腹部横断层解剖.ppt

腹部横断层解剖,F,AbdomenSectionalAtlas:1,Thefollowingcross-sectionalatlasofanormalmaleabdomendemonstratesanatomicalrelationshipsoftheabdominalorgansinthecontextoftheCTscan.ThesectionsspantheareabetweenthedomeoftherighthemidiaphragmatT9toL5belowtheaorticbifurcation.,AbdomenSectionalAtlas:2,Theair-filledcolonoutlinesapendenttransversecolonbetweenprominenthepaticandsplenicflexures.NotetheproximityofthehearttothecardiaofthestomachandthelessercurveofthestomachcrossingtheT12-L1disc.,AbdomenSectionalAtlas:3,Thesequenceofabdomensections1to14below,shownasananimation.,AbdomenSectionalAtlas:4,Thesectionlevelssuperimposedonanx-ray.Clicktheappropriatenumberabovetoviewaparticularsection.,1234567891011121314,AbdomenSectionalAtlas:section1,Byconvention,CTcrosssectionsareviewedfromacaudalperspective.Section1,atthelevelofT9,cutsacrossthedomeoftherighthemidiaphragm,thebasesofthelungs,andthelongaxisoftheventriclesoftheheart.Theterminationiftheinferiorvenacavaisseenatitsjunctionwiththerightatrium(seeHeartAnatomy,Cross-Sections).,AbdomenSectionalAtlas:section2,Thesecondsection,throughT10,sectionsthedomeoftheliverwherefainttracesofthehepaticveinscanbeseenconvergingtowardthehepaticportionoftheinferiorvenacava(seeRightUpperQuadrantAnatomy).Theaortaisstilltotheleftofthemidlineinthelowerposteriormediastinumandtheesophagusliesdirectlyanteriortoit.Whenexploringanabdomenwithnonasogastrictubeinplace,theaorticpulsationistheguidetothelocationoftheesophagus.,AbdomenSectionalAtlas:section3,Level3,atthetopofT11,startstocatchthecardiaofthestomachandtheadjacentupperpoleofthespleen.Notetheesophagusanteriortotheaorta,indicatingthissectionisabovetheesophago-gastricjunction.,AbdomenSectionalAtlas:section4,AtthebottomofT11,theportalveinisseeninthehepatichilum.Theesophago-gastricjunctionisseen.Thebodyofthespleenispartiallyseparatedfromthebodyofthestomachbytheprominentsplenicflexureinthisindividual(seeSpleenAnatomy).,AbdomenSectionalAtlas:section5,AtthemiddleofT12,thebodyofthegallbladderisseenasaradiallucencywithintheliver.Theplanethroughthegallbladderbedandtheinferiorvenacavadividestheliverintorightandleftlobes(seeHepaticAnatomy,CaudalView).Thecruraofthediaphragmareseenunitinganteriortotheaortaasthearcuateligament.TheposteromedialborderofthespleenisindentedbythebeginningofperinephricfatwithinGerotasfascia.Thehilumandgastricsurfaceofthespleenfacesanteromedial.,AbdomenSectionalAtlas:section6,AttheupperborderofL1,theceliactrunkemergesperpendiculartotheaorta,justbeneaththearcuateligamentofthecrura(seeimageabdG3004).Thepancreasisdrapedacrosstheoriginoftheceliacandthetailofthepancreasabutsthehilumofthespleen(seeimagepanG3001).Theupperpoleoftheleftkidneyandadjacentadrenalglandareseen.Thetopoftherightadrenalglandisseenimmediatelyposteriortotheinferiorvenacavawheretheadrenalveindrainsdirectlyintoitsposteriorwall.,AbdomenSectionalAtlas:section7,AtthebottomofL1,thesuperiormesentericarteryarisesfromtheaorta.Immediatelyanteriortoit,theceliacisdippingdowntodivideintosplenicandhepaticbranches.Justanteriortotheceliac,thesplenicveinisseenasalightstreakalongtheposteriorborderofthepancreas.Thesplenicveindrainsintotheportalveinposteriortotheneckofthepancreas(seePortalVeinanatomy).Thelowerpoleofthespleenabutsthemiddleoftheleftkidney.,AbdomenSectionalAtlas:section8,AtthelevelofL2,thesuperiormesentericarteryandveinaredistinctlyseenintherootofthesmallbowelmesentery.Thethirdportionoftheduodenumpassesbetweenthemandthegreatvessels(seepanG3001).Theleftrenalveincrossestheaortatodrainintotheinferiorvenacava.Notetheshortrightrenalvein.Branchesoftherenalarteries,whicharoseanterolaterallyjustbelowthelevelofthesuperiormesenteric,areseenenteringtherenalhila.,AbdomenSectionalAtlas:section9,AtthetopofL3,thetipoftherighthepaticlobeisseenaswellastheleftrenalpelvis.,AbdomenSectionalAtlas:section10,AtthelowerportionofL3,theinferiormesentericarteryisseenarisingfromtheaorta(seeLowerGIBleedCaseStudy).Theleftureterisvisualizedlyingattheanteriorborderoftheleftpsoasmuscle.Thedrapedtransversecolonoccupiestheanteriorabdominalspace.,AbdomenSectionalAtlas:section11,NearthetopofL4,thelowerpolesofthekidneysareseenaswellasthenumerousvesselsinthesmallbowelmesentery.Thelucencyaroundthekidneysisperinephricfat,whichtapersaboveandbelowthekidneyswithinGerotasfascia(seeimagebilL3018).,AbdomenSectionalAtlas:section12,AtL4,theaorticbifurcationisseen.Thenarrowdescendingcolonontheleftandwidececumontherightareseen.Theappendixisvisualizedwithcontrastinthelumen(seeAppendectomy).Theappendixisretrocecalhereasitisinthemajorityofindividuals.,AbdomenSectionalAtlas:section13,AtthetopofL5,thecommoniliacarteriesdiverge.Thebaseoftheappendixisseenatthececum.Notetheumbilicusinrelationtotheaorticbifurcation.,AbdomenSectionalAtlas:section14,AtthelowerportionofL5nearthelumbosacraljunction,thepsoasmuscleshavebecomelargerandroundedastheybegintheiranteriorcoursearoundthebrimofthetruepelvis(seeimageabdG3004).,AbdomenSectionalReconstructions:1,Stackingthesectionsallowsconceptualreconstructionandvisualizationofrelationships(seeimageabdG3005).,AbdomenSectionalReconstructions:2,Thehighposteriorpositionofthespleenbeneaththelefthemidiaphragmaffordsprotectionbytheribcage(andmakesitdifficulttoreachbylaparotomy).Notetherelationshipstocardiaofstomach,leftkidneyandsplenicflexureofcolon(seeSpleenAnatomy).,AbdomenSectionalReconstructions:3,Thekidneyslieintheretroperitoneumsurroundedbyperinephricfat,encapsulatedwithintheanteriorandposteriorlaminaofGerotasfascia.Thefusiformpsoasmusclesdirecttheaxisofthekidneysanterolaterallytowardthelowerpoles.Noterelationshipstosurroundingstructures(seeimagesabdG3004andabdG3005).,AbdomenSectionalReconstructions