Unit 2

10 Transaxial CT Images of the Male Pelvic Cavity 12 Coronal MRI images of the Female Pelvic Cavity

There are no drawings with this unit

The images of the male pelvis start just below the iliac crest, several cm lower than where the abdomen images left off. They continue in 1 cm increments through the pelvic cavity.

The coronal images of the female pelvic cavity start posterior and continueanterior.

First set of parenthesis, in bold, is page number for 3rd edition

Second set of parenthesis, not bold, is page number for 4rd edition

Unit 2

1. Ala of Rt. ilium 2. Sacrum3. Sacroiliac joints4. Psoas major muscles5. Lt. common iliac artery (381)(401) 6. Lt. common iliac vein*7. Small bowel (with barium)8. Rt. iliacus muscle (478)(496)

9. Gluteus maximus muscle (476, 477)(494-495)10. Gluteus medius muscle11. Gluteus minimus muscle12. Rt. common iliac vein**13. Lt. ureter (with iodine contrast) (381)(401)

* These pelvic sections begin below the aorta and IVC. Compare the appearance of the Rt. and Lt. common iliac vessels to plate 381 in Netter to appreciate why they are in this position, e.g. the artery on the right is medial to the vein, but on the left it is lateral.** The elongated, apostrophe like shape of the Rt. iliac vein at this level is due to anastomosis of the internal and external iliac veins which are seen in image 3.

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Male Images 1 & 2

Images 1-4

1. Rt. external iliac artery (381-383)(401-403) 2. Rt. external iliac vein3. Rt. internal iliac artery4. Rt. internal iliac vein

5. Body of bladder (348)(361)6. Rectosigmoid junction* (374, 348)(393-361)7. Rt. external iliac artery**8. Lt. external iliac vein***9. Branches of the internal iliac veins (383)(403) & arteries****

* Identified by its position behind this full bladder** Rt. external iliac vein is against, but behind the artery*** Lt. external iliac artery is against, but in front of the vein.****The internal iliac artery and vein are no longer identifiable. Numerous branch vessels are seen as spots or streaks.

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Reference Images 3 & 4

1. Bladder, with urine and iodine contrast 2. Body of the Rt. ilium (468)(486)3. Rt. ureter* (348)(361)4. Lt. external iliac artery5. Lt. external iliac vein6. Rt. iliopsoas muscle** (478)(398)

7. Roof of Rt. acetabulum8. Rt. femoral artery9. Rt. femoral vein*** (253)(262)10. Rectum****

* Seen as a streak, rather than a spot, because it has turned anterior toward the bladder. The Lt. ureter is not seen because at the moment in time it was imaged no contrast happened to be in it.** The psoas major and iliacus muscles have merged into the iliospsoas. On image 4 the two can still be seen separately. *** The external iliac vessels become femorals when they pass through the inguinal canal, which is not seen. However, the level of the top of the acetabulum is close to the inguinal canal. ****The sigmoid colon crosses the top of the bladder, but posterior to it becomes the rectum.

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ReferenceImages 5 & 6

Images 5-8

1. Greater trochanter of Lt. femur (469)(487) 2. Coccyx3. Ureterovesical (ureterocystic) junctions4. Rt. & Lt. ampulla of vas deferens (367)(384)5. Rt. & Lt. seminal vesicle*6. Rt. & Lt. spermatic cords

7. Ischium bone8. Pubic bone9. Rt. & Lt. spermatic cords (241-243, 348) (249-251, 361)10. Rt. & Lt. femoral veins**11. Greater trochanter of the Rt. femur

* Two spellings, vesicle (little bladder) and vesical, (bladder shape) are similar, though “icle” is used for the seminal vesicles. ** Arteries are against, and anterior to the veins

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Images 7 & 8

1. Pubic symphysis 2. Prostate gland (367)(384)3. Rt. Gluteus maximus muscle

4. Rt. ischial tuberosity (468)(385)5. Proximal shaft of Lt. femur

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Images 9 & 10

Images 9 & 10

1. Adipose tissue 2. Rt. ilium3. Rectum4. Posterior wall of acetabulum*5. Rt. & Lt. gracilis muscle (482, 487)(500, 505)6. Greater trochanter of Lt. femur7. Lesser trochanter of Lt. femur 8. Intertrochanteric crest of Lt. femur (470, 471)(488,489)

9. Posterior elements of lumbar spine10. Sigmoid colon11. Rt. femoral head**12. Rt. internal iliac vein*** (373)(392)13. Lt. internal iliac artery****

* Superior part is composed of ilium, inferior part is ischium** Most posterior aspect*** Artery is immediately below it****Vein is immediately above it. See Netter’s plate 373 to appreciate why the internal vein is superior to the internal artery in these coronal sections.

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ReferenceMRI Coronal Images of the Female Pelvis

Female Images 1 & 2

Images 1-4

1. Rt. & Lt. sacroiliac joints 2. Neck of the Rt. femur3. Vertebral canal4. Shaft of the right femur*5. Sacral plateau

* On image 3 & 4 the proximal shaft of the femur is seen to be anterior to the distal shaft: muscle tissue is covering the distal shaft on image 3. For this reason it is evident that as the distal portion of the shaft appears it will be cortical bone that first comes into the imaged plane. That is why the distal shaft is dark. Cortical bone is dense and contains little hydrogen, so no signal is returned.

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Images 3 & 4

1. Rt. pedicle of the 4th lumbar vertebra 2. Body of the 5th lumbar vertebra3. Branches of the Lt. internal iliac artery*4. Posterior wall of the vagina

5. Fundus of the uterus** (352)(365)6. L4-L5 intervertebral disk material (space)

* See Netter’s plate 383 (403) to appreciate the appearance of this streak in this coronal plane**First seen in image 5

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Images 5 & 6

Images 5-8

1. Uterus 2. Urinary Bladder*3. Lt. common iliac vein (381-383)(401-403)4. Lt. internal iliac artery

5. Lt. external iliac vein**6. Rt. iliopsoas muscle (478)(496)7. Small bowel

* Depending on the position of the uterus (see plate 358) (374), the amount of urine in the bladder, and the angle of the cut plane of the scan, when the bladder appears it may be superior or inferior to the uterus. The images seen here are similar to illustration B.

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Reference

A B

**In image 7 #3, the Lt. common iliac vein appears. The dark spot, #4, is the internal iliac artery which is unchanged from its first appearance in image #2. Where the internal iliac artery crosses the vein marks the spot where the common iliac vein becomes the external iliac vein. See plate 381 (401).

Images 7 & 8

1. Urinary bladder 2. Neck of bladder and internal urethral orifice (353)(366)3. Uterus4. Rt. psoas muscle5. Rt. iliacus muscle6. Rt. iliopsoas muscle7. Rt. internal iliac artery*

8. Rt. external iliac vein9. Inferior vena cava**10. Vestibule of the vagina (359)(377)

* Just the darker spot** Most proximal part, at the anastomosis of the Rt. & Lt. common iliac veins.

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Images 9 & 10

Images 9-12

1. Rt. & Lt. common iliac arteries 2. Inferior vena cava (381)(401)3. Cecum of the colon4. Lt. ovary (354-356)(369-371)5. Lt. fallopian tube (oviduct)

6. Rt. & Lt. external iliac artery7. Rt. & Lt. femoral artery (superficial femoral)*8. Abdominal aorta9. Pubic symphysis10. Labia majora (labium=singular)

* On this image we see the origin of the deep femoral (profunda) where the various branches of the circumflex feed the proximal femur. Compare the right side to plate 494 (512).

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Images 11 & 12