Saremi / Sanchez-Quintana / Kiyosue Imaging Anatomy

Text and Atlas Volume 2: Abdomen and Pelvis
1. Auflage 2022
ISBN: 978-1-63853-611-6
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 678 Seiten, ePub

Reihe: Atlas of Imaging Anatomy

Normal imaging anatomy and variants, including diagnostic and surgical anatomy, are the cornerstones of radiologic knowledge. is the second in a series of four richly illustrated radiologic references edited by distinguished radiologist Farhood Saremi. The atlas is coedited by esteemed colleagues Damián Sánchez-Quintana, Hiro Kiyosue, Dakshesh B. Patel, Meng Law, and R. Shane Tubbs with contributions from an impressive cadre of international authors. Succinctly written text and superb images provide readers with a virtual, user-friendly dissection experience.

This exquisitely crafted atlas combines fundamental core anatomy principles with modern imaging and postprocessing methods to increase understanding of intricate anatomical features. Twenty-two concise chapters cover the abdominal wall, alimentary tract, liver, biliary system, pancreas, spleen, peritoneum, genitourinary system, pelvic floor, neurovasculature, and surface anatomy. Relevant anatomical components of the abdomen and pelvis are discussed, including musculature, arteries, veins, lymphatics, ducts, and innervation.

Key Highlights

• High-quality cross-sectional multiplanar and volumetric color-coded CT, MRI, and angiography imaging techniques provide detailed insights on specific anatomy
• Cross-sectional and topographic cadaveric views by internationally known anatomists coupled with more than 1,600 illustrations clearly elucidate difficult anatomical concepts
• Consistently formatted chapters include an introduction, embryology, review of anatomy, discussion of anatomical variants, postsurgical anatomy, and congenital and acquired pathologies

This unique resource provides an excellent desk reference for differentiating normal versus pathologic anatomy. It is essential reading for medical students, radiology residents and veteran radiologists, internists, and general surgeons, as well as vascular and transplant surgeons.

This print book includes complimentary access to a digital copy on https://medone.thieme.com.

Publisher's Note: Products purchased from Third Party sellers are not guaranteed by the publisher for quality, authenticity, or access to any online entitlements included with the product.

Autoren/Hrsg.

Saremi, Farhood

Sanchez-Quintana, Damian

Kiyosue, Hiro

Law, Meng

Patel, Dakshesh

Tubbs, R. Shane

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Vorklinische Medizin: Grundlagenfächer Anatomie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Bildgebende Verfahren, Nuklearmedizin, Strahlentherapie Radiologie, Bildgebende Verfahren

Inhaltsverzeichnis

1. Abdominopelvic Wall
2. Esophagus
3. Stomach
4. Small Intestine
5. Colon
6. Liver
7. Spleen
8. Biliary System
9. Pancreas
10. Mesenteric Vasculature of Lower Gastrointestinal System
11. Portal Venous System
12. Peritoneal Spaces
13. Adrenal Glands, Kidneys, Ureters, and Bladder
14. Extraperitoneal Space
15. Male Genitourinary
16. Female Genital System
17. Perineum
18. Pelvic Floor
19. Abdominal Aorta and Major Branches
20. Systemic Veins of the Abdomen and Pelvis
21. Lymphatics of the Abdomen, Pelvis, and Perineum
22. Surface Anatomy and Projectional Surface Anatomy

Leseproben

1 Abdominopelvic Wall

Farhood Saremi

Introduction

The upper border of the abdominal cavity is delimited by the thoracoabdominal line, a horizontal plane passing through the base of the xiphoid appendix and the spinous process of T12.1,2 The upper border of the anterior abdominal wall is defined by the “costal line,” a line passing along the lowest edge of the costal arch which corresponds to the anatomic location of the diaphragm (?Fig. 1.1). The lower limit of the abdominal cavity is bordered by the pubic symphysis, inguinal arc, and iliac crest anteriorly and laterally, and by the spinous process of the L5 posteriorly. Using horizontal and vertical umbilical planes, the anterior abdomen/pelvis is subdivided into four quadrants extending between the costal line and inguinal ligaments. In French literature, nine regions are defined, namely, the epigastrium, mesogastrium (umbilical), and hypogastrium in the middle and the hypochondrium, flanks, and iliac on the sides (?Fig. 1.1).

Fig. 1.1 (a) The upper border of the anterior abdominal wall is defined by the costal line which corresponds to the anatomic location of the diaphragm. The lower limit of the abdominal cavity is bordered by the pubic symphysis, inguinal arc, and iliac crest. (b) Clinical divisions of the abdominal cavity.

Using axillary lines (anterior, mid, and posterior), the abdomen is divided into four walls: anterior, posterior, right, and left lateral.

These surface landmarks have been historically used to address pathologies in certain parts of the abdominal cavity in clinical examinations. Obviously, clinically relevant limits are usually different from the anatomical limits. On the other hand, the internal border between the abdomen and pelvis is not clear and both cavities can be discussed under abdominal or abdominopelvic cavity which extends between the diaphragm and pelvic floor. This delimitation better suits radiologic descriptions of this part of the body.

Layers of the abdominal wall include the skin, superficial fascia, muscles with their aponeurosis, investing muscle fasciae, transversalis fascia, and peritoneum. Although each layer is a distinct anatomic structure, they function together as a solitary unit.

Fascial System of the Abdominal Wall

Before reviewing the anatomy of the abdominal muscles and associated structures, it is necessary to address the definition of fascia, aponeurosis, and retinaculum. Embryonic mesenchyme is the source of many structures including hematopoietic tissue, bones, cartilage, lymphoid, and fascial system. Federative International Programme on Anatomical Terminologies (FIPAT) has defined the fascia as aggregated sheets of connective tissue beneath the skin that attach, enclose, and separate muscles and other internal organs. The Fascia Nomenclature Committee introduced a very broad definition for the fascial layers. In their definition, the fascial system consists of the three-dimensional continuum of collagen-containing loose and dense fibrous connective tissues that include many structures in the body such as adipose tissue, adventitia and neurovascular sheaths, aponeuroses, deep and superficial fasciae, epineurium, joint capsules, ligaments, membranes, meninges, myofascial expansions, periosteum, retinacula, tendons, visceral fasciae, and all intramuscular septa.

The fascia is composed of irregularly arranged collagen fibers. Conversely, tendons, ligaments, retinaculum, and aponeuroses are formed by the collagen fibers that are regularly arranged.3,4 The irregular arrangement of collagen fibers in fascia increases the tensile strength of the fascia and allows it to resist tensional forces in every direction. An aponeurosis is a flat fibrous sheet that connects a muscle to a fixed point. Aponeurosis is covered with fascia.

The fascial system of the abdominal wall can be divided into two groups: (1) superficial or pannicular and (2) deep or investing. The superficial fascia refers to the fascia of the subcutaneous tissue. There has been considerable controversy with respect to the organization of superficial fascia in the human body. According to Lockwood, all the connective tissue between the dermis and muscle fascia in the body should be considered as a superficial fascial system which has the basic function of supporting the skin and fat of the body.4 This fascial system consists of one to several thin, horizontal membranous layers separated by varying amounts of fat with interconnecting vertical or oblique fibrous septa (?Fig. 1.2, ?Fig. 1.3). In cross-sectional imaging this membranous layer is seen as a thin, 1 to 2 mm band surrounded on both sides by fat (?Fig. 1.2).5,6 In the abdomen this membranous layer is called the Scarpa’s fascia and in the perineum, the Colles’ fascia. The fatty layer superficial to the membranous layer was previously named the Camper’s fascia. Below the inguinal ligament, the Scarpa’s fascia blends with the fascia lata, the deep fascia of the thigh. The arrangement and thickness of this membranous layer varies according to the sex and location of the body. The membranous layer may be double or even triple layer on the posterior trunk, thigh, and arm. It is thicker in the posterior abdominal wall (?Fig. 1.2). Functionally, the membranous superficial fascia plays a role in the integrity of the skin and support for subcutaneous structures.7

Fig. 1.2 Myofascial compartments on computed tomography (CT) scan. The hypaxial myofascial compartment is located anteriorly surrounding the body cavity and the epaxial myofascial compartment is located posteriorly. The epaxial compartment is divided into two subcompartments by the spinous process of the vertebra. The hypaxial and epaxial compartments are separated by an intermuscular septum that medially attaches to the transverse processes of the vertebra. In the lumbar region, this septum forms the middle layer of the thoracolumbar fascia. The membranous layer of the superficial fascia is shown. It is thicker in the posterior abdominal wall. EO, external oblique; ES, erector spinae muscles including medially positioned multifidus lumborum (ML) and laterally located iliocostalis lumborum (ICL); IO, internal oblique; LD, latissimus dorsi; P, psoas; QL, quadratus lumborum; RA, rectus abdominis; T, transverse muscle.

Fig. 1.3 The hypaxial and epaxial compartments are separated by an intermuscular septum that medially attaches to the transverse processes of the vertebra. In the lumbar region, this septum forms the middle layer of the thoracolumbar fascia. The posterior layer of the thoracolumbar fascia covers the posterior surface of the erector spinae. Latissimus dorsi (LD) aponeurosis forms the superficial lamina of the posterior layer of the thoracolumbar fascia. The deeper lamina of the posterior layer forms an encapsulating retinacular sheath around the paraspinal muscles. The aponeurosis of the erector spinae muscles and the overlying thoracolumbar fascia are separate, but they fuse at or slightly above the level of the posterior superior iliac spine to form the thoracolumbar composite. The transversalis fascia continues medially covering the anterior side of the investing fascia of the quadratus lumborum (QL) and also fuses with the psoas muscle (P) fascia. The internal (IO) and external obliques (EO) are seen external to the transverse abdominal muscle. Erector spinae muscles are shown including medially positioned multifidus lumborum (ML), laterally located iliocostalis lumborum (ICL), and deeply located longissimus thoracis (LT). The serratus posterior inferior (SPI) is often not present caudal to the L3 level. EO, external oblique; IO, internal oblique; LD, latissimus dorsi; P, psoas; QL, quadratus lumborum; RA, rectus abdominis; SPI, serratus posterior inferior; T, transverse muscle.

The deep fascia invests all bones, cartilages, muscles, tendons, ligaments, and aponeuroses, and blends into the periosteum of bone, epimysium of skeletal muscle, and peritenon of tendons and ligaments.8 The investing fascia of the muscles that are anterior to the transverse process of the vertebrae is called hypaxial fascia (?Fig. 1.2, ?Fig. 1.3, ?Fig. 1.4). These muscles are innervated by the anterior ramus. The fascia investing the muscles posterior to the transverse process (paraspinal muscles) is called epaxial fascia and the inside muscles are innervated by the posterior ramus.8 The hypaxial and epaxial fasciae together fuse to the transverse process of the vertebrae, creating an intermuscular septum (?Fig. 1.2, ?Fig. 1.3). Abdominal wall muscles including the internal oblique, external oblique, and transversus muscles are covered on both sides by the deep fascia. This investing fascia originates from the embryonic parietal fascia and is divided into three layers, namely, deep, intermediate, and superficial.9–11 The superficial layer is called the Gallaudet’s fascia that covers the outer surface of the external oblique muscle. The deep layer is called the transversalis fascia that covers the inner surface of the transverse abdominal muscle.

Fig. 1.4 (a) Posterior view of the back illustrating the attachments of the latissimus dorsi, trapezius, and gluteus maximus to the thoracolumbar fascia (TLF) and thoracolumbar composite (TLC). (b) Posterior view of the paraspinal muscles in the lumbosacral region. The posterior layer of the thoracolumbar fascia (PLF) has been removed to expose the iliocostalis lumborum (IcL) and the longissimus thoracis (LoT), as well as the aponeurosis of these two muscles (apo...