Abdominal CT of Cholangiocarcinoma

http://info.med.yale.edu/surgery/anatomy/radiology/abdomen_ct_2_content.php

TOPICS

SLIDE 1
Questions
10a. What is the contrast containing structure posterior to the liver?
- IVC
10b. What are the contrast containing structures dumping into the IVC?
- The right, middle and left hepatic veins
11. What anatomically divides the liver into lobes (right and left) and segments?
- The hepatic veins. Middle hepatic vein divides the right and left lobes. Right hepatic splits the right lobe into anterior and posterior segments. The left hepatic lobe divides the left lobe into medial and lateral segments.
12. What lobe of the liver is marked with the arrows?
- the caudate lobe
13. Can you identify the bright structure surrounded by the black arrows?
- this is the left portal vein
14. Can you identify the bright structure marked by the black arrows?
- this is the right portal vein
15a. Can you identify the low attenuating structure marked by black arrows?
- this is the common hepatic duct
15b. What branch of the aorta is marked by the black arrow?
- this is the celiac trunk
15c. What are the branches of the celiac trunk?
- common hepatic, splenic and left gastric
17. What is this fluid and air filled structure between the liver and spleen?
- this is the stomach
17b. What portion of the colon do you see anterior to the spleen and next to the stomach?
- this is the splenic flexure
17c. what part of the pancreas is this?
- this is the body
17d. what part of the pancreas is this?
- this is the tail and usually extends further over toward the spleen
18a. What is the low attenuation structure (black arrows) adjacent to the pancreas (white arrows)?
- common bile duct
18b. What are the metallic structures anterior to the common bile duct?
Hint: does this patient have a gallbladder?
- these are clips from a cholecystectomy
18c. What is this vein just behind the pancreas?
- splenic vein (the left most arrow is the portal vein)
18d. What venous structure does this join to make up the portal vein?
- the splenic vein joins the superior mesenteric vein to make up the portal vein
19. What is the structure anterior and near the superior aspects of the left kidney?
- the left adrenal gland
20. Do you see the SMV in this image? Try tracing it from the junction of the splenic and portal veins. Trace the vein superiorly, where the splenic vein comes to join it from the portal vein.
21a. What part of the pancreas are these arrows defining?
Hint: it is the most inferior portion of the pancreas
- this is the pancreatic head
21b. What is this small pointed area medial to the head of the pancreas?
Hint: it is the most inferior portion of the pancreas
- this is the uncinate process
21c. What is this high attenuating structure (artery) just anterior to the uncinate process?
- the superior mesenteric artery
22a. What is this low attenuating structure in the pancreatic head?
- this is the intrapancreatic portion of the common bile duct.
22b. What is this tiny low attenuating structure in the pancreas?
- this is the pancreatic duct
23a. What are these 2 vascular structures?
- IVC (white arrow)
- Aorta (black arrow)
23b. Why is the aorta filled with contrast and the IVC is not?
Hint: Do we give our injections in the artery or vein? And do we inject in the upper or lower extremity?
- We inject intravenously in the upper extremity (arm), so the blood goes to the SVC to heart to arterial system then to lower extremity venous system
24. Do you see this patient’s tumor?
Hint: it is very subtle, it is right where the CBD enters the duodenum at the ampulla.
- If you picked up that tumor, you have a promising career in radiology!
25. What part of the colon is this?
Hint: it is anterior on a long mesentery
- this is the transverse colon

SUMMARY
- The exercise emphasizes important anatomy that should be traced superiorly and inferiorly to appreciate the three-dimensional structure

- The tumor is difficult to see in many images. Rather than focussing on pathology in the image you should be able to explain in simple terms how this tumor contributed to the patient’s jaundice.

Abdominal cross section anatomy at T12

Terms:

Left side: pyloric canal, pylorus, right colic (hepatic) flexure of colon, gallbladder, superior (1st) part of duodenum, hepatoduodenal ligament, portal triad (common bile duct, hepatic artery, portal vein), inferior vena cava,  right suprarenal gland, right crus of diaphragm, pancreas

Right side: stomach, jejunum, transverse colon (acsending to left colic flexure), bifurcation of celiac trunk, descending colon (descending from left colic flexure), spleen, splenic artery and vein, left suprarenal gland, superior pole of left kidney, left crus of diaphragm, thoracic aorta, pancreas

Source:
Netter Anatomy

T12 Abdominal cross section anatomy - click on the links below to view the image

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Anatomical terms:
Right side:
Liver, falciform ligament, superior epigastric vessels, hepatic nerve plexuses, transversalis fascia, parietal peritoneum, visceral peritoneum of liver, diaphragm, inferior diaphragmatic fascia, hepatic artery proper (bifurcation), common hepatic duct, gallbladder, cystic duct, hepatic portal vein, costodiaphragmatic recess of pleural cavity, pleura, intercostal vessels and nerve, omental foramen (epiploic foramen of Winslow), common hepatic artery (retroperitoneal), inferior vena cava, omental bursa (lesser sac), right lesser and least splanchnic nerves, right sympathetic trunk, right crus of diaphragm, azygos vein, thoracic duct, anterior longitudinal ligament, celiac ganglia, abdominal aorta, body of T12 vertebra

Left side:
Linea alba, rectus sheath, rectus abdominis muscle, lesser omentum, left gastric artery and vein, external oblique aponeurosis, transversus abdominis muscle, 8th costal cartilage, diaphragmatic slip of origin, 7th costal cartilage, external oblique muscle, diaphragm, stomach, gastrosplenic ligament and short gastric vessels, 8th rib, spleen, serratus anterior muscle, intercostal muscles, splenorenal ligament with splenic vessels, parietal peritoneum on posterior wall of omental bursa, left gastric artery, left kidney, left suprarenal gland, 12th rib, latissimus dorsi muscle, erector spinae muscle (iliocostalis, longisimus, spinalis);

Source
Netter Anatomy