Anatomy & Radiology of pelvis

Anatomy & Normal Radiology of Pelvis Mohammed Fathy Bayomy, MSc, MD Lecturer Clinical Oncology & Nuclear Medicine Faculty of Medicine Zagazig University

Anatomy

(1) Pelvic Bones Sacrum (os sacrum) 2. Ilium (os ilium) 3. Ischium (os ischii ) 4. Pubic bone (os pubis) 5. Pubic symphysis 6. Acetabulum (of the hip joint) 7. Foramen obturatum 8. Coccyx/ (os coccygis )

Hip bone

Inlet and pelvic exit

Pelvic walls

Anterior wall

Posterior wall

Side walls

(2) Ligaments of the pelvis

(3) Muscles of the pelvis

Obturator internus muscle

Piriformis & Coccygeus muscles

Piriformis muscle

Coccygeus (ischococcygus) muscle

Levator ani muscle

(4) Pelvic Blood Vessels

Common Iliac Artery (CIA)

Internal Iliac Artery (IIA)

External Iliac Artery (EIA)

(5) Pelvic lymph node groups Can be divided into - • Parietal nodes. • Visceral nodes.

(I) Parietal Nodes 1- Superficial Parietal:- joining with superficial inguinal nodes (functional territory – fascial sheath of urogenital diaphragm, distal vagina, hymen & inf. anal canal) 2- Deep parietal - related to vessels include inferior epigastric, circumflex iliac and sacral nodes

(II) Visceral Nodes 1- Juxta -visceral Nodes:- Bladder – pre lateral, post. & sub vesical nodes Genital compartment – lateral to the vagina & cervix – paravaginal & parauterine Pararectal – around right and left aspects of the rectum 2- Common iliac Nodes 3- Internal iliac (Hypogastric) Nodes (include presacral nodes) 4- External iliac Nodes (include obturator nodes)

Common iliac lymph nodes Three chains: Lateral Middle Medial 5 th Lumbar vertebrae

Lateral chain:- Located lateral to the common iliac artery. 5 th Lumbar vertebrae Sacral promontory

Medial chain:- Occupies the triangular area bordered by both common iliac arteries from aortic bifurcation to bifurcations of the external & internal iliac arteries Include nodes at sacral promontory. Sacral promontory

Middle chain:- located in lumbosacral fossa Posteromedially: lower lumbar or upper sacral vertebral bodies, Anterolaterally: psoas muscle Anteromedially: common iliac vessels) Between common iliac artery & common iliac vein

Three chains: Lateral Middle Medial External iliac lymph nodes

Lateral chain:- Located along lateral aspect of external iliac artery

Medial chain (obturator nodes) :- Medial chain contains nodes located medial & posterior to external iliac vein.

Middle chain :- Located between the external iliac artery & external iliac vein

Three chains: Visceral Sacral Junctional Internal iliac (hypogastric) lymph nodes Sacrum

Sacrum Visceral chains :- Accompanying each of visceral branches of internal iliac artery

Sacrum Sacral chain :- Central location of sacrum (presacral)

Sacrum Junctional chain :- Located at junction between internal & external iliac nodal groups

Sections

Transverse Sections

Sagittal Sections

Coronal Sections

Normal Radiology of Pelvis

Plain X-ray

1 Spinous process of L 5 vertebra 2 Transverse process of L 5 vertebra 3 Spinous process of first sacral segment 4 Lateral sacral mass 5 Ilium 6 Sacroiliac joint 7 Sacral foramen of S 2 vertebra 8 Spinous process of S 3 vertebra 9 Coccyx: first segment of three 10 Iliac crest 11 Anterior superior iliac spine 12 Anterior inferior iliac spine 13 Pelvic brim 14 Ischial spine 15 Body of ischium 16 Ischial tuberosity 17 Ramus of ischium 18 Inferior pubic ramus 19 Body of pubic bone 20 Pubic symphysis 21 Superior pubic ramus 22 Acetabulum 23 Head of femur 24 Fovea 25 Neck of femur 26 Greater trochanter of femur 27 Lesser trochanter of femur 28 Intertrochanteric femur

CT Axial cuts

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♂ Psoas major muscle IVC Ao Descending colon Ascending colon 4 th Lumbar vertebrae

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♂ IVC RT CIA Lt CIA 5 th Lumbar vertebrae Psoas major muscle Ascending colon Descending colon Iliac bone

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♂ 5 th Lumbar vertebrae Psoas major muscle LT CIA RT CIA RT CIV LT CIV Iliac bone

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♂ 5 th Lumbar vertebrae Psoas major muscle Iliacus muscle LT CIV LT CIA RT CIV RT CIA

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♂ LT EIA LT IIA RT CIA RT CIV LT CIV Psoas major muscle 1 st sacral vertebrae Iliacus muscle

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♂ Iliopsoas muscle LT CIV LT EIA LT IIA RT EIA RT IIA RT EIV RT IIV 1 st sacral vertebrae Rectum Sigmoid colon Ala of ilium Iliopsoas muscle

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♂ LT EIV RT EIV Bladder Rectum RT EIA LT EIA Ureter LT II artery & vein Piriformis muscle Body of ilium Piriformis muscle

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♂ Bladder Rectum Seminal vesicle Ureter Ureter RT EIV RT EIA Piriformis muscle Piriformis muscle Obturator internus muscle Obturator internus muscle Iliopsoas muscle LT EIV LT EIA

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♂ Bladder Rectum Obturator internus muscle LT EIA LT EIV Iliopsoas muscle Seminal vesicle RT EIV RT EIA Piriformis muscle

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♂ Prostate Coccyx Obturator internus muscle Head of femur Pubis Ischium Obturator artery & vein LT EIA LT EIV Iliopsoas muscle Sertorius muscle Obturator externus muscle Rectum Levator ani muscle Rectus femoris muscle Tensor Fascia latae muscle Bladder

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♂ Pubis Obturator externus muscle Pectinus muscle Obturator internus muscle Prostate Rectum Levator ani muscle Ischiorectal fossa Iliopsoas muscle Sertorius muscle Rectus femoris muscle Ischium Femur

MRI Axial cuts

Abbreviations

* ♂

* ♀

♀

MRI Sagittal cuts

* ♂

* ♀

♂

♀

MRI Coronal cuts

* ♂

* ♀

* ♀ LS Lumbosacral trunk M Myometrium O Ovary

♂

♀

Anatomy & Radiology of pelvis

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Anatomy &amp; Radiology of pelvis

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Anatomy & Radiology of pelvis