16.12.2019 1 Imaging techniques Topography Regional anatomy of the head Regio parotideomasseterica • Tragus, zygomatic arch,angulus mandibulae, masseter • Nervus auriculotemporalis • Parotid gland • A. et v. temporalis supf. • Nervus facialis !!! Fossa infratemporalis • Ramus mandibulae, tuber maxillae, styloid septum, pharynx • N. mandibularis • A. et v. maxillaris 16.12.2019 2 Regiones faciei Fossa cranii interna 16.12.2019 3 REGIONAL ANATOMY OF THE NECK 16.12.2019 4 16.12.2019 5 Trigonum scalenovertebrale REGIONAL ANATOMY OF THE CHEST Mediastinum and its division Superior mediastinum Superior mediastinum 16.12.2019 6 Superior mediastinum Anterior Mediastinum Middle Mediastinum Posterior mediastinum - I Posterior mediastinum - II Posterior mediastinum III 16.12.2019 7 Right lateral view Left lateral view REGIONAL ANATOMY OF THE ABDOMEN BOARDERS OF THE ABDOMEN SKIN CAMPER SCARPA ABDOMINAL WALL 16.12.2019 8 Above the linea semilunaris (upper 2/3) Under the linea semilunaris (lower 1/3) Morphology of the abdominal wall VV. SUBCUTANEAE ABD. V. THORACOEPIGASTRICA V. EPIGASTRICA SPF. V. CIRCUMFLEXA ILIUM SPF. VV. PARAUMBILICALES A. EPIGASTRICA SPF. A. CIRCUMFLEXA ILIUM SPF. AA. INTERCOSTALES A. SUBCOSTALIS AA. LUMBALES A. EPIGASTRICA SUP. A. EPIGASTRICA INF. A. CIRCUMFLEXA ILIUM PROF. AA. INTERCOSTALES A. SUBCOSTALIS AA. LUMBALES NN. INTERCOSTALES N. SUBCOSTALIS N. ILIOHYPOGASTRICUS N. ILIOINGUINALIS NODI LYMPHATICI AXILLARES NODI LYMPHATICI INGUINALES SPF. 16.12.2019 9 Canalis inguinalis Anterior wall: aponeurosis of the m. obliquusexternus Superior wall: margine of the musculus obliquus int. abdominisand m. transversus abdominis Inferior wall: lig. inguinale CANALIS INGUINALIS Posterior wall: Fascia transversalis: Anulus inguinalis prof. Lig. interfoveolare Trigonum inguinale (Hesselbachi) Falx inguinalis (conjoint tendon) Tractus iliopubicus Anulus femoralis CANALIS INGUINALIS Plica umbilicalis mediana - lig. umbilicale medianum (chorda urachi) Fossa supravesicalis Plica umbilicalis medialis - lig. umbilicale mediale (laterale) (pars occlusa a. umbilicalis s. chorda umbilicalis) Fossa inguinalis medialis - direct inguinal hernia Plica umbilicalis lateralis - vasa epigastrica inf. Fossa inguinalis lateralis - indirect inguinal hernia Projection of the organs 1 medioclavicular line 2 Right umbilikoaxillary line 3 Liver 4 Triangle of Labeé 5 Transpyloric line 6 Murphy´s point 7 Désjardins pancreatic point 8 Umbilicus 9 Monroe´s line 10 MacBurney´s point 11 Lanz point 13 Bispinal line ascites CAVITAS ABDOMINALIS P – cavitas peritonealis A – spatium preperitoneale R – spatium retroperitoneale S – spatium subperitoneale (infraperitoneale) S 16.12.2019 10 Intraperitoneal organs: Abdominal part of the oesophagus, stomach, superior part of the duodenum, jejunum, ileum, appendix vermiformis, colon transversum, colon sigmoideum, liver, spleen Secondarily retroperitoneal organs: Most of duodenum, pancreas, caecum, colon ascendens, colon descendens Primarily retroperitoneal organs: Kidneys, suprarenal glands, aorta, vena cava inf. Cavitas peritonealis - pars supramesocolica, inframesocolica Pars supramesocolica Truncus coeliacus Right infra(meso)colic compartment A. mesenterica superior Left infra(meso)colic compartment A. mesenterica inferior Omentum minus - lig. hepatogastricum - lig. hepatoduodenale - a. hepatica propria - v. portae - ductus hepaticus comm. (d.choledochus) 16.12.2019 11 LIGAMENTUM HEPATODUODENALE Omentum majus - lig. gastrocolicum Bursa omentalis - vestibulum - recessus sup. b.o. - recessus sinister b.o. - recessus inf. b.o. Bursa omentalis Recessus inferior bursae omentalis (2) RECESSUS PERITONEALES 16.12.2019 12 Recessus intersigmoideus 1. diaphragma 4. m. transversus abdominis 2. 11th rib 5. m. quadratus lumborum 3. 12th rib 6. m. psoas major 1. fascia renalis 5. corpus adiposum pararenale 2. lamina praerenalis 6. peritoneum 3. lamina retrorenalis 7. fascia transversalis 4. capsula adiposa Th XII 16.12.2019 13 Median section through the male pelvis 1. excavatio rectovesicalis Median section through the female pelvis 1. excavatio rectouterina (Douglas) 2. excavatio vesicouterina CAVITAS PELVIS PERITONEALIS EXCAVATIO RECTOVESICALIS LIGAMENTUM LATUM UTERI LIGAMENTUM OVARII PROPRIUM LIGAMENTUM SUSPENSORIUM OVARII LIGAMENTUM TERES UTERI 16.12.2019 14 A. UTERINA X URETER Fasciae of the back Fascia dorsalis superficialis Fascia nuchae Fascia thoracolumbalis Aponeurosis lumbalis Trigonum lumbale (Petiti)Tetragon Krausei Foramen humerotricipitale boarders: m. teres major et minor, caput longum m. tricipitis brachii, humerus content: n. axillaris, a. circumlexa humeri posterior Foramen omotricipitale boarders: m. teres major et minor, caput longum m. tricipitis brachii content: a. circumlexa scapulae Ventral wall: Tendon of the m. pectoralis major Dorsal wall: m. latissimus dorsi and m. teres major Medial wall: Chest and m. serratus anterior Lateral wall: humerus, caput breve m. bicipitis brachii, m. coracobrachialis Base - fascia axillaris apex- 1. rib, lateral part of the clavicle and scapula Content: plexus brachialis, a. axillaris Fossa axillaris Fascia antebrachii Connected with dorsal side of ulna septum intermusculare ant. septum intermusculare post. retinaculum flexorum et extensorum 16.12.2019 15 Eminentia carpi radialis et ulnaris Retinaculum flexorum (lig. carpi transversum) Canalis carpi: Radial part: m. flexor carpi radialis Ulnar part: m. flexor digitorum superficialis m. flexor digitorum profundus m. flexor pollicis longus nervus medianus Vaginae synovialesof flexors Vagina synovialis tendinis m. flexoris carpi radialis Vagina synovialis tendinis m. flexoris pollicis longi Vagina synovialis communis musculorum flexorum Vaginae synoviales digitorum manus Vaginae fibrosae digitorum manus (pars anularis, pars cruciformis) Vaginae synovialesof the extensors Retinaculum extensorum (radius - os triquetrum a os hamatum) 1. m. abductor pollicis longus m. extensor pollicis brevis 2. m. extensor carpi radialis longus et brevis 3. m. extensor pollicis longus 4. m. extensor indicis m. extensor digitorum communis 5. m. extensor digiti minimi 6. m. extensor carpi ulnaris Fasciae manus Fascia dorsalis manus superificialis Fascia dorsalis manus intertendinea Fascia dorsalis manus interossea Facia palmaris superficialis – aponeurosis palmaris Fascia palmaris interossea Septum palmare radiale (3rd metacarpal bone) Septum palmare ulnare (5th metacarpal bone) Spatium palmare radiale, ulnare, medium Foramen suprapiriforme: Content: vasa glutea superiora, nervus gluteus superior Foramen infrapiriforme: nervus ischiadicus, nervus cutaneus femoris posterior, vasa glutea inferiora, nervus gluteus inferior, vasa pudenda interna, nervus pudendus Inguinal ligament, arcus iliopectineus, os coxae Lacuna vasorum: Arteria et vena femoralis, ramus femoralis nervi genitofemoralis Lacuna musculurom: Iliopsoas, nervus femoralis, nervus cutaneus femoris lateralis 16.12.2019 16 Trigonum femorale, fossa iliopectinea: Boarders: Inguinal ligament, musculus sartorius, musculus adductor longus Content: nodus lymphaticus inguinalis profundus, vena femoralis, arteria femoralis, nervus femoralis, ramus femoralis nervi genitofemoralis Canalis adductorius: Musculus vastus medialis, musculus adductor magnus, Lamina vastodductoria Vasa femoralia, nervus femoralis Fossa poplitea: Boarders: musculus biceps femoris, musculus semitendinosus, musculus semimembranosus, caput mediale et laterale musculi gastrocnemii Content: nervus tibialis, nervus fibularis communis, vena poplitea, arteria poplitea Vaginae synoviales – ventral group Retinaculum musculorum extensorum superius (between malleolus medialis et lateralis) three osteofibrous spaces: m. tibialis ant. m. extensor hallucis longus m. extensor digitorum longus Retinaculum musculorum extensorum inferius (X or Y shape) Synovial vaginae – lateral group Retinaculum musculorum peroneorum superius (between malleolus lat. and tuber calcanei) Common synovial vagina Retinaculum musculorum peroneorum inferius (between tuber calcanei, trochlea peronealis calcanei and distal part of retinaculum extensorum inf.) 2 osteofibrous canals: m. fibularis longus (below trochlea peronealis) m. fibularis brevis (above trochlea peronealis) Synovial vagianae – medial group Retinaculum musculorum flexorum (between malleolus lateralis and tuber calcanei) Three osteofibrous spaces m. tibialis post. m. flexor digitorum longus (a. and v. tibialis post., n. tibialis) m. flexor hallucis longus Synovial vagina for each muscle Fascia cruris Doesn´t cover facies medialis tibiae septum intermusculare anterius et posterius (anteriot, lateral and posterior group) Dorsal group – deep fascial sheath Firmed in retinaculum musculorum extensorum, flexorum, peroneorum 16.12.2019 17 Fasciae pedis Fascia dorsalis pedis Fascia dorsalis pedis interossea Fascia plantaris superficialis – aponeurosis plantaris Fascia plantaris pedis interossea Septum intermusculare mediale (1st metatarsal bone) Septum intermusculare laterale (5th metatarsal bone) Spatium plantare mediale, laterale, medium Description of the X-ray picture Oesophagography Gastrography 16.12.2019 18 Cholecystography ERCP (endoskopic retrograde cholangiopancreaticography) Irigography intravenous urography Retrograde pyelography Hysterosalpingography 16.12.2019 19 Coronarography a. coronaria cordis sin. Coronarography a. coronaria cordis dx. A. carotis interna - angiogram a. carotis int. a. vertebralis flebography 16.12.2019 20 A. hepatica comm. Truncus coeliacus A. renalis https://is.muni.cz/auth/do/med/el/anatomie_samo studium/pages/18-RTG.html References: Putz, R. (2008): Atlas of Human Anatomy Sobotta. Elsevier Books. Keith L. Moore, Arthur F. Dalley (2005): Clinically Oriented Anatomy. Williams and Wilkins. Platzer, W., Kahle, W., Leonhardt H. (1992): Locomotor system. Georg Thieme Verlag, Stuttgart, New York, 4th edition. Čihák, R. (1987): Anatomie 1. Avicenum, Zdravotnické nakladatelství. Netter, F. H. (1997): Interactive Atlas of Clinical Anatomy. Novartis, USA.