Lecture 11- Pelvis Lecture

Radiological Anatomy of theRadiological Anatomy of the Pelvis, Walls and Viscera

Department of Radiology,p gy,Vancouver General Hospital

Dr. Savvas NicolaouDirector of ER/Trauma Radiology

[email protected]

B bl t id tif th f ll i t t l l i di h

Lecture Objectives

Pelvis Pelvis continued..

Be able to identify the following structures on a normal pelvic radiograph:

• Ilium

• Ischial spine

• Obturator foramen

• Sacro-iliac joints

• Pelvic inlet• Ischial tuberoses

• Pubis

S i bi

Pelvic inlet

• Anterior-superior iliac spine

• Superior pubic ramus

• Inferior pubic ramus

• Sacrum

Femur

• Head

N k• Sacrum

• Coccyx

• Pubic symphysis

• Neck

• Greater trochanter

• Lesser trochanterPubic symphysis

• Acetabulum

Lecture Objectives

• Bladder

Be able to identify the following anatomy on Pelvis CT:

• Bladder

• Uterus

• RectumRectum

• Prostate

• Seminal vesicle

A t R iAnatomy Review

3 Bones

Gross Anatomy of Pelvic Region

3 Bones1. Sacrum2. Hip/Pelvic Bone3. Coccyx

112

3

Pelvic inletinlet

3 Parts of Pelvic Bone

Gross Anatomy of Pelvic Bone

1. Ilium2. Ischium3. Pubis

1

2

3

2

Pelvis Bone - Anterior

1. Ischiopubic rami

Anterior

2. Obturator Foramen

3. Anterior superior Iliac Spine

4. Iliac Crest4. Iliac Crest

5. Iliac Fossa

6. Ischial Spine

7. Pubic Tubercle

8. Pubic Crest

9 P bi S h i9. Pubic Symphysis

10. Sacro-iliac joints

11. Ala of sacrum

Pelvis: Lateral View

1. Iliac Crest

2. Anterior superior iliac spinep p

3. Acetabulum

4. Superior pubic ramus

5. Inferior pubic ramus

6. Ischial spine

7 Ischial tuberosity7. Ischial tuberosity

8. Obturator foramen

9. Greater sciatic notch

10. Lesser Sciatic notch

Muscles of Pelvis

1. Piriformis 2. Obturator Internus 3. Levator Ani

11 1

22

23

Viscera and Vascular Review- Female

4 1. Rectum8

52. Uterus

3. Ovary

4. Aorta

1 36

4. Aorta

5. Common Iliac

Artery1

23 6. External Iliac

Artery

7 I t l Ili A t7. Internal Iliac Artery

8. Inferior Vena Cava

Female Pelvic Region – Sagittal View

Male or Female? Which View?

1. Uterus

2. Ovary

3. Bladder

1

25 63. Bladder

4. Rectum

5. Vesico-uterine pouch13 4

6. Recto-uterine pouch

Male Pelvic Region- Sagittal View

Male or Female? Which View?

1. Bladder

2. Prostate

3. Seminal vesicle

3 4. Rectum

5. Urethra

1

3

41

2

4What pouch is outlined in red?

Recto-vesical pouch

5

Femur

1. Femoral Head

2 Femoral Neck2. Femoral Neck

3. Greater trochanter

4. Lesser trochanter112 3

44

RADIOLOGY ATLAS

What view is this radiograph?What view is this radiograph?

AP view

What is this particular type of

radiograph called?radiograph called?

KUB – radiograph is focused on Kidneys, Ureter BladderUreter, Bladder

What is this

called again?called again?

Pelvic Inlet

1. Ilium2. Sacrum

4. Ischium5. Pubic bone2. Sacrum

3. Coccyx5. Pubic bone

L Ili C tAla of sacrum

R Anterior superior

L Iliac Crest

superior iliac spine

L Ili FL Iliac Fossa

R acetabulum L Sacroiliac joint

R Ischial Spine

Pubic Tubercle

R superiorR superior pubic ramus R inferior pubic ramus

R ischialtuberosity

RectumR femoral head

Pubic Symphysis

R femoral neck

L Obturatorfforamen

Is this Right or Left?

Right hip and femurg p

1. Femoral Head

2 Greater Trochanter of femur

12. Greater Trochanter of femur

3. Intertrochanteric Crest

4. Femoral Neck

24

5. Obturator foramen3 5

Is this Right or Left?

Right hip and femur

8

g p

6. Lesser Trochanter of femur

7 Acetabulum7

8

7. Acetabulum

8. Hip Joint

9. Ischial Tuberosityy

69

Coronal pelvic structures:G CXRGross vs CXR

L Iliac CrestAla of sacrumR Ischial SpineIlium

Sacrum

R Anterior superior

L Iliac Fossa

Ilium

superior iliac spine

L Sacroiliac joint

R acetabulumjoint

Coccyx

Pubic Tubercle

RectumR femoral head

R superiorPubic Symphysis

R femoral neck

L Obturatorf

Ischium

R superior pubic ramus R inferior pubic ramus

R ischialtuberosity

foramen

Pubic bone

Coronal pelvic structures: Gross vs CXR

11 112

2

1. Anterior Superior Iliac Spine2. Rectum

Coronal pelvic structures: Gross vs CXR

22

1

4

31

3

45

67

45 6

7

1. Ilium2. Iliac Crest3. Iliac Fossa

5. Superior Pubic Ramus6. Pubic Tuberosity7. Pubic Symphysis

4. Pubic bone

Coronal pelvic structures: Gross vs CXR

2

21

6

3

7

1

3

4

85 6

87

4

8

5

1. Ilium2. Iliac Crest3. Iliac Fossa4 I f i P bi R

1. Obturator Foramen2. Acetabulum3. Femoral Head4 F l N k4. Inferior Pubic Ramus 4. Femoral Neck

Coronal pelvic structures: Gross vs CXR

1

2

43 2

5

7

1

3

45

6 7

56

1. Ilium2. Iliac Crest3. Sacrum

5. Ischium6. Ischial Tuberosity7. Rectum

4. Sacroiliac Joint

Coronal pelvic structures: Gross vs CXR

12

4

1 2

34

3

1. Ilium2. Ala of Sacrum3. Ischium4. Ischial Spine

Coronal pelvic structures: Gross vs CXR

1

1

1. Coccyx

CT ATLAS OF PELVIS

Pelvis- Axial View

1. Bowel

2. Piriformis muscle

3. Gluteus muscles

4. Pubic bone1 4

4. Pubic bone2

3

1

2

4

23

Pelvis- Axial View

5. Sacrum7

6. Rectum

7. Bladder

56

7

56

Pelvis- Axial View

1. Rectus abdominus muscle1

2. Piriformis muscle

3. Gluteus muscles

4. Pubic bone4

4. Pubic bone2

3

11

2

4

23

Pelvis- Axial View

5. Sacrum7

8

6. Rectum

7. Uterus

8. Ovary

7

8. Ovary

56

788 8

6

5

Pelvis– axial view level of hip joints

1 12 2 53

56

36

7 74 34

1. Femoral Head 5. Pubic Bone

2. Bladder

3. Ischium

4 Ischial Spine

6. Acetabulum

7. Rectum

4. Ischial Spine

Pelvis– axial view level of hip joints

66 77

5 5

7

5. Gluteus muscles

6. Seminal Vesicle

7 Obturator internus muscle7. Obturator internus muscle

1

Pelvis– axial view at level of greater trochanter

1. Pubic Symphysis

2. Rectum

3. Prostate gland

4. Ischial spine23

4

1

23

4

Pelvis– axial view at level of greater trochanter

5. Femoral neck

6. Greater trochanter

7. Ischio-rectal fossa

8. Obturator internus muscle5

68

7

567

8

What plane is this? Male or female?

Male Pelvis– Sagittal view

1. Pubic Symphysis

2. Bladder

3. Prostate gland

4. Rectum

5. Seminal vesicle

6. Recto-vesical pouch5 6

23

4

13

What plane is this? Male or female?

Female Pelvis– Sagittal view

1. Pubic Symphysis

2 Bladder2. Bladder

3. Uterus

22

3

31 1

2

What plane is this? Male or female?

4. Rectum

5 Recto uterine pouch

Female Pelvis– Sagittal view

5. Recto-uterine pouch

6. Vescio-uterine pouch

56

44

56

6

Coronal view

What plane is this view in?

1 12 2

4 453 3

1. Ilium

2. Sacrum

4. Rectum

5. Obturator internus muscle

5

3. Ischium

1. Inferior Vena Cava2 Aorta

5. Left External Iliac Artery6 Left Internal Iliac Artery

Vascular Review- CT Coronal

2. Aorta3. Left Common Iliac Artery4. Right Common Iliac Artery

6. Left Internal Iliac Artery7. Right External Iliac Artery8. Right Internal Iliac Artery

11 2

12

373457

3

4 5

8

7

68

1. Inferior Vena Cava2 Aorta

5. Left External Iliac Artery6 Left Internal Iliac Artery

Vascular Review- CT Coronal

2. Aorta3. Left Common Iliac Artery4. Right Common Iliac Artery

6. Left Internal Iliac Artery7. Right External Iliac Artery8. Right Internal Iliac Artery

1 21 2

33

5768

4

68

8