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 CT scan

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

TOPICS
SLIDE 1
Goals
1. To understand vascular anatomy of the liver and how the vessels define the segmental anatomy of the liver
2. To review and understand the developmental anatomy and fetal circulation of the liver and what remnants are still present in the adult liver
3. To review colonic and small bowel anatomy and be able to predict where you may visualize different segments of bowel and axial CT
4. To understand the anatomy, relationships and orientation of the pancreas
5. To review and understand the relationships of major arterial and venous structures in the abdomen and pelvis and how they can be seen on axial CT

SLIDE 2
Questions
2. What is this high attenuation structure in the liver?
- this is the left portal vein.
1a. Do the portal veins divide the liver into segments?
- No. the hepatic veins do.
4a. What is this black line that runs through the liver?
- this is the fissure for the ligamentum teres
4b. What structure ran through this region?
- the umbilical vein
4c. What is this fissure anterior to the caudate lobe?
- this is the fissure for the ligamentum venosum
5a. what part of the colon is this?
- this is the distal transverse extending to the splenic flexure
5b. Why does the colon look white?
- the patient was given oral contrast
6. what portion of the pancreas is this?
- this is the tail
9. what portion of the colon is this?
- hepatic flexure
10. what is this venous structure extending from the left kidney to the IVC?
- this is the left renal vein
13. what portion of the colon is labeled by each arrow?
- ascending colon (black)
- descending colon (white)
14. What vessel is coming off the aorta?
- hint: it is colonic supply and below the level of the SMA
- inferior mesenteric artery
15. Look at the small bowel without contrast (white arrows) and the colon with contrast (black arrows) and note that the bowel wall is extremely thin. Normally it is approximately 3mm.
18. What is this small tubular structure partially filled with contrast on this and the subsequent image.
19. This is the appendix. Note this is normal; thin walled, filled with contrast and no inflammatory changes in the adjacent fat.
23. What portion of the colon is labeled with arrows?
- sigmoid colon
24. What vascular structures are marked by the arrows?
- the external iliac arteries and veins
26a. What is this fluid filled structure?
- the bladder
26b. What portion of bowel is this located posterior to the bladder and anterior to the sacrum?
- the rectum
26c. What is the significance of the space between the bladder and the sacrum?
- this is the most dependent portion of the peritoneal cavity in a male.

SLIDE 3
SUMMARY
- You will need to be able to navigate your way through CT and MRI images of the abdomen. This exercise focuses on important structures and represents an appropriate level of detail.
- You should become skilled at tracing structures superiorly and inferiorly to appreciate their relations in three dimensions.

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

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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

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

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

Anatomy Images

Upper abdomen, female

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHF1600R.html

Identify the following regions in the image above: Rectus abdominus – External oblique – Serratus posterior inferior – Latissimus dorsi – Sacrospinalis – Multifidus – Psoas major – Right lobe of liver – Left lobe of liver – Gallbladder – Body of stomach – Right kidney – Left kidney – Descending aorta – Inferior vena cava – Vertebral body – Spinal cord

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Abdomen, female

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHF1650R.html

Identify the following regions in the image above: Rectus abdominus – External oblique – Internal oblique – Latissimus dorsi – Psoas major – Sacrospinalis – Multifidus – Right kidney – Left kidney – Ascending colon – Transverse colon – Descending colon – Jejunum – Descending aorta – Inferior vena cava – Left adrenal gland – Vertebral body – Apophyseal joint – Spinal cord

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Lower abdomen, female

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHF1700R.html

Identify the following regions in the image above: Rectus abdominus – External oblique – Sacrospinalis – Multifidus – Psoas major – Ascending colon – Transverse colon – Descending colon – Descending aorta – Jejunum – Mesentery – Inferior vena cava – Vertebral body – Spinal canal

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Upper abdomen, male L1 level

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHM1550R.html

Identify the following regions in the image above: Rectus abdominus – External oblique – Latissimus dorsi – Serratus posterior inferior – Sacrospinalis – Multifidus – Body of stomach – Colonic splenic flexure – Jejunum – Pancreas – Spleen – Diaphragm – Descending aorta – Inferior vena cava – Gallbladder – Liver – Vertebral body – Spinal cord

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Upper abdomen, male L1 level

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHM1560R.html

Identify the following regions in the image above: Rectus abdominus – External oblique – Latissimus dorsi – Serratus posterior inferior – Sacrospinalis – Multifidus – Body of stomach – Pylorus – Duodenal bulb – Colonic splenic flexure – Colonic hepatic flexure – Jejunum – Pancreas – Spleen – Diaphragm – Descending aorta – Inferior vena cava – Left adrenal gland – Right adrenal gland – Gallbladder – Liver – Vertebral body – Spinal cord

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Upper abdomen, male L1-L2 level

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHM1580R.html

Identify the following regions in the image above: Rectus abdominus – External oblique – Latissimus dorsi – Sacrospinalis – Multifidus – Pyloric antrum – Colonic splenic flexure – Colonic hepatic flexure – Jejunum – Pancreas – Splenic vein – Spleen – Diaphragm – Descending aorta, celiac axis branch – Inferior vena cava – Left adrenal gland – Right adrenal gland – Left kidney – Right kidney – Gallbladder – Liver – Intervertebral disc – Spinal cord

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Abdomen, male L2 level

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHM1600R.html

Identify the following regions in the image above: Rectus abdominus – Transversus abdominis – Intercostal m. – External oblique – Internal oblique – Latissimus dorsi – Sacrospinalis – Multifidus – Erector spinae m. – Psoas major – Uncinate process of pancreas – Transverse colon – Jejunum – Descending colon – Spleen tip – Left kidney – Right kidney – Crus of diaphragm – Liver – Descending aorta, superior mesenteric branch – Inferior vena cava – Superior mesenteric vein – Vertebral body – Conus medullaris
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Abdomen, male L3-L4 level

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHM1650R.html

Identify the following regions in the image above: Rectus abdominus – External oblique – Internal oblique – Latissimus dorsi – Sacrospinalis – Multifidus – Psoas major – Quadratus lumborum – Iliocostalis – Longissimus dorsi – Spinalis dorsi – Ascending colon – Descending colon – Transverse colon – Jejunum – Left kidney – Right kidney – Left ureter – Right ureter – Descending aorta – Inferior vena cava – Superior mesenteric vein – Intervertebral disc – Cauda equina
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Lower abdomen, male L4 level

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHM1700R.html

Identify the following regions in the image above: Linea alba – Rectus abdominus – External oblique – Internal oblique – Transversus abdominis – Sacrospinalis – Multifidus – Erector spinae muscle group (iliocostalis, longissimus dorsi, spinalis dorsi) – Psoas major – Quadratus lumborum – Ascending colon – Descending colon – Ileum – Descending aorta – Inferior vena cava – Vertebral body – Superior articular process – Inferior articular process – Apophyseal joint – Spinal canal with cauda equina – Thoracolumbar fascia
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