Radiological Anatomy of the Pelvis, Walls and Viscera

Department of Radiology, p gy, Vancouver General Hospital

Dr. Savvas Nicolaou Director of ER/Trauma Radiology savvas.nicolaou@vch.ca

Lecture Objectives
Be bl to identify th f ll i B able t id tif the following structures on a normal pelvic radiograph: t t l l i di h Pelvis Ilium Ischial spine Ischial tuberoses Pubis Superior pubic ramus S i bi Inferior pubic ramus Sacrum Coccyx Pubic symphysis Acetabulum Femur Head Neck N k Greater trochanter Lesser trochanter Pelvis continued.. Obturator foramen Sacro-iliac joints Pelvic inlet Anterior-superior iliac spine

Lecture Objectives
Be able to identify the following anatomy on Pelvis CT:

Bladder Uterus Rectum Prostate Seminal vesicle

Anatomy R i A t Review

Gross Anatomy of Pelvic Region

3 Bones 1. Sacrum 2. Hip/Pelvic Bone 3. Coccyx

1 2 3
Pelvic inlet

Gross Anatomy of Pelvic Bone

3 Parts of Pelvic Bone 1. Ilium 2. Ischium 3. Pubis

3 2

Pelvis Bone - Anterior

Anterior 1. Ischiopubic rami 2. Obturator Foramen 3. Anterior superior Iliac Spine 4. Iliac Crest 5. Iliac Fossa 6. Ischial Spine 7. Pubic Tubercle 8. Pubic Crest 9. Pubic Symphysis 9 P bi S h i 10. Sacro-iliac joints 11. Ala of sacrum

Pelvis: Lateral View

1. Iliac Crest p p 2. Anterior superior iliac spine 3. Acetabulum 4. Superior pubic ramus 5. Inferior pubic ramus 6. Ischial spine 7. 7 Ischial tuberosity 8. Obturator foramen 9. Greater sciatic notch 10. Lesser Sciatic notch

Muscles of Pelvis
1. Piriformis 2. Obturator Internus 3. Levator Ani

1 2 2

1 3

Viscera and Vascular Review- Female

8 4 5 6

1. Rectum 2. Uterus 3. Ovary 4. Aorta 5. Common Iliac

1 2

Artery 6. External Iliac Artery 7. Internal Iliac Artery 7 I t l Ili A t 8. Inferior Vena Cava

Male or Female? Which View?

Female Pelvic Region Sagittal View

1. Uterus 2. Ovary

2 6 1 3 4

3. Bladder 4. Rectum 5. Vesico-uterine pouch 6. Recto-uterine pouch

Male or Female? Which View?

Male Pelvic Region- Sagittal View

1. Bladder 2. Prostate 3. Seminal vesicle

3 1 2 5 4

4. Rectum 5. Urethra

What pouch is outlined in red? Recto-vesical pouch

Femur

1. Femoral Head 2. 2 Femoral Neck 3. Greater trochanter

4. Lesser trochanter

2 3

RADIOLOGY ATLAS

What view is this radiograph? AP view

What is this particular type of radiograph called? KUB radiograph is focused on Kidneys, Ureter, Ureter Bladder

What is this called again? Pelvic Inlet

1. Ilium 2. Sacrum 3. Coccyx

4. Ischium 5. Pubic bone

Ala of sacrum L Ili C t Iliac Crest R Anterior superior iliac spine L Ili F Iliac Fossa

R acetabulum

L Sacroiliac joint

R Ischial Spine

Pubic Tubercle

R superior pubic ramus

R ischial tuberosity

R inferior pubic ramus

R femoral head R femoral neck Pubic Symphysis

Rectum

L Obturator foramen

Is this Right or Left? g p Right hip and femur

1 2 3 4 5

1. Femoral Head 2. 2 Greater Trochanter of femur 3. Intertrochanteric Crest 4. Femoral Neck 5. Obturator foramen

Is this Right or Left? g p Right hip and femur

8 7
6. Lesser Trochanter of femur 7. 7 Acetabulum 8. Hip Joint 9. Ischial Tuberosity y

9 6

Coronal pelvic structures: Gross vs CXR G

Sacrum Ilium R Anterior superior iliac spine R acetabulum R Ischial Spine Ala of sacrum L Iliac Crest

L Iliac Fossa

L Sacroiliac joint Coccyx

R femoral head R femoral neck R superior pubic ramus Pubic Symphysis R ischial tuberosity R inferior pubic ramus Ischium Pubic bone

Rectum Pubic Tubercle

L Obturator foramen f

Coronal pelvic structures: Gross vs CXR

1 2

1. Anterior Superior Iliac Spine 2. Rectum

Coronal pelvic structures: Gross vs CXR

2 2 1 1 3 3

4 5 76

6 7

1. 2. 3. 4.

Ilium Iliac Crest Iliac Fossa Pubic bone

5. Superior Pubic Ramus 6. Pubic Tuberosity 7. Pubic Symphysis

Coronal pelvic structures: Gross vs CXR

2 1 3 1 3 7 8 4 8 4 5 6 5 7 6

1. 2. 3. 4. 4

Ilium Iliac Crest Iliac Fossa Inferior P bi Ramus I f i Pubic R

1. 2. 3. 4. 4

Obturator Foramen Acetabulum Femoral Head Femoral N k F l Neck

Coronal pelvic structures: Gross vs CXR

4 1 7 3 4

1. 2. 3. 4.

Ilium Iliac Crest Sacrum Sacroiliac Joint

5. Ischium 6. Ischial Tuberosity 7. Rectum

Coronal pelvic structures: Gross vs CXR

1 2 1 2

4 3 4

1. 2. 3. 4.

Ilium Ala of Sacrum Ischium Ischial Spine

Coronal pelvic structures: Gross vs CXR

1. Coccyx

CT ATLAS OF PELVIS

Pelvis- Axial View

1. Bowel 2. Piriformis muscle 1 2 4 3. Gluteus muscles 4. Pubic bone 3

1 2

Pelvis- Axial View

5. Sacrum 6. Rectum 7. Bladder

6 5

6 5

Pelvis- Axial View

1. Rectus abdominus muscle 2. Piriformis muscle 4 2 3 1 3. Gluteus muscles 4. Pubic bone

4 2 3

Pelvis- Axial View

8 5. Sacrum 7 6. Rectum 7. Uterus 8. Ovary 6 5

7 8

6 5

Pelvis axial view level of hip joints

2 7

6 3 4

2 7

5 6 3 4

1. Femoral Head 2. Bladder 3. Ischium 4. 4 Ischial Spine

5. Pubic Bone 6. Acetabulum 7. Rectum

Pelvis axial view level of hip joints

6 5

5. Gluteus muscles 6. Seminal Vesicle 7. 7 Obturator internus muscle

Pelvis axial view at level of greater trochanter

1 1. Pubic Symphysis 2. Rectum 3. Prostate gland 3 2 4. Ischial spine 4 1

3 2 4

Pelvis axial view at level of greater trochanter

5. Femoral neck 6. Greater trochanter 7. Ischio-rectal fossa 5 8 7 6 8. Obturator internus muscle

8 7

5 6

What plane is this? Male or female?

Male Pelvis Sagittal view 1. Pubic Symphysis 2. Bladder 3. Prostate gland 4. Rectum 5. Seminal vesicle 6. Recto-vesical pouch 5 6

2 1 3

What plane is this? Male or female?

Female Pelvis Sagittal view 1. Pubic Symphysis 2. 2 Bladder 3. Uterus

3 2 1 2 1 3

What plane is this? Male or female?

Female Pelvis Sagittal view 4. Rectum 5. Recto-uterine 5 Recto uterine pouch 6. Vescio-uterine pouch

5 4 6 5 4

What plane is this view in?

Coronal view

1 4 3

1 4

3 4. Rectum 5

1. Ilium 2. Sacrum 3. Ischium

5. Obturator internus muscle

Vascular Review- CT Coronal

1. 2. 2 3. 4. Inferior Vena Cava Aorta Left Common Iliac Artery Right Common Iliac Artery 5. 6. 6 7. 8. Left External Iliac Artery Left Internal Iliac Artery Right External Iliac Artery Right Internal Iliac Artery

1 1 2 3 5 8 6 8 7 4 2 3 5

4 7

Vascular Review- CT Coronal

1. 2. 2 3. 4. Inferior Vena Cava Aorta Left Common Iliac Artery Right Common Iliac Artery 5. 6. 6 7. 8. Left External Iliac Artery Left Internal Iliac Artery Right External Iliac Artery Right Internal Iliac Artery

1 1 2 3 5 6 8 8 6

2 3

4 7