UCSF Students

March 27, 2010

Diverticulitis on CT scan

Diverticulitis on CT scan

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

SLIDE 1
Goals
To examine how diverticulitis affects the:
1. Wall of the colon
2. Lumen of the colon
3. Fat in the mesentery of the colon

SLIDE
Normal and diseases sigmoid colon are shown for comparison. The sigmoid colon is filled with contrast.
Compare:
- In the sigmoid colon: width of the colon, width of the lumen
- In the neighboring fat: stranding due to inflammatory response, normal fat

SLIDE 2
SUMMARY
1. Inflammation causes a thickening of the colon wall that narrows the lumen
2. Stranding is the radiographic appearance of an inflammatory response by the fat in the mesentery

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March 26, 2010

Abdominal CT scan

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.

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March 17, 2010

Abdominal cross section anatomy at L5

Abdominal cross section anatomy at L5

Terms:

Left term: umbilical impression, ileum, rectus abdominis muscle, ileocecal junction, cecum, internal oblique muscle, external oblique muscle, psoas major muscle, iliacus muscle, body of L5 vertebra, lumbar cistern of subarachnoid space

Right term: common iliac arteries, ureter, ileum, descending colon, transversus abdominis muscle, lumbar plexus (ventral rami of L2-L4 becoming femoral and obturator nerves and L4 part of lumbosacral trunk), iliac crest, erector spinae muscle

Source:
Netter Anatomy

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Abdominal cross section anatomy at L2

Abdominal cross section anatomy at L2

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

Source:
Netter Anatomy

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Abdominal cross section anatomy at T12

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

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March 16, 2010

CT Abdomen and Pelvis

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

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