ovarianbranchof uterineartervand vein


Ligamentof ovary
Mesometrium of
b r o a dl i g a m e n t Uterineartery

C u te d g eo {
peflIoneum
(mesometrium)

U t e r i n ev e i n
U t e r i n ea r t e r ya n d v e i n
Uterosacra
l i lg a m e n t ligament
Uterosacral

Cervixof uterus

Vaginalartery

supplyto uterus(posterior
Vascular view)

Vertebralcolumn

C o m m o ni l i a ca r t e r y

Catheter

Externaliliacartery

I n t e r n aill i a ca r t e r y

Superiorglutealartery
(traumatized)

Uterineartery Uterineartery

Inferiorglutealartery

Vascular
supplyto uterus.
Anoiooram

235
PELVISAND PERINEUM.Venous
drainoge andpenis
ofprostate

Inferiorvenacava

Leftcommon iliacvein

R i g h ti n t e r n aill i a c
arteryand vein

R i g h te x t e r n aill i a c R i g h ti n t e r n a l
arteryand vein pudendal
arteryand vein

O b t u r a t o irn t e r n u s
Middle rectalvein
(coveredby fascia)

Obturatorvein
lschiococcygeus
O b t u r a t o cr a n a l lcoccy9eus,
lliococcygeus

V e s i c apl l e x u s
Inferiorrectalartery
Pubococcygeus andvein

P u b i cs y m p h y s i s Rectum
Pubococcygeus

Left internalpudendal
Deepdorsalvein of penis arteryand vein

Leftdorsalarteryof penis Deeptransverseperineal

Leftdorsalarteryof penis
C o r p u sc a v e r n o s u m
P e r i n e am
l embrane

C o r p u ss p o n g i o s u m Prostatrcplexusof veins

Posteriorscrotalartervand vein

G l a n so f p e n i s

Venousdrainage of pelvic viscerain men


(oblique sagittal view)

236
M e d i a ns a c r aal r t e r ya n d v e i n
(from aortaand inferiorvenacava)
Superiorrectalarteryand vein
(from inferiormesentericvessels)

l n t e r n aill i a cv e i n
Left internaliliacartery
C o m m o ni l i a cv e i n
Leftcommon iliacartery
Peritoneum

Obturatorartery Obturatorvein
Superiorvesicalvein
U m b i l i c aal r t e r y Communicationbetween
internaland external
Middle rectalartery rectalplexus

Bladder Middle rectalvein


lliococcygeus
(partof levatorani) v e s i c avl e i n

O b t u r a t o ri n t e r n u s P e r i m u s c u l ar er c t a l
v e n o u sp t e x u s
I n t e r n apl u d e n d aal r t e r y
I n t e r n apl u d e n d avl e i n
a n d v e i ni n p u d e n d acl a n a l
i n p u d e n d acl a n a l
Pubococcygeus
(partof levatorani) lnferiorrectalvein

Inferiorrectal
arteryand vein

lschio-ana
f ol s s a

E x t e r n aal n a ls p h i n c t e r I n f e r i op
r u b i cr a m u s

S u b c u t a n e o upsa r to f e x t e r n aal n a ls p h i n c t e r I n t e r n arl e c t a p


l lexus

I n t e r n aal n a ls p h i n c t e r Externalrectalplexus

of the rectum(posterior
Vasculature view)

Urethra Femur
Vagina
Obturatorinternus
P u d e n d acl a n a l

A n a lr e g i o n lschialtuberosity

G l u t e u sm a x i m u s

Inferiorrectalbranchto anal region


Inferiorrectalneurovascular fossa.
bundlecrossingthe ischio-anal
T 2 - w e i g h t e dM R i m a g e i n a x i a lp l a n e

237
PELVISAND PERINEUM.Sacral plexuses
nerve
andcoccygeal

Dorsaldivisions
Lumbosacra
t rlu n k
V e n t r adl i v i s i o n s

S u p e r i ogr l u t e a l

Sacralplexus
Inferiorgluteal

To piriformismuscle
P e l v i cs p l a n c h n inc e r v e
(preganglionicparasympathetics
I lrbrap l art from 52)
nerve--l
JCraIrc
f i b u l a p
r art Perforatingcutaneousnerve
lCommon

To levatorani, ischiococcygeus, and Coccygealplexus


e x t e r n aal n a ls p h i n c t em
r uscles
T o q u a d r a t u fse m o r i sa n d i n f e r i o g
r e m e l l u sm u s c l e s
T o o b t u r a t o ri n t e r n u sa n d s u p e r i ogr e m e l l u sm u s c l e s
Anococcygealnerves
Posteriorfemoralcutaneous
P e l v i cs p l a n c h n inc e r v e s P u d e n d anl e r v e
(preganglionicparasympathetics from 53-54)

Components
and branches nerveplexuses
ofthe sacraland coccygeal

Lumbosacra
t rlu n k

Nerveto piriformismuscle

S u p e r i ogr l u t e a ln e r v e

I n f e r i og
r l u t e a ln e r v e
P e l v i cs p l a n c h n inc e r v e s
Perforatingcutaneousnerve (preganglionicparasympathetics
Sciaticnerve from 52 to 54)
Nerveto obturatorinternus P u d e n d anl e r v e
a n d s u p e r i ogr e m e l l u s
Coccygealplexus
Obturatornerve
(from lumbar plexus)

Anococcygealnerves
Nerveto quadratusfemoris
andinferiog
r emellus
Nervesto ischiococcygeus,
levatorani
and externalanalsphincter

Posteriorfemoralcutaneousnerve

withinthe pelviccavity(sagittalview)
nerveplexuses
Sacraland coccygeal
238
Prevertebralplexus

R i g h tl u m b a rs y m p a t h e t itcr u n k Left lumbarsympathetictrunk

R i g h tc o m m o ni l i a ca r t e r y
Leftcommon iliacartery
Superiorhypogastricplexus

G r a vr a m u sc o m m u n i c a n s

Righthypogastric
nerve
Lumbosacral
trunk
S a c r asl p l a n c h n i c
Left hypogastric
nervesto inferior
nerve
hypogastricplexus
(postganglionic Superior
sympathetic) glutealnerve

Greatersciatic
S u p e r i ogr l u t e a l foramen
nerve
S a c r asl p l a n c h n i c
nervesto inferior
P e l v i cs p l a n c h n i c
hypogastricplexus
nerves
(postganglionic
(preganglionic
parasympathetics sympathetic)
from 52 to 54) P e l v i cs p l a n c h n i c
Inferiorhypogastric nerves
plexus (pregangl;onic
parasympathetics
from 52 to 54)
Coccygealplexus
Piriformis
Pudendalnerve

lschiococcygeus
(coccygeus)
G a n g l i o ni m p a r

lliococcygeus
(partof levatorani)

Pubococcygeus
(partof levatorani)

Pelvicextensions nerveplexus(anteriorview)
of the prevertebral

239
PELVIS . H'ypogastric
ANDPERINEUM plexus

R i g h ts y m p a t h e t itcr u n ka n d g a n g l i o n

S u p e r i ohr y p o g a s t r ipcl e x u s

Left sympathetictrunk and ganglion

S u p e r i ogr l u t e a ln e r v e

Righthypogastricnerve P e l v i cs p l a n c h n i c
n e r v e s( p r e g a n g l i o n i c
Piriformis
parasympathetic)
Inferiorglutealnerve
P u d e n d anl e r v e S a c r asl p l a n c h n i c
nerves(sympathetics)

Obturatornerve
Nervesto
Inferiorhypogastricplexus ischiococcygeus,
l e v a t o ra n i ,a n d
externalanal
sphincter
obturator internus
(coveredby fascia) lschiococcygeus
(coccygeus)
Levatorani

P u b i cs y m p h y s i s
G a n g l i o ni m p a r

:xf,- DeePPerinealpouch

P e r i n e am
l embrane
tatic plexus
Cavernousnerve

G l a n so f p e n i s

Hypogastricnerveplexuses
(obliquesagittalview)

240
Surfaceonatomyof theperineum

B o d yo f p e n i s

G l a n so f p e n i s Testiclesin scrotum

Musclesof
thethigh

Ischiocavernos
us

l s c h i atlu b e r o s i t y

Superficialtransverse
Bulbospongiosus p e r i n e am