Angiograms of the Abdomen

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

SLIDE 1
Angiograms of the abdomen
- is a composite of angiograms taken from different patients.
- The position of the transumbilical plane is approximated by the red line.
- The three images on the right are standard x-ray films with reverse contrast (a positive was made from the x-ray negative)
- The image on the left was reconstructed from a CT study
- The individual images with labels can be viewed on the following pages

- celiac trunk
- superior mesenteric artery
- inferior mesenteric artery
- abdominal aorta with branches of the celiac trunk deleted

SLIDE 2
SUMMARY
1. The celiac and SMA originate close to each other, which the IMA originated more distally close to the transumbilical plane
2. Note the gross differences in the distribution of the vessels
3. The celiac branches are superior and on both sides of the midline
4. The SMA branches are widely distributed, through heavily in the upper left quadrant
5. The IMA branches are entirely on the left
6. In your further studies you should be able to identify what organs the major branches are supplying and where the vessels are located (i.e. in mesenteries or retroperitoneal)

Renal Cell Carcinoma CT Scan

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

SLIDE 1
Renal Cell Carcinoma
- Why does the right kidney look like a donut with bright stuff in the donut hole?
– the kidney treats venous contrast like a waste product and concentrates it in the urine

- Why is the tumor in the left kidney duller than the rest of the donut?
– the tumor is hypovascular in relation to the renal parenchyma

- Is this section closer to the transpyrolic, subcostal, or umbilical plane? Why?

– the transpyloric: the superior mesenteric artery branches off the aorta; the pancreas is present; ribs are present; renal arteries (subcostal plane) ureters (which whould be bright with contrast, are absent)

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.

CT reconstruction of the kidneys and renal arteries and 3-D reconstruction of kidneys and SMA vasculature

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

TOPICS

SLIDE 1
Goals
1. Be able to identify the renal vessels, aorta and ureters as these structures are rotated in 3-D
2. Be able to explain the relative position of important nearby structures that are not shown such as the 12th rib and IVC

SLIDE 2
- CT reconstruction of the kidneys and renal arteries
- Rib 12 is colored blue, the abdominal aorta is pink and the renal arteries are red
- Transpyloric plane
- Subcostal plane

SLIDE 3
[...]

SLIDE 4
3-D reconstruction of kidneys and SMA vasculature
- aorta
- left renal artery
- left renal vein
- right renal artery
- left ureter
(and questions)
- right ureter
- SMA (superior mesenteric artery)
- IMA (inferior mesenteric artery)

SLIDE 5
- lumbar segmental arteries
(question)

SUMMARY
1. The renal vessels are at the subcostal plane
2. The left renal artery is posterior to the left renal vein
3. The kidneys are posterior to the aorta and IVC, so the vessels course posteriorly from the midline to reach their targets

Abdominal cross section anatomy at L2 <– Click on this link to view the image

Terms:

Left side: greater omentum, pancreas with uncinate process, transverse colon, junction of 2nd and 3rd parts of duodenum, ascending colon, liver, right renal vein (entering inferior vena cava), right kidney, inferior vena cava, right crus of diaphragm, psoas major muscle, L1-L2 intervertebral disc

Right side: superior mesenteric vein, superior mesenteric artery, transverse colon, ileum, jejunum, perirenal fat, ureteropelvic junction, descending colon, renal fascia, left kidney, minor calyx and renal pelvis, pararenal fat, left renal artery, left renal vein (entering inferior vena cava), left crus of diaphragm, abdominal aorta

IF YOU ARE STUDYING FOR THE ABSITE EXAM 2011, CHECK OUT THIS BOOK.

THE ABSITE Q&A

Source:
Netter Anatomy

CLICK ON THE IMAGES BELOW TO READ STUDENT REVIEWS AND GET FREE ACCESS TO SEARCH WITHIN THE BOOK

CT abdomen and pelvis

Terms listed:
Image A, superior to Image D, inferior.

Image A: left lobe of liver, inferior vena cava, stomach, aorta, right lobe of liver, rib, body of vertebra, spleen

Image B: stomach, inferior vena cava, aorta, right lobe of liver, right kidney, body of vertebra, left kidney, spleen

Image C: rectus abdominis muscle, transverse colon, ascending colon, inferior vena cava, aorta, descending colon, right lobe of liver, right kidney, body of vertebra, deep back muscles

Image D: Linea alba, ileum, ascending colon, right common iliac artery, left common iliac artery, descending colon, psoas muscle, body of vertebra, deep back muscles

Source
Netter Anatomy

L4 abdominal cross section anatomy

Terms:
Left side:
Round ligament (ligamentum teres) of liver, transverse colon, branches of inferior epigastric vesselss, rectus sheath, transversus abdomini aponeurosis, external oblique aponeurosis, mesentery of small intestine, superior mesenteric vessels, small intestine (ileum), lymph node, ascending colon, right paracolic gutter, tendon of origin of transversus abdomini muscle, iliohypogastric nerve, ilioinguinal nerve, layers of thoracolumbar fascia (combined, middle, posterior), right colic vessels and branches, right genitofemoral nerve, transverse process of L4 vertebra, inferior vena cava, anterior longitudinal ligament, ligamentum flavum, abdominal aorta, spinous process of L3 vertebra, supraspinous ligament

Right side:
Linea alba, rectus abdominis muscle, omental appendices, greater omentum, parietal peritoneum, transversalis fascia, transversus abdominis muscle, internal oblique muscle, external oblique muscle, small intestine (jejunum), descending colon, left paracolic gutter, left ureter, quadratus lumborum muscle, latissimus dorsi muscle, testicular (ovarian) vessels, psoas minor muscle, parietal peritoneum, psoas major muscle, inferior mesenteric and 1st sigmoid vessels, left sympathetic trunk, left lumbar plexus ventral rami of L2,L3 spinal nerves, erector spinae muscle, superior articular process of L4 vertebra, Intercostal disc between L3 and L4 vertebrae, intermesenteric (aortic) plexus

Source:
Netter Anatomy

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

CLICK ON THE IMAGES BELOW TO READ STUDENT REVIEWS AND GET FREE ACCESS TO SEARCH WITHIN THE BOOK

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