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Pelvis and lower extremity anatomy 2010-2012

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Pelvis and lower extremity anatomy 2010-2012

  1. 1. Pelvic and lower extremity anatomy and angiography Dustin Thompson MD PGY 4
  2. 2. Pelvic and lower extremity anatomy and angiography • Pelvis –Plain X-rays –Cross sectional anatomy –Angiography • Iliac arteries and branches • Lower Extremity –Plain X-rays • Hip, knee, ankle, foot –Cross sectional anatomy • Muscles of the thigh –Angiography
  3. 3. Bones of the Pelvis Ilium Ischium Pubis
  4. 4. AIIS Sacroiliac joints Superior pubic rami Pubic symphisis ASIS Inferior pubic rami and ischial tuberosities
  5. 5. Pelvis – Cross Sectional Anatomy Cecum Ureters IVC Aorta Descending colon Umbilicus Rectus abdominis Quadratus lumborum Erector spinae group Psoas External oblique, internal oblique, and transversus abdominis Small intestine and mesentery
  6. 6. Pelvis – Cross Sectional Anatomy Common iliac arteries Common iliac veins Iliacus Gluteus medius Ureters
  7. 7. Pelvis – Cross Sectional Anatomy Appendicitis External iliac arteries Ureters Internal iliac arteries External iliac veins Internal iliac veins Gluteus minimus Gluteus medius Gluteus maximus
  8. 8. Pelvis – Cross Sectional Anatomy Uterus External iliac arteries External iliac veins Internal iliac veins Internal iliac arteries Left Ovary
  9. 9. Pelvis – Cross Sectional Anatomy Common femoral veins Common femoral arteries Urinary bladder Vagina Rectum Sartorius Iliopsoas Tensor fasciae latae Gluteus minimus Gluteus maximus Obturator internus
  10. 10. Pelvis – Cross Sectional Anatomy Common femoral veins Common femoral arteries Pubic symphisis Tensor fasciae latae Iliopsoas Gluteus minimus Sartorius Rectus femoris Pectineus Obturator internus Obturator externus Adductor longus Gluteus maximus
  11. 11. Pelvis – Cross Sectional Anatomy Rectosigmoid junction Uterus Urinary bladder Vagina Pubis
  12. 12. Distal aortogram – Native Image
  13. 13. Distal aortogram – Digital subtraction
  14. 14. Distal aortogram – Digital subtraction
  15. 15. Iliac Artery Branches • Common Iliac • External Iliac – Deep Iliac Circumflex – Inferior Epigastric • Internal Iliac – Posterior Division • Superior Gluteal • Iliolumbar • Lateral Sacral – Anterior Division • Obturator • Uterine • Vesicle • Inferior Gluteal • Internal Pudendal
  16. 16. • Internal Iliac –Posterior Division • Superior Gluteal • Iliolumbar • Lateral Sacral –Anterior Division • Obturator • Uterine • Vesicle • Inferior Gluteal • Internal Pudendal Iliac Artery Branches
  17. 17. Distal aortogram – Digital subtraction • Sequential images show filling of the distal aorta and iliac branches • Prominent tortuous uterine arteries are seen
  18. 18. Distal aortogram – Digital subtraction
  19. 19. Clinical Correlation • Uterine artery embolization (UAE) for fibroids • Prophylactic uterine artery occlusion during caeserean section • Embolization for malignancies
  20. 20. Uterine artery embolization for Right uterine artery Pre-embolization fibroids Right internal iliac artery Post-embolization
  21. 21. Preoperative Selective Arterial Catheters Occluding Balloon Catheter
  22. 22. Cervical carcinoma Uterine Neovascularity Post- Embolization
  23. 23. Lower Extremity
  24. 24. Left hip AP view
  25. 25. Right knee lateral and AP views
  26. 26. Right tibia and fibula AP and lateral views
  27. 27. Left ankle AP and lateral views
  28. 28. Left foot lateral AP and oblique views
  29. 29. Cross Sectional Anatomy Vastus lateralis, intermedius, medialis Rectus femoris Sartorius Gluteus maximus Adductors (longus, brevis, magnus) Gracilis Semimembranosus, semitendinosus, and biceps femoris (long head) See Netter Plate 487 Femoral arteries (superficial and deep)
  30. 30. Cross Sectional Anatomy Vastus lateralis, intermedius, medialis Rectus femoris Sartorius Adductors (longus, brevis, magnus) Gracilis Biceps femoris Semimembranosus (medially) and semitendinosus See Netter Plate 487 Femoral artery
  31. 31. Cross Sectional Anatomy Vastus lateralis, intermedius, medialis Quadriceps tendon Biceps femoris Sartorius Gracilis Semimembranosus (medially) and semitendinosus See Netter Plate 487
  32. 32. Cross Sectional Anatomy Patella Popliteal Artery Femoral condyles
  33. 33. Cross Sectional Anatomy • Last patient ran out of contrast so this is a new case • Please note this is the left leg not the right like on the previous images • Also, this patient is much younger and more muscular than the last Popliteal artery as it gives of the anterior tibial branch
  34. 34. Cross Sectional Anatomy Anterior tibial artery Posterior tibial artery Peroneal artery
  35. 35. Cross Sectional Anatomy • Compartments – Anterior • Tibialis anterior • Extensor digitorum longus • Extensor hallucis longus – Lateral • Peroneus brevis and longus –Deep Posterior • Tibialis posterior • Flexor digitorum longus • Flexor hallucis longus – Superficial Posterior • Soleus • Gastrocnemius See Netter Plate 504
  36. 36. Cross Sectional Anatomy Anterior tibial artery Posterior tibial artery Peroneal artery
  37. 37. Cross Sectional Anatomy Posterior tibial artery Dorsalis pedis artery
  38. 38. CT angiogram of the left lower extremity
  39. 39. Clinical Correlation • Atherosclerotic disease is a common indication for angiography and intervention
  40. 40. External iliac artery stent Long, diffuse stenosis
  41. 41. Iliac artery occlusion
  42. 42. Iliac artery occlusion
  43. 43. Thank You! •Any questions or comments please send to dustin.thompson.md@gmail.com • Lectures will be posted online at https://www.mi-sir.org/

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