Human Sectional Anatomy Atlas of Body Sections, CT and MRI Images 4ed-127-201

04-HSA-Section 4-Thorax-cpp.
indd 108
108
THORAX
1
3 5
30 32
4
28 7 33
29 22 6
27 21 34
26 8 36
31 20
25 37
8 9 38 35
Axial section 3 – Male

24 23 19 13 10 33
18
17 39 40
11
14 45 41
12
16 46
44 42
43
47 33
15 51
48 43
50
49
1 Sternocleidomastoid sternal head 15 Spine of first thoracic vertebra 27 Phrenic nerve 42 Infraspinatus
2 Anterior jugular vein 16 Spinal cord within dural sheath 28 Vagus nerve (X) 43 Scapula
3 Sternohyoid 17 Part of body of second thoracic 29 Subclavius 44 Subscapularis
4 Sternothyroid vertebra 30 Right subclavian vein 45 Serratus anterior
5 Clavicle 18 Part of intervertebral disc between 31 Tendon of right biceps long head 46 Serratus posterior superior
6 Internal jugular vein – junction first and second thoracic vertebrae 32 Pectoralis major 47 Superficial (transverse) cervical
with left subclavian vein 19 Part of body of first thoracic 33 Deltoid artery and vein
7 Left subclavian vein vertebra 34 Subdeltoid bursa 48 Rhomboideus minor
8 Subclavian artery 20 Oesophagus 35 Head of humerus 49 Trapezius
9 First rib 21 Common carotid artery 36 Tendon of left biceps long head 50 Rhomboideus major
10 Intercostal muscles 22 Trachea 37 Coracoid process of scapula 51 Erector spinae
11 Second rib 23 Right lung apex 38 Nerve to serratus anterior
12 Intercostal neurovascular bundle 24 Scalenus medius 39 Tendon of subscapularis 52 Supraspinatus
13 Apex of left lung 25 Root of first thoracic nerve 40 Glenoid fossa of scapula
14 Head of second rib 26 Scalenus anterior 41 Suprascapular artery and vein
04-HSA-Section 4-Thorax-cpp.indd 109
8 21
6/7 1 ➜ Orientation ➜ Section level
Anterior
32
22 22
Right Left
23 35
44 20 13 20
23 13
T1–2
51
52 Posterior
49
A 43 B
View
A B
Axial computed tomogram (CT) Axial computed tomogram (CT)
Axial section 3
Ellis, Logan, Dixon: Human Sectional Anatomy
➜ Notes Figure No. p107a Ellis, Logan, Dixon: Human Sectional Anatomy
Artist E Evans Figure No. p107b
This section, through the intervertebral disc Date

Here, posterior to the medial end of the22clavicle
05 14 overlying rib and lies
Artistprotected within the subcostal
E Evans
between the first and second thoracic vertebrae (5), the internal jugular vein (6) joins with the groove. Date 22 05 14
(18), enters the apex of the thorax and traverses subclavian vein (7) to form the brachiocephalic vein Only in transverse section is the extreme thinness
the apices of the upper lobes of the lungs (13, 23). (see Axial section 4). of the blade of the scapula (43) appreciated fully.
There are considerable differences between the The intercostal neurovascular bundle (12) is One CT (A) is displayed at soft tissue settings
THORAX
section and CT images at this level because the CT seen well. Note that it comprises the intercostal (window level and width of grey scale), the other
is performed with the arms elevated alongside the vein, artery and nerve from above downwards; CT (B) at lung windows.
head in order to reduce artefacts from the humeri. the nerve corresponds to the number of its
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10
110
THORAX
1
2
47 4
48 3 5
46 20
6 22
17 18 7 24
45 21
19
43
44 14 8 23
13

16 25
49 40 12 30
41 42 15 11 9
31
10
32
39 28
33
29 27 26 25
38
37
28
36 35
28
34
1 Pectoralis major 15 Upper lobe of right lung 28 Scapula 38 Spinal cord within dural sheath
2 Manubrium of sternum 16 Right vagus nerve (X) 29 Subscapularis 39 Body of third thoracic vertebra
3 Sternothyroid 17 Right brachiocephalic vein 30 Second rib 40 Axillary nerve
4 Sternoclavicular joint 18 Brachiocephalic artery 31 Intercostal artery and vein and 41 Radial nerve
5 First rib 19 Left common carotid artery nerve 42 Ulnar nerve
6 Internal thoracic artery 20 Left brachiocephalic vein 32 External and internal intercostal 43 Median nerve
7 Left phrenic nerve 21 Right phrenic nerve muscles 44 Right axillary artery
8 Left vagus nerve (X) 22 Pectoralis minor 33 Third rib 45 Right axillary vein
9 Upper lobe of left lung 23 Coracobrachialis and biceps (short 34 Trapezius 46 Axillary fat
10 Thoracic duct head) 35 Rhomboideus major 47 Pectoral branch of the
11 Oesophagus 24 Long head of biceps tendon 36 Erector spinae acromiothoracic artery and vein
12 Left subclavian artery 25 Deltoid 37 Fourth rib with articulation of its 48 Cephalic vein
13 Left recurrent laryngeal nerve 26 Infraspinatus head with body of third thoracic 49 Shaft of humerus
14 Trachea 27 Suprascapular artery and vein vertebra transverse process
2
➜ Orientation ➜ Section level
1
Anterior
22
17 20 18
19
14 12 23 14
15 9 Right Left
11
11 28 9
15
29
26
36
35 Posterior
A 34
B
T3
View
A B
Axial section 4
Ellis, Logan, Dixon: Human Sectional Anatomy Ellis, Logan, Dixon: Human Sectional Anatomy
Figure No. p109a Figure No. p109b
Artist E Evans Artist E Evans
Date 22 05 14 Date 22 05 14
➜ Notes
The contents of the upper mediastinum – including the Note that the cephalic vein (48) runs in the deltopectoral
THORAX
oesophagus, trachea and great vessels – are demonstrated groove between the medial edge of deltoid and the lateral
in this section, which traverses the manubrium and the third edge of pectoralis major.
thoracic vertebra; these are also shown in Axial section 5.
This section also shows the walls and contents of the axilla.
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11
112
THORAX
1
31
2
3 4
51 30 36
25
29 27 31
49 28 24
23 34
5

50 16 20 26 35
18
22 33 32
18 6 37
19 21 43
38 39
16
15 42
40
7 44
14
17 45 41
17 13
12 46
11 8
10 9 47
44
48
1 Manubriosternal joint (angle of 14 Part of intervertebral disc between 26 Left vagus nerve (X) 41 Circumflex scapular artery and vein
Louis) fourth and fifth thoracic vertebrae 27 Left phrenic nerve 42 Subscapularis
2 Internal thoracic artery and vein 15 Part of body of fourth thoracic 28 Pretracheal lymph node 43 Serratus anterior
3 Thymic residue within anterior vertebra 29 Superior vena cava 44 Body of scapula
mediastinal fat 16 Azygos vein 30 Right phrenic nerve 45 Teres minor
4 Second rib 17 Apical segment lower lobe lung 31 Pectoralis major 46 Infraspinatus
5 Intercostal separated by oblique fissure from 32 Deltoid 47 Rhomboideus
6 Third rib (18) 33 Shaft of humerus 48 Trapezius
7 Fourth rib 18 Upper lobe of lung 34 Biceps – long head 49 Axillary vein
8 Fifth rib 19 Oesophagus 35 Biceps – short head and 50 Axillary artery
9 Fifth costotransverse joint 20 Trachea at bifurcation coracobrachialis 51 Cephalic vein
10 Erector spinae 21 Recurrent laryngeal nerve 36 Pectoralis minor
11 Transverse process of fifth thoracic 22 Left subclavian artery orifice 37 Subscapular artery vein and nerve 52 Oblique fissure
vertebra 23 Aortic arch 38 Latissimus dorsi
12 Spinal cord within dural sheath 24 Left common carotid artery orifice 39 Triceps – lateral head
13 Sympathetic chain 25 Brachiocephalic artery orifice 40 Triceps – long head
2
1
Anterior
31
18 18
29 23
16 Right Left
20
16 19
42
12
17 Axial Posterior T4–5
44
47
46 computed
A A
tomogram
48 (CT) View
18 18
20
52
17
Axial
17 computed
tomogram
B B
(CT)
Axial section 5
➜ Notes Ellis, Logan, Dixon: Human Sectional Anatomy
Figure No. p111a
Artist E Evans
This section passes through the important anatomical and its contents, and the posterior mediastinum, are present in the lung parenchyma adjacent to a
Date 22 05 14
level of the manubriosternal joint, the angle of Louis behind the pericardium. fissure.
(1). At this joint articulate the second costal cartilage The trachea bifurcates at this level (20). In the Pretracheal nodes (28) may become enlarged
and rib (4), and it is from here that the ribs can be living upright subject, however, the bifurcation may due to a wide variety of disease processes. They are
conveniently counted in clinical practice. Posteriorly be as low as the level of T6, particularly in deep accessible for biopsy via mediastinoscopy.
this plane passes through the T4/5 intervertebral disc inspiration. Subscapularis (42) arises not only from the
(14). The cranial portions of the oblique fissures of periosteum of the medial two-thirds of the
This plane demarcates the junction between the lungs (17, 52) are traversed on this section. subscapular fossa of the scapula but also from
THORAX
the superior and the lower mediastinum, the The normal oblique fissures are not always seen on tendinous laminae in the muscle itself, which are
latter of which is subdivided into the anterior conventional CT images of the lung parenchyma. attached to prominent transverse ridges on the
mediastinum, in front of the pericardium, the The position canEllis,
beLogan,
inferred, however
Dixon: Human Sectional (see CT b) by
Anatomy subscapular fossa. This is shown clearly in this
middle mediastinum, occupied by the pericardium the paucity of blood vessels;
Figure No. only small
p111b terminal vessels section.
Artist E Evans
Date 22 05 14
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11
114
2
1
THORAX
55
3
3
54
26 31
34 32 29 4
53 33
16 30
52 25
49

51 48 21 23
27
50 28 16
47
24 20
46 44 22 5
45
43
42 19 18 17
12 15 6
41 39 13
40 11
14 7
38
37 10 9 8
36
35
1 Body of sternum 13 Intercostal artery and vein 29 Pulmonary vein tributary 44 Ulnar nerve
2 Internal thoracic artery and vein 14 Lower lobe of lung 30 Segmental bronchus 45 Radial nerve
3 Thymic residue within anterior 15 Oblique fissure 31 Left phrenic nerve with 46 Latissimus dorsi tendon
mediastinal fat 16 Upper lobe of lung pericardiacophrenic artery 47 Axillary artery and vein
4 Third rib 17 Descending aorta 32 Ascending aorta 48 Biceps and coracobrachialis
5 Fouth rib 18 Thoracic duct 33 Superior vena cava 49 Median nerve
6 Intercostal muscle 19 Azygos vein 34 Right phrenic nerve 50 Shaft of humerus
7 Fifth rib 20 Oesophagus 35 Trapezius 51 Deltoid
8 Sixth rib 21 Lymph node 36 Rhomboideus major 52 Serratus anterior
9 Transverse process of sixth thoracic 22 Left vagus nerve (X) 37 Infraspinatus 53 Lateral thoracic artery and vein
vertebra 23 Left main bronchus 38 Scapula 54 Pectoralis minor
10 Spinal cord within dural sheath 24 Right intermediate bronchus 39 Subscapularis 55 Pectoralis major
11 Part of intervertebral disc between 25 Right pulmonary artery 40 Teres major
fifth and sixth thoracic vertebrae 26 Pulmonary trunk 41 Triceps – long head 56 Superior pulmonary vein
12 Part of body of fifth thoracic 27 Left pulmonary artery 42 Triceps – lateral head 57 Left basal pulmonary artery
vertebra 28 Pulmonary artery branch 43 Subscapular artery and vein
2 ➜ Orientation ➜ Section level

1
Anterior
16 53
32
26
33 56
56 25 Right Left
27
24 23
20
57 52
19 17
38 Axial Posterior
10 T5–6
14 37 computed
A A
tomogram
35 (CT)
View
16 16
20
24 23
Axial
15 15
14 14 computed
tomogram
B B
(CT)
Axial section 6
➜ Notes Ellis, Logan, Dixon: Human Sectional Anatomy
Figure No. p113a
This section, traversing the upper body of the At the left hilum,
Artistthe superior pulmonary
E Evans vein (56) artery (28) that accompany the segmental and
sternum (1) and the lower part of the body of the lies anterior to theDate
bronchus (23),22which 05 14 in turn lies subsegmental bronchi (30) usually lie dorsolaterally
fifth thoracic vertebra (12), passes through the great anterior to the left basal pulmonary artery (57). On to these structures; each pulmonary segment
arterial trunks as these emerge from the heart, the the right side, the vein (56) lies anterior to the right receives an independent arterial supply. The bronchi
pulmonary trunk (26) and the ascending aorta (32). pulmonary artery, which lies anterior to the right usually separate the dorsolateral pulmonary artery
On the CT image, the left main bronchus has intermediate bronchus (24). branch from the ventromedially situated pulmonary
already given off its common upper lobe/lingular In the anatomical section, the right (25) and vein tributary (29). Peripherally, many pulmonary
branch. On the right, the upper lobe bronchus has left (27) pulmonary arteries lie in the same axial venous tributaries run between, and drain
THORAX
already originated more cranially (on both CT images plane. In most subjects, the left pulmonary artery adjacent, pulmonary segments. Thus, an individual
and section); hence, the term ‘intermediate bronchus’ is at a more cranial level than the right – hence the bronchopulmonary segment will have its own
(24) is applied to that portion of the right bronchus discrepancy between the Dixon:
Ellis, Logan, section
Humanand CTAnatomy
Sectional image bronchus and artery but not an individual pulmonary
between its upper lobe and middle lobe branches. appearances. The branches
Figure No. of the pulmonary
p113b venous drainage.
Artist E Evans
Date 22 05 14
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116
3 4
1 2
5
46
48
THORAX
42 6
47
27 45
43
41
44 7
36
49 34 37
61 51 38 26
60 50 35 8

54 52 39
55 33
53 26 31 32 40
9 11
59 30 28
56 57
29 10
25
58 25
24 12
17 16
23 13
15
22
21 18
20
19 14
1 Third costal cartilage with 15 Scapula 26 Upper lobe of lung 40 Left pulmonary artery 50 Coracobrachialis
adjacent sternocostal joint 16 Subscapularis 27 Middle lobe of right lung branch to lingula 51 Axillary artery and vein
(see Notes) 17 Fifth rib 28 Descending aorta 41 Superior vena cava 52 Medial cutaneous nerves
2 Body of sternum 18 Rhomboideus major 29 Azygos vein 42 Artefactual gap within the of arm and forearm
3 Internal thoracic artery 19 Trapezius 30 Thoracic duct pericardial space 53 Basilic vein
and vein 20 Erector spinae 31 Oesophagus 43 Ascending aorta, with 54 Median nerve
4 Partially calcified third 21 Sixth rib, with adjacent 32 Left vagal plexus orifice of left coronary 55 Ulnar nerve
costal cartilage costotransverse joint to 33 Right vagal plexus artery (arrowed) 56 Triceps – medial head
5 Pectoralis major transverse process of sixth 34 Right superior pulmonary 44 Left ventricle wall 57 Radial nerve with
6 Pectoralis minor thoracic vertebra vein 45 Coronary artery (left profunda brachii artery
7 Third rib 22 Spinal cord within dural 35 Left superior pulmonary anterior interventricular and vein
8 Intercostal muscle sheath vein branch) 58 Triceps – long head
9 Fourth rib 23 Thoracic sympathetic chain 36 Left atrium 46 Infundibulum of right 59 Triceps – lateral head
10 Serratus anterior 24 Body of sixth thoracic 37 Left auricle (atrial ventricle with pulmonary 60 Shaft of humerus
11 Subscapular artery vein vertebra, with part appendage) valves 61 Deltoid
and nerve of intervertebral disc 38 Left pulmonary vein 47 Fibrous pericardium
12 Teres major between the sixth and tributary to lingula 48 Right auricle (atrial 62 Oblique fissure
13 Latissimus dorsi seventh thoracic vertebrae 39 Left bronchus segmental appendage)
14 Infraspinatus 25 Lower lobe of lung branch to lingula 49 Biceps

2
Anterior
10 27 46
48 45
43
Right Left
36
31
28
29
25 25 Axial Posterior
13 computed
A
19
A
tomogram T6–7
(CT)
View
27 26
62
25
Axial
25
B computed
tomogram
B
Axial section 7
(CT)
Figure No. p115a
➜ Notes Artist E Evans

Date 28 10 14
The plane of this section traverses the lower part surfaces on both the chondral and the sternal is normally more circular in outline than in this
of the body of the sixth thoracic vertebra (24). components of the joint. In some or all of these subject. Note that this section passes through the
Anteriorly, it passes through the body of the joints, however, an arrangement may be found infundibulum of the right ventricle and demonstrates
sternum (2) at the level of the third costal cartilage similar to that of the first joint. the pulmonary valves (46).
(1). Note the adjacent sternocostal joint. These vary; The presence of a pericardial effusion in this On the CT image, both the ascending aorta (43)
THORAX
the first lacks a synovial cavity, its costal cartilage subject has produced an artefactual gap in the and the region of the pulmonary valves (46) have
being attached by fibrocartilage to the manubrium. superior reflection of the pericardial space (42). indistinct outlines due to pulsation (compliance) of
The second to seventh joints are usually synovial (as The aorta at its origin (43) shows the orifice of their walls during the 1-s data-acquisition time.
in this subject), with the fibrocartilaginous articular the left coronary artery. The descending aorta (28)
Figure No. p115b
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Artist E Evans
11
118
1 2 3
4
THORAX
41 39 5
37
38
40
35
42 34
36 32
31 33

46 29 28 6
30
27
47
57 22
52 49 48
26
21
56 51 43 19 25
50 20 7
53 44 24
55 45 23
17 8
18
54 18 9
11
16
15 14
13
12 10
1 Internal thoracic artery 16 Spinal cord within dural 29 Interatrial septum 39 Right coronary artery 50 Basilic vein
and vein sheath 30 Phrenic nerve with 40 Right auricle (atrial 51 Ulnar nerve
2 Body of sternum 17 Intervertebral disc pericardiacophrenic artery appendage) 52 Shaft of humerus
3 Fourth costal cartilage between seventh and and vein 41 Fibrous pericardium 53 Triceps – short head
4 Pectoralis major eighth thoracic vertebrae 31 Middle lobe of right lung 42 Nerve to serratus anterior 54 Triceps – long head
5 Fourth rib 18 Lower lobe of lung 32 Wall of left ventricle 43 Intercostal neurovascular 55 Triceps – lateral head
6 Fifth rib 19 Azygos vein 33 Mitral valve bundle 56 Radial nerve with
7 Sixth rib 20 Descending aorta 34 Vestibule of left ventricle 44 Innermost intercostal profunda brachii artery
8 Serratus anterior 21 Thoracic duct (outflow tract) leading to 45 External and internal and vein
9 Latissimus dorsi 22 Oesophagus root of aorta intercostal muscles 57 Deltoid
10 Scapula inferior angle 23 Pulmonary artery branch 35 Divided cusp of aortic 46 Biceps
11 Seventh rib 24 Branches of left lower lobe valve 47 Median nerve with 58 Coronary sinus
12 Trapezius bronchus 36 Right atrium musculocutaneous nerve
13 Erector spinae 25 Pulmonary vein tributaries 37 Anterior interventricular (lateral to it)
14 Eighth rib 26 Oblique fissure (descending) branch of left 48 Brachial artery with two
15 Lamina of seventh thoracic 27 Upper lobe of left lung coronary artery venae comitantes
vertebra 28 Left atrium 38 Right ventricle cavity 49 Coracobrachialis

37
Anterior
31 39
38 27
36 34
32
28 Right Left
8 22 58
20
19
Axial
18 18 computed Posterior
13 A
tomogram
9
(CT) T7–8
A
View
31
27
26 26
Axial
18 computed
18
tomogram
Axial section 8
B
B (CT)
Figure No. p117a
Artist E Evans
➜ Notes Date 22 05 14
This section lies at the level of the intervertebral disc oesophagus (22), separated by the pericardium. The mortem thrombus in the right atrium (36). The
between the seventh and eighth thoracic vertebrae left ventricle (32) forms the bulk of the left border of septum is normally straighter.
(17) and passes through the body of the sternum (2) the heart, and the right ventricle (38) constitutes the The lower four or five digitations of serratus
at the level of the fourth costal cartilage (3). All four major component of the anterior cardiac surface. anterior (8) converge to insert on the costal aspect
cardiac chambers can be seen and their relationships In this subject, the left ventricular wall (32) of the inferior angle of the scapula. This component
THORAX
to each other appreciated. Note that the right becomes thinner in the region of the apex of the left of the muscle, together with the trapezius,
atrium (36) forms the right border of the heart. The ventricle, due to a previous myocardial infarction. powerfully pulls the inferior angle of the scapula
left atrium (28) is the major contribution to the base The interatrial septum (29) has a rather curious forwards and upwards in raising the arm above the
of the heart and lies immediately anterior to the convexity. This has been caused by extensive post- head.
Figure No. p117b
Artist E Evans
Date 22 05 14
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11
120
2
1 4 5
3
THORAX
47 6
17
7
8 9 12
19
16 10
46 18
45

14 13 11 20
21
15 21
43 22
44
42
41 23
40 37
23 24
39 38
25
36
35 27
34 33
28 26
32
30
31 29
1 Fifth costal cartilage 14 Left atrium 27 Serratus anterior 40 Azygos vein

2 Sternocostal joint 15 Coronary sinus 28 Eighth rib 41 Thoracic duct
3 Internal thoracic artery and vein 16 Right atrium 29 Trapezius 42 Oesophageal vagal plexus
4 Body of sternum 17 Fibrous pericardium 30 Erector spinae 43 Oesophagus
5 Pectoralis major 18 Left phrenic nerve, with 31 Spine of eighth thoracic vertebra 44 Dome of right hemidiaphragm
6 Papillary muscle pericardiacophrenic artery and vein 32 Lamina of eighth thoracic vertebra 45 Apex of right lobe liver
7 Chordae tendinae within right 19 Fifth rib 33 Ninth rib 46 Right phrenic nerve, with
ventricular cavity 20 Upper lobe of left lung (lingula) 34 Right sympathetic chain pericardiacophrenic artery and vein
8 Triscupid valve 21 Oblique fissure 35 Spinal cord within dural sheath 47 Middle lobe of right lung
9 Interventricular septum 22 Sixth rib 36 Intervertebral disc between eighth
10 Left ventricular cavity 23 Lower lobe of lung and ninth thoracic vertebrae 48 Inferior vena cava
11 Normal left ventricular wall 24 Seventh rib 37 Aorta 49 Right ventricular cavity
12 Thinned left ventricular wall 25 Lateral thoracic artery and vein 38 Origin of eighth intercostal artery
13 Mitral valve 26 Latissimus dorsi 39 Hemiazygos vein

17
47 20 Anterior
49
16 10 Right Left
48
15
27 43
40 37
Axial Posterior
39
35 23 computed
23
tomogram
A A
26 30
(CT)
47 20
T8–9
21
21
23 View
Axial
Axial section 9
23 computed
tomogram
B B
(CT) Anatomy
Ellis, Logan, Dixon: Human Sectional
Figure No. p119a
Artist E Evans
➜ Notes Date 22 05 14
This section traverses the intervertebral disc between the Note how only a tiny portion of the left atrium (14) is
eighth and ninth thoracic vertebrae (36) and slices through present on this section. This demonstrates that the left
the dome of the right hemidiaphragm (44) and a sliver of the atrium is situated more cranially than the other three cardiac
underlying right lobe of the liver (45). chambers.
THORAX
In this section, there is considerable thinning and The terminal fibres of the right phrenic nerve (46) usually
discoloration of the left ventricular wall at the apex (12), pass through the vena caval opening in the diaphragm but
consistent with infarction associated with left anterior may traverse the muscle itself.
descending (interventricular) coronary arterial disease.

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Figure No. p119b

12
122
1
41 42 2
43
40
THORAX
3
39 11
10
7
5 4
12 8 6
13

9
32 44
33
38 34 30
14
29
15
31
28
37 27 25 17
26 16
23 24
16 18
36 22
20
35
21 19
1 Pectoralis major 13 Upper lobe of left lung (lingula) between ninth and tenth thoracic 35 Tenth rib
2 Internal thoracic artery and vein 14 Left dome of diaphragm vertebrae 36 Ninth rib
3 External oblique 15 Spleen 24 Left sympathetic chain 37 Eighth rib
4 Extrapericardial pad of fat 16 Lower lobe of lung 25 Hemiazygos vein 38 Seventh rib
5 Left ventricle 17 Serratus anterior 26 Azygos vein 39 Sixth rib
6 Interventricular septum 18 Latissimus dorsi 27 Thoracic duct 40 Middle lobe of right lung
7 Right ventricle 19 Trapezius 28 Aorta 41 Sixth costal cartilage
8 Tricuspid valve 20 Erector spinae 29 Oesophagus 42 Fifth costal cartilage
9 Coronary sinus 21 Tip of spine of eighth thoracic 30 Left vagus nerve (X) 43 Sternum
10 Diaphragm vertebra 31 Right vagus nerve (X) 44 Oblique fissure
11 Fibrous pericardium 22 Spinal cord within dural sheath 32 Inferior vena cava
12 Line of fusion of diaphragm and 23 Body of ninth thoracic vertebra, 33 Right hepatic vein 45 Right coronary artery
pericardium with part of intervertebral disc 34 Right lobe of liver

11
Anterior
13
45
7
5
44
32 Right Left
29
34
26 15
28
Axial Posterior
16 16
22 computed
20 tomogram
A A
(CT)
13
T9–10
16 Axial
Axial section 10
16
computed View
Ellis, Logan, Dixon: Human
tomogram
B B Sectional Anatomy
Figure No. p121a
(CT)
Artist E Evans
Date 28 10 14
➜ Notes
This section is at the level of the body of the ninth thoracic which passes through the right hepatic vein at its termination
vertebra (23) and traverses the dome of the left diaphragm (14). (33).
The cranial portion of the spleen (15) is, therefore, revealed. The aorta (28) at this level has become the immediate
THORAX
The fusion of the diaphragm (10) with the base of the posterior relation of the oesophagus (29), which, in this
fibrous pericardium (11) is shown clearly at this point. patient, is enlarged with a small hiatus hernia developing just
The massive size of the hepatic veins as they drain into the superior to the diaphragm (10).
inferior vena cava (32) is well demonstrated in this section,

Figure No. p121b
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Artist E Evans
12
124
THORAX
18 19 20
17
1 1
16 46
46
43
2
42
24
39
41
Axial section 1 – Female

15 40
3
38 44
37
21
45
36
14 33
35
22
34 29 30
28 25
13 32 27 26 23
31 5
11 10 4
23
9
8 7
12
6
1 Breast 14 Fifth rib 29 Oesophagus 41 Left ventricle

2 Pectoralis major 15 Fourth rib 30 Mediastinal lymph node 42 Right ventricle
3 Intercostal muscles 16 Third rib 31 Pulmonary arterial branch in lower 43 Right coronary artery
4 Latissimus dorsi 17 Third costal cartilage lobe 44 Left phrenic nerve
5 Serratus anterior 18 Third sternocostal joint 32 Bronchus – segmental branch in 45 Fibrous pericardium
6 Trapezius 19 Sternum lower lobe 46 Extrapericardial fat pad
7 Erector spinae 20 Internal thoracic artery and vein 33 Orifice of right inferior pulmonary
8 Spine of seventh thoracic vertebra 21 Upper lobe of left lung (lingula) vein 47 Ascending aorta
9 Spinal cord within dural sheath 22 Left oblique fissure 34 Right inferior pulmonary vein 48 Descending aorta
10 Part of intervertebral disc between 23 Lower lobe of lung 35 Coronary sinus 49 Pulmonary trunk
the seventh and eighth thoracic 24 Middle lobe of right lung 36 Left atrium 50 Right pulmonary artery
vertebrae 25 Aorta 37 Interatrial septum 51 Superior vena cava
11 Body of seventh thoracic vertebra 26 Azygos vein 38 Right atrium 52 Left basal pulmonary artery
12 Seventh rib 27 Right sympathetic chain 39 Tricuspid valve 53 Upper lobe of right lung
13 Sixth rib 28 Thoracic duct 40 Aortic valve 54 Carcinoma right breast
➜ Section level
54
53
49 21
47
51
50
52
29 T7–8
48
26
23 23
View
Axial computed tomogram (CT)
➜ Notes
Axial section 1
This section of a female subject passes through the body becomes atrophied. The inner wall of the left ventricle,
of the seventh thoracic vertebra (11) and through the immediately proximal to the aortic valve (40), is smooth-
third sternocostal joint (18). Note the general smaller walled and termed the aortic vestibule.
configuration of the female thorax and the smaller, less This CT image shows a patient with a large carcinoma ➜ Orientation
bulky muscles. of the right breast, which has ulcerated and extended into,
The breast (1) contains the mammary gland. This extends and infiltrated, a wide area of adjacent skin. The anatomical Anterior
vertically from the second to the sixth rib and transversely level is considerably more cranial than the cadaveric section;
from the side of the sternum to near the mid-axillary line. it corresponds closely to that shown in Axial section 6 of
The gland is situated within the superficial fascia and is the male thorax.
separated from the fascia covering pectoralis major, serratus Note that in this section, the margin of the mass of Right Left
anterior and the external oblique muscle by loose areolar left ventricular muscle (41) has been cut across; there is
THORAX
tissue. In old age, as in this subject, the glandular tissue infarction in the anterior free wall.
Posterior
08/01/201
12
THORAX Selected images – Heart – Axial CTs
R L
A B
Axial computed tomogram (CT) Axial computed

I
tomogram (CT)
9
15 19
8 2
18
7
6
4
1 1
12 13 8
5
11
2 4
3 10
14
9
16
15
A 17
B
Images A–B 7 Tricuspid valve 10 Left atrioventricular 15 Aorta

8 Right atrioventricular groove for circumflex 16 Oesophagus
1 Right atrium groove for right branch of left 17 Thoracic vertebra
2 Right ventricle coronary artery coronary artery 18 Right coronary artery
3 Left atrium 9 Interventricular 11 Mitral valve 19 Left coronary artery
4 Left ventricle groove for anterior 12 Anterior leaflet of
5 Interatrial septum branch of left mitral valve
6 Interventricular coronary artery 13 Papillary muscle
septum 14 Pulmonary vein
➜ Notes
Multidetector CT with rapid data acquisition has dimensional reconstruction so that all four chambers
opened up huge opportunities for imaging the heart can be seen on one oblique image. This is a standard
and great vessels. If the data for a whole revolution view used in many imaging investigations, including
of the CT gantry can be acquired in less than 400 ms, CT, ultrasound and MRI. It allows direct comparison of
then a considerable amount of information can the left and right sides of the heart. It elegantly shows
be obtained in the relatively quiescent period of the interventricular septum. The close relationship of
the cardiac cycle. If the patient’s heart rate is slow the oesophagus to the posterior aspect of the left
and regular, then a succession of images can be atrium explains the advantages of transoesophageal
obtained during one breath-hold at the same phase echocardiography.
of the cardiac cycle; these can be combined and a The coloured three-dimensional surface rendered
three-dimensional dataset created. This can provide view of the ventricles and coronary arteries provides a
exceptional anatomical (and, increasingly, functional) good general overview but, in practice, the coronary
information. arteries (B) are better displayed and analysed using
126 The four-chamber view (A) is a multiplanar two- more selective analysis tools.
Selected images – Heart – Axial CTs THORAX
20 6 10
7 11
1
8
2
3
9
4 16
13
5 15
12 18
17
14
Image C
1 First rib (right)
C
2 Second rib
Axial computed tomogram (CT) 3 Third rib
4 Fourth rib
5 Fifth rib
6 Clavicle
7 Sternoclaviclar joint
8 Sternum – manubrium
9 Sternum – body
10 Hyoid bone
11 Left subclavian vein
➜ Orientation ➜ Orientation 12 Right atrium
13 Right atrial appendage
Anterior Anterior
14 Right ventricle
15 Right ventricular outflow tract
16 Pulmonary trunk
Right Left Right Left 17 Left ventricle
18 Left anterior descending – branch of left
coronary artery
19 Right coronary artery
A Posterior B C Posterior 20 Right subclavian artery
➜ Notes
This edited 3D view of the chest (C) has been by the contrast medium and are well shown. It is
presented as a collage whereby the skin and just possible to see the right subclavian artery (20)
subcutaneous tissues have been ‘peeled away’ to between the right first rib (1) and the right clavicle
expose the internal structures of the chest. By using (6). The coronary vessels are well shown with the
different window widths and colouring, it has been left anterior descending artery (LAD, 18) seen in the
possible to demonstrate some lung detail in areas, interventricular groove and the right coronary artery
which have not been obscured by overlying structures. (19) seen in the right atrioventricular groove. Note the
These images were obtained during a long bolus way that the 2nd rib (2) leads to the sterno-manubrial
injection of dilute iodinated contrast medium via the angle (of Louis). Of course the chondral part of the
left arm. Hence the left subclavian vein (11) is well rib, which articulates with the sternomanubrial joint,
demonstrated but not the right. The heart, great is not sufficiently calcified to be seen at these settings.
vessels and coronary arteries are rendered opaque
127
128
THORAX
7 10 8
10
9
4 9 11 21 11
2 3
20 5
6 13
1 17
20
16 15
18
1
Selected images – Mediastinum – Axial CTs

19 22 16
A A 18
14
Axial computed tomogram (CT) D
9
4
2 3
20
1 12
16
19
B B
D
7
9 21
4
2
20
12
1
16
19
C C
Images A–D 12 Aortic arch (with fleck of ➜ Orientation ➜ Section level

calcification in wall in image C)
1 Trachea 13 Ascending aorta
2 Right brachiocephalic vein Anterior
14 Descending aorta
3 Brachiocephalic artery 15 Left pulmonary artery
4 Left brachiocephalic vein 16 Oesophagus
5 Left common carotid artery 17 Superior vena cava
Right Left
6 Left subclavian artery 18 Azygos vein
7 Manubrium of sternum 19 Right superior intercostal vein
8 Body of sternum 20 Fat in pretracheal space
9 Internal thoracic artery and vein 21 Fat in anterior mediastinal space
Posterior
10 Pectoralis major (with thymic remnant)
Selected images – Mediastinum – Axial CTs

11 Pectoralis minor 22 Azygos-oesophageal recess
A
B
C
D
View
➜ Notes
This patient has copious mediastinal fat, which the structure (partial volume effect). The space the cardinal veins, is of immense importance when
makes the normal structures very conspicuous. immediately caudal to the aortic arch and cranial to the vena cava becomes blocked for any reason
Enlarged lymph nodes would show up well in such the bifurcation of the pulmonary artery is known (usually by a tumour). For example, in superior
a patient (see Axial section 6). If such nodes lie in as the subaortic fossa or aortopulmonary window. vena cava obstruction caused by mediastinal
the pretracheal space (20), then biopsy material can The ligamentum arteriosum (the obliterated ductus nodal enlargement secondary to carcinoma of the
be obtained via mediastinoscopy. arteriosus passing from the left pulmonary artery to bronchus, the venous return from the head, neck
The trachea (1) is bifurcating on image D; this the aorta) runs through this space. This fossa may and arms will go via collateral veins around the
point is known as the carina. The left pulmonary also contain enlarged lymph nodes. scapula and retrogradely in the intercostal veins into
THORAX
artery (15) lies at a more cranial level than the The azygos vein (18) can be seen approaching the azygos and thence back to the heart, bypassing
right; it is just entering part of the section shown the posterior aspect of the superior vena cava (17) the obstruction in the superior mediastinum.
on image D. It appears indistinct because only on image D. This venous system, which developed
part of the thickness of the slice is occupied by at an early stage of embryological development of
08/01/201
12
130
THORAX
1 1
1 2 2
5 5 3
4
6 6
Selected images – Coronal MRIs

12 10
7 12 13 15 9
8
19
8 11 7 12
14 16 17 16
20 16
18 19 18 25 21 22
47 18
26 27 29 27 23/24 40
40 40 29 31 39
32 28 36
33 30
33 39 34
39 41 35 41 35
41 34
44
45 45 46 43
A 42 46 B 38 C 45
38 37 37
A B C
Coronal magnetic resonance image (MRI) Coronal magnetic resonance image (MRI) Coronal magnetic resonance image (MRI)
1 Falx cerebri 25 Brachiocephalic vein ➜ Orientation ➜ Section level

2 Lateral ventricle 26 Carina (bifurcation of trachea into
3 Third ventricle two main bronchi) Superior
4 Lateral sulcus (Sylvian fissure) 27 Aortic arch A B C
5 Tentorium cerebelli 28 Superior vena cava View
6 Cerebellum 29 Left pulmonary artery
7 Sternocleidomastoid 30 Right pulmonary artery
Right Left
8 Spinal cord 31 Main pulmonary artery
9 Second cervical vertebra (axis) 32 Left superior pulmonary vein
10 Parotid gland 33 Left atrium
11 Scalene muscles 34 Right atrium
12 Clavicle 35 Left ventricle Inferior
13 Acromioclavicular joint 36 Ascending aorta
14 Glenoid fossa of scapula 37 Descending aorta
15 Acromion process of scapula 38 Inferior vena cava
16 Humeral head 39 Left lung
17 Coracoid process of scapula 40 Right lung
Selected images – Coronal MRIs

18 Deltoid 41 Liver
19 Trachea 42 Right hepatic vein
20 Thyroid gland 43 Middle hepatic vein
21 Internal jugular vein 44 Left hepatic vein
22 Subclavian vein 45 Stomach
23 Axillary vessels 46 Spleen
24 Brachial plexus and resulting 47 Vertebral artery
nerves
➜ Notes
These three T1-weighted coronal magnetic depend much on the degree of thoracic spine cancer, the axilla may be affected both by nodal
resonance images are included to show the overall kyphosis, body habitus and degree of inspiration. metastases and by the effects of radiotherapy. These
relations of the head, neck, thorax and upper The relations in this relatively obese subject are fairly can cause either neurological symptoms in the arm
THORAX
abdomen. Only rarely would such a large field of representative. or lymphoedema. Coronal images of the two axillae
view be used in clinical practice, as the anatomical A wide field of view is used when trying to together can be very helpful in this differentiation,
spatial resolution is inevitably compromised. Of compare structures on the two sides. The brachial which can be difficult on clinical grounds.
course, the exact relations on the coronal plane plexus (image B, 24) is a case in point. In breast
08/01/201
13
THORAX Selected images – Chest CT
A B
Coronal computed tomogram (CT) Coronal computed tomogram (CT)
20
17
17
3 2
6 2 5 18
4 5
19
A B
C D
Sagittal computed tomogram (CT) Sagittal computed tomogram (CT)

Left Lung Right Lung
11
11
15
16
15
13
12
12 13
15
15
132 C D
Selected images – Chest CT THORAX
➜ Orientation ➜ Orientation
Superior Superior
Right Left Anterior Posterior
A B E Inferior C D Inferior
E
1 Trachea 12 Lingula (on the left)
Reconstructed 3D computed 2 Right main bronchus 13 Lower lobe
tomogram (CT) 3 Right upper lobe bronchus 14 Middle lobe (on the right)
4 Bronchus intermedius 15 Oblique fissure
5 Left main bronchus 16 Horizontal fissure (on the
1
6 Left upper lobe/lingular right)
bronchus 17 Aortic knuckle
7 Left lower lobe bronchus 18 Left pulmonary artery
20
8 Left upper lobe bronchus 19 Oesophagus (containing
9 Left upper lobe lingular some swallowed air)
2
3 5
6
8
bronchus 20 Carina – the bifurcation of
9
4 10 Right lower lobe bronchus the trachea
7
11 Upper lobe
10
➜ Notes
A spiral CT dataset of the chest at full inspiration has lowest image is a three-dimensional reconstruction
been obtained on a multidetector CT system. Next, just extracting out the airways and accentuating the
the individual thin slices have been loaded together interface between air and soft tissue – this provides
to form a three-dimensional volume with each voxel a graphic map of the anatomy of the trachea and
isometric so that the x, y and z resolutions of the main bronchi. These images elegantly show the more
resulting pixels are identical. This three-dimensional vertical nature of the right main bronchus (2) – hence
dataset can be analysed in a variety of ways. the peanut and the endotracheal tube tend to enter
The first two images show coronal multiplanar the right side preferentially. They also show the
reconstructions viewed at lung settings to show the greater length of the left main bronchus (5); on the
anatomy of the airways in this plane. The middle right, the takeoff for the upper lobe bronchus can be
images shows sagittal reconstructions to demonstrate very close to the carina (20, the point of bifurcation of
the lobes and fissures of the left and right lungs. The the trachea into two main bronchi).
133
THORAX Selected images – Arterial system
134
Selected images – Arterial system THORAX
1 9
3
11 12
10
3
8 13
8
14
15 14
4 5
6
4 4
7 B
A
1 Heart 9 Twelfth thoracic vertebra ➜ Orientation

2 Ascending aorta 10 First lumbar vertebra
3 Abdominal aorta 11 Coeliac artery Superior
4 Common iliac artery 12 Splenic artery
5 External iliac artery 13 Hepatic artery
6 Common femoral artery 14 Superior mesenteric artery
7 Superficial femoral artery and arcade
Right Left
8 Kidney and pelvicalyceal 15 Cholecystectomy clips
system
Inferior
➜ Notes
These two surface rendered 3D angiograms have On the right image the patient has had a previous
been obtained on a modern CT system following the laproscopic cholecystectomy and the clips (15)
injection of standard iodinated contrast medium. The can readily be identified as very dense structures
CT data were acquired during the aortic phase of overlying the right kidney and close to the hepatic
the passage of contrast medium through the body artery (13). Note the way the aorta changes in calibre
and the images subsequently manipulated on the at the L1 level; it is smaller inferior to the coeliac
workstation. artery, superior mensenteric artery and the two renal
On the left image the global view allows the arteries. The superior mensenteric arcade is beautifully
relationship of the heart, aorta, iliac and femoral demonstrated (14). The tortuosity of the iliac vessels
vessels to be appreciated in relation to the skeletal is normal in middle age and above. The renal and
structures. A test dose of contrast medium has been splenic parenchyma are only faintly seen in this early
given sometime before and this accounts for the phase.
dense iodine being excreted from the kidneys and
pelvicalyceal system (8).
135
05-HSA-Section 5-Abdomen-cpp.indd 136
136
Abdomen
1 3 6
2 4
7
8 10
9
7
38

39
35
37
36 12
34 11
35
7
33 27
26
32 13
25 15
24 22 23
31 21
20
16
7 20 14
19
29 18
30 28
17
1 Sixth costal cartilage 9 Left ventricle 18 Erector spinae 25 Thoracic duct 34 Inferior vena cava
2 Superior epigastric artery 10 Extrapericardial fat 19 Spinal cord within dural 26 Aorta 35 Hepatic vein
and vein 11 Fundus of stomach sheath 27 Right crus of diaphragm 36 Caudate lobe of liver
3 Seventh costal cartilage 12 Oesophagogastric junction 20 Sympathetic chain 28 Tenth rib 37 Fissure for ligamentum
4 Xiphoid 13 Spleen 21 Body of tenth thoracic 29 Lower lobe of right lung venosum – lesser omentum
5 Rectus abdominis 14 Lower lobe of left lung vertebra 30 Ninth rib 38 Left lobe of liver
6 External oblique 15 Serratus anterior 22 Origin of intercostal artery 31 Eighth rib 39 Sixth rib
7 Diaphragm 16 Latissmus dorsi 23 Hemiazygos vein 32 Right lobe of liver
8 Right ventricle 17 Trapezius 24 Azygos vein 33 Seventh rib
➜ Section level
38
37 7
12 11
34
26
32 13
18
T10

View
➜ Notes
This section passes through the body of the tenth thoracic reaches the diaphragm, where its two layers separate to
vertebra (21) and anteriorly transects the xiphoid (4). surround the lower end of the oesophagus.
Axial section 1
The oesophagogastric junction (12) is seen in longitudinal The ligamentum venosum is the thrombosed cord of the
section. This acts as a physiological sphincter in the ductus venosus, which, in fetal life, connects the left portal
prevention of reflux. The fundus of the stomach (11) vein to the anterior aspect of the inferior vena cava.
contains air in the erect position but in the supine position The spleen (13) lies against the diaphragm (7) opposite ➜ Orientation
is normally full of fluid. ribs 9 (30), 10 and 11. This section demonstrates clearly
The lesser omentum is the fold of peritoneum that how a stab wound of the left lower chest posteriorly might Anterior
extends to the liver from the lesser curvature of the traverse the pleural cavity, injure the lower lobe of the
stomach and the commencement of the duodenum. lung (14), traverse the diaphragm and lacerate the spleen.
Superiorly it attaches to the porta hepatis and to the Similarly, a stab wound of the right chest at this level might
bottom of the fissure for the ligamentum venosum (37). injure the liver (32).
Right Left
At the cranial margin of this fissure, the lesser omentum
Abdomen
Figure No. p135
Artist E Evans
Date 28 10 14 Posterior
08/01/201
13
138
Abdomen
3
1 2
4
6
5 7
39 40
38
8
37
9
36

35 10
32
34
33 11
31
23
24
30 12
20 22
18 13
25 19
5
21 14
5
26 17 16
29 27
15
28
1 Seventh costal cartilage 10 Left gastric artery 18 Body of eleventh thoracic 27 Lower lobe of right lung 36 Hepatic vein
2 Xiphoid branches vertebra 28 Tenth rib 37 Left lobe of liver medial
3 Rectus abdominis 11 Splenic pedicle 19 Intercostal artery 29 Ninth rib segment
4 Superior epigastric artery 12 Spleen 20 Thoracic duct 30 Eighth rib 38 Left lobe of liver lateral
and vein 13 External oblique 21 Intercostal vein 31 Right lobe of liver segment
5 Diaphragm 14 Latissimus dorsi 22 Left suprarenal gland 32 Seventh rib 39 Sixth costal cartilage and rib
6 Pericardial fat 15 Erector spinae 23 Aorta 33 Inferior vena cava 40 Falciform ligament
7 External oblique 16 Lower lobe of left lung 24 Right crus of diaphragm 34 Caudate lobe of liver
8 Greater omentum 17 Spinal cord within dural 25 Right suprarenal gland 35 Lesser omentum in fissure
9 Body of stomach sheath 26 Head of eleventh rib for ligamentum venosum
9 Anterior
37
38
34
33 Right Left
31 23
24
12
15 Posterior
➜ Notes
This section passes through the body of the eleventh the CT images that the separate limbs of the suprarenal
thoracic vertebra (18) and the xiphoid (2). glands are demarcated.
This is the most caudal section that transects intrathoracic The right crus of the diaphragm (24) on the CT image
viscera – note the pericardial fat (6) anteriorly and the lower is often bulky. The crura change shape during respiration;
lobe of the left lung (16). normally they are bulkier on inspiration. T11
The suprarenal glands (22, 25) have a constant
Axial section 2
relationship to the diaphragmatic crura (24, 45). Note on

Figure No. p137 View
Artist E Evans
Date 22 05 14
Abdomen
08/01/201
13
140
Abdomen
1
3 2
42
4
43 4
5
44
41

34 33 32
27
31 28 26
6
40 30 9
36 35 25
29
20 21 24
18 23 7
22
19
39 15 16
17
8
10
8 14
11
38 13
37
12
1 Linea alba 11 Serratus posterior inferior 18 Thoracic duct 29 Inferior vena cava 40 Ninth rib
2 Rectus abdominis 12 Erector spinae 19 Left crus of diaphragm 30 Caudate lobe of liver 41 Eighth rib
3 Superior epigastric artery 13 Spine of eleventh thoracic 20 Right crus of diaphragm 31 Portal vein 42 Seventh costal cartilage
and vein vertebra 21 Aorta 32 Hepatic artery 43 Left lobe of liver (lateral
4 Greater omentum 14 Conus medullaris 22 Right suprarenal gland 33 Common bile duct segment)
5 Body of stomach surrounded by cauda 23 Left suprarenal gland 34 Radicle of portal vein 44 Left lobe of liver (medial
6 Left colic (splenic) flexure equina within dural sheath 24 Tail of pancreas 35 Hepatic artery branch segment)
7 Spleen 15 Body of twelfth thoracic 25 Splenic vein 36 Right lobe of liver
8 Diaphragm vertebra 26 Splenic artery 37 Twelfth rib 45 Jejunum
9 External oblique 16 Left kidney 27 Body of pancreas 38 Eleventh rib
10 Latissimus dorsi 17 Right kidney 28 Left gastric artery and vein 39 Tenth rib
➜ Section level
44
5
43
45 6
31
36 27
29
22
18 23 7
19 16
17
12
Axial computed tomogram (CT) T12
View
➜ Notes
This section passes through the body of the twelfth thoracic teres and ligamentum venosum on its visceral surface. This is
vertebra (15). It demonstrates well the relationships of the simply a gross anatomical descriptive term, with no morphologi-
Axial section 3
structures at the porta hepatis – the common bile duct (33) cal significance. Two subsidiary additional lobes are marked out
anterior and to the right, the hepatic artery (32) anterior and to on the visceral aspect of the liver – the quadrate lobe anteriorly,
the left, and the portal vein (31) posterior to these structures. between the gall bladder fossa and the fissure for the ligamen-
The inferior vena cava (29) lies immediately behind the portal tum teres, and the caudate lobe posteriorly, between the groove
vein; between the two is the epiploic foramen, or the aditus to for the inferior vena cava and the fissure for the ligamentum ➜ Orientation
the lesser sac (the foramen of Winslow). The division between venosum. The transverse fissure for the porta hepatis separates
the cortex (peripheral) and medulla (central) of the kidneys (16, the quadrate and caudate lobes. The distribution of the right Anterior
17) is shown well; in the plane of this division run the small and left branches of the hepatic artery and of the hepatic duct
arcuate vessels, which can just be identified in this section. shows that the morphological division of the liver is into a right
Post-mortem changes account for the discrepancy in the and left lobe demarcated by a plane that passes through the
differentiation between cortex and medulla in the left kidney. fossa of the gall bladder and the fossa of the inferior vena cava Right Left
Abdomen
(the median plane of the liver). Morphologically, the quadrate
Note on the lobes of the liver Ellis, Logan, Dixon: Human
lobe and Sectional Anatomy
the left half of the caudate lobe are part of the mor-
The gross anatomical division of the liver is into right and left phological
p139 left lobe of the liver. Further subdivision into hepatic
Figure No.
lobes, demarcated by the attachment of the falciform ligament segements is made by the Couinaud system (segments I–VIII).
Artist
on the anterior surface and by the fissures for the ligamentum E Evans Posterior
Date 28 10 14
08/01/201
14
142
1
2
44
3
Abdomen
41
43 40 4 5
45
6
39 29 7
42 28
38 26

25 7
27 24
23
37
30 8
36 22
32 21 20 19
31 9
15
18 17
33 13 14
35 16 10
12 11
34
1 Linea alba 14 Left kidney 19 Left crus of diaphragm 31 Right renal artery 42 Ninth rib
2 Rectus abdominis 15 Left renal vein (intrarenal 20 Thoracic duct 32 Right renal vein 43 Eighth costal cartilage
3 Transversus abdominis portion); see also 23 21 Right crus of diaphragm 33 Right kidney 44 Ninth costal cartilage
4 Stomach, body/antrum 16 Conus medullaris 22 Aorta 34 Twelfth rib 45 Left lobe of liver (medial
5 Transverse colon surrounded by cauda 23 Left renal vein 35 Eleventh rib segment)
6 External oblique equina within dural sheath 24 Superior mesenteric artery 36 Tenth rib
7 Jejunum 17 Part of intervertebral 25 Splenic vein 37 Right lobe of liver 46 Right colic (hepatic) flexure
8 Lower pole of spleen disc between the twelfth 26 Portal vein 38 Gall bladder 47 Superior mesenteric vein
9 Descending colon thoracic and first lumbar (commencement) 39 First part of duodenum
10 Latissimus dorsi vertebrae, with part of 27 Common bile duct (cap)
11 Serratus posterior inferior body of twelfth thoracic 28 Head of pancreas 40 Left lobe of liver (lateral
12 Erector spinae vertebra 29 Neck of pancreas segment)
13 Quadratus lumborum 18 Psoas major 30 Inferior vena cava 41 Falciform ligament
➜ Section level
45
38 5
46
28
47 7
37 24
30 23
8
32 21
22
19
33 14
16
12
Axial computed tomogram (CT) T12–L1
View
➜ Notes
This section transects the intervertebral disc between the superior to the vein. These features are demonstrated
twelfth thoracic and the first lumbar vertebrae (17). The well on the CT image in Axial section 5. In exposure of
Axial section 4
spinal cord tapers into the conus medullaris (16), which the abdominal aorta (22), the surgeon can divide the left
terminates, in this subject, at the level of the body of the renal vein (23) in order to obtain additional access. The left
first lumbar vertebra. The site of termination is variable, the kidney is not infarcted if this is done because the left renal
range being from the disc between the twelfth thoracic and vein receives the terminations of the left gonadal and left ➜ Orientation
first lumbar vertebrae to the lower border of the second suprarenal veins, so that venous drainage of the left kidney
lumbar vertebra. can take place via collaterals from these vessels. Anterior
The plane of this section passes through the left renal Note the circular folds of mucous membrane that project
vein (23) and demonstrates well the close relationship into the lumen of the small intestine transversely to its long
of this vein to the superior mesenteric artery (24), which axis (7). These are termed the plicae circulares. Radiologists
passes forward from its aortic origin (22) immediately and clinicians refer to these as valvulae conniventes. Right Left
Abdomen
Figure No. p141
Artist E Evans
Posterior
Date 28 10 14
08/01/201
14
144
1
2
Abdomen
42 3
40 43 6
41 7
4
4 5
7
39 28

29 27 4 8
9
38 7
30 7
37 31
24
22 26
25 23
21 10
20
19 16
17
32
36 15
33
35 14
18 11
12
34 13
1 Linea alba 13 Erector spinae 20 Right sympathetic chain 32 Commencement of right 42 Falciform ligament
2 Rectus abdominis 14 Quadratus lumborum 21 Right crus of diaphragm ureter 43 Left lobe of liver (lateral
3 Transversus abdominis 15 Left kidney 22 Aorta 33 Right kidney segment)
4 Greater omentum 16 Left ureter 23 Para-aortic lymph node 34 Twelfth rib
5 Antrum of stomach 17 Psoas major 24 Cisterna chyli 35 Renal fascia 44 Left renal vein
6 Transverse colon 18 Cauda equina within dural 25 Inferior vena cava 36 Eleventh rib 45 Renal cyst
7 Jejunum sheath 26 Inferior mesenteric vein 37 Right lobe of liver 46 Uncinate process pancreas
8 Internal oblique 19 Body of first lumbar 27 Superior mesenteric artery 38 Tenth rib
9 External oblique vertebra, with portion of 28 Superior mesenteric vein 39 Gall bladder
10 Descending colon intervertebral disc between 29 Head of pancreas 40 Left lobe of liver (medial
11 Latissimus dorsi the first and second lumbar 30 Common bile duct segment)
12 Serratus posterior inferior vertebrae 31 Duodenum 41 Ninth costal cartilage

2 6
6 Anterior
6 6 29 28
27
28 26 7
29 46 27 7 31 10
37 31 25 22 25 44 22
10 37 Right Left
44 21 21
33 45 15
15
13
13
A B Posterior
A B
Axial computed tomogram (CT) Axial magnetic resonance image (MRI)
Axial section 5
L1–2
➜ Notes
This section passes through the body of the first lumbar anterior to the kidney and its vessels and merges with the
vertebra (19), with a small portion of the intervertebral disc connective tissue anterior to the aorta and inferior vena View
between the first and second lumbar vertebrae. cava. The posterior layer extends medially in front of the
The kidneys (15, 33) are embedded in a mass of fatty fascia covering quadratus lumborum (14) and psoas major
connective tissue termed the perirenal (perinephric) fat, (17) and to the vertebrae and intervertebral discs. The
which is thickest at their medial and lateral borders. The perirenal fat and renal fascia (35) are surrounded by further
Abdomen
fibro-areolar tissue surrounding the kidney and perirenal fat retroperitoneal (pararenal) fatty connective tissue. The
condenses to form a sheath termed the renal fascia (35). amount varies with the relative obesity of the subject.
At the lateral border of the kidney, the two layers of the In this section, a tiny portion of the lateral segment of
renal fascia are fused. The anterior layer is carried medially the left lobe of the liver can be seen (43).
08/01/201
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146
1
2
Abdomen
41 3
4
5
5 3 6
39 7
5
40 38 37

5
8
35
32 36
5 5
34 5
24 22
33 25 21 19
31 23 9
29 20
28 15 18
27 26 17
16
11
14 13
30 10
12
1 Linea alba 13 Quadratus lumborum (arrowed) 32 Right lobe of liver 40 Gall bladder
2 Rectus abdominis 14 Cauda equina within dural 21 Left testicular vein 33 Right colic (hepatic) flexure 41 Falciform ligament
3 Greater omentum sheath 22 Para-aortic lymph node 34 Duodenum – second part
4 Transverse colon 15 Body of second lumbar 23 Left lumbar vein (with ampulla marked with 42 Ascending colon
5 Jejunum vertebra 24 Aorta a white bristle) 43 Right crus of diaphragm
6 External oblique 16 Psoas major 25 Inferior vena cava 35 Head of pancreas 44 Left renal vein
7 Internal oblique 17 Left kidney 26 Right lumbar vein 36 Uncinate process of 45 Left renal artery
8 Transversus abdominis 18 Left ureter 27 Right ureter pancreas
9 Descending colon 19 Left colic artery – ascending 28 Right kidney 37 Superior mesenteric artery
10 Latissimus dorsi branch 29 Right testicular vein 38 Superior mesenteric vein
11 Renal fascia 20 Inferior mesenteric vein, 30 Twelfth rib 39 Mesentery with mesenteric
12 Erector spinae with origin of left colic vein 31 Eleventh rib vessels

4
Anterior
33 4 38
4 37
38
37 35 44 5
35 36 20
5 34
25
44
34 25 24 9
32 24 Right Left
43 9 32 45
42
28 43
17
16 17
28
10
12
12
Posterior
A B
A B
Axial section 6
➜ Notes L2
This section passes through the body of the second lumbar This section passes through the second part of the
vertebra (15). The plane of section passes through a prominent duodenum (34). The orifice of the ampulla of Vater on its
left lumbar vein (23) as it passes posterior to the aorta (24) papilla is marked with a white bristle. View
to drain into the inferior vena cava (25). Occasionally, it may On both the section and the CT image, the uncinate
constitute the principal venous return from the left kidney, process of the pancreas (36) is seen clearly. This lies
Abdomen
when it is termed a retro-aortic renal vein. posterior to the superior mesenteric artery (37) and vein
The right testicular vein (29) drains directly into the (38) and is related closely to the entry point of the left renal
inferior vena cava, whereas the left testicular vein (21) vein (44) into the inferior vena cava (25).
(together with the left suprarenal vein) drains into the left
renal vein.
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148
Abdomen
1 2
3
3 4
5 6
4
5 7
5

27 28
32 31 8
3 5
31 26 3
5
17
24 21 20 5
31 25 18
9
19
23 22 16
30 15
29 14
12
13
10
11
1 Linea alba 10 Latissimus dorsi the second and third 23 Right ureter 30 Right kidney lower pole
2 Rectus abdominis 11 Erector spinae lumbar vertebrae 24 Inferior vena cava 31 Ascending colon and right
3 Greater omentum 12 Quadratus lumborum 17 Aorta 25 Right testicular vein colic (hepatic) flexure
4 Transverse colon 13 Cauda equina within dural 18 Para-aortic lymph node 26 Duodenum, third part 32 Right lobe liver
5 Jejunum sheath 19 Left ureter 27 Superior mesenteric artery
6 External oblique 14 Root of second lumbar 20 Inferior mesenteric vein and vein 33 Ascending colon
7 Internal oblique nerve 21 Left testicular artery and 28 Mesentery with mesenteric 34 Left kidney
8 Transversus abdominis 15 Psoas major vein vessels 35 Ileum
9 Descending colon 16 Intervertebral disc between 22 Right sympathetic chain 29 Renal fascia

2 2
8 4 8 Anterior
6 5
27 5 27
7 35
35 33 28
26
33 26 17
26 5
24 17 5 24
20 5
30 9 Right Left
9 15 34
30 15 19
19 34
12
12
11
11 10 10
A B Posterior
L2–3
A B View
Axial section 7
➜ Notes
This section passes through the intervertebral disc this produces obstruction of the third part of the the internal oblique; the posterior sheath is made
between the second and third lumbar vertebrae duodenum (duodenal ileus). up of the aponeurosis of the transversus abdominis
(16). It transects the most caudal part of the right Seen clearly in this section are the three layers reinforced by the posterior portion of the internal
lobe of the liver (32). The caudal extent of this lobe of muscles that constitute the lateral part of the oblique. Below a line roughly halfway between
is variable and may project downwards in some anterior abdominal wall – the external oblique (6), the umbilicus and the pubis, the posterior sheath
Abdomen
subjects for a considerable distance as a broad internal oblique (7) and transversus abdominis (8). is deficient and all three aponeuroses pass in front
tongue-like process (Riedel’s lobe). Medially, their aponeuroses form the sheath that of the rectus to form the anterior sheath. These
Note the third part of the duodenum (26) lying surrounds the rectus abdominis (2). The anterior muscles are demonstrated well on the CT image in
in the inverted V between the aorta (17) and the sheath comprises the aponeurosis of the external Axial section 8.
superior mesenteric vessels (27). Occasionally, oblique together with the split anterior portion of
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150
Abdomen
2
1
3
31 31
4 3
31 4

31
30 5
5
3 4 25 3 8
24 5 7
18 23
27 5
29 22 6
28 26 17 21
19 20 9
15
16
14
13
10
12
11
1 Linea alba 10 Quadratus lumborum 17 Body of third lumbar vertebra 25 Duodenum, third part
2 Rectus abdominis 11 Erector spinae 18 Aorta 26 Right sympathetic chain
3 Greater omentum 12 Cauda equina within dural sheath 19 Left sympathetic chain 27 Inferior vena cava
4 Ileum 13 Dorsal root ganglion of third 20 Left ureter 28 Right ureter
5 Jejunum lumbar nerve 21 Left testicular artery and vein 29 Ascending colon
6 Transversus abdominis 14 Ventral ramus of second lumbar 22 Left colic artery and inferior 30 Mesentery with mesenteric vessels
7 Internal oblique nerve mesenteric vein 31 Transverse colon
8 External oblique 15 Psoas major 23 Para-aortic lymph node
9 Descending colon 16 Third lumbar artery 24 Inferior mesenteric artery
➜ Section level
1
2
4
5
5
29 4
25
27 18 24
7 6 5
8 15
9
12
10
11
L3
➜ Notes
View
This section passes through the body of the third lumbar The linea alba (1) is wide above the umbilicus and
vertebra (17). This is just distal to the origin of the inferior becomes quite narrow below this level (see page 164).
Axial section 8
mesenteric artery (24) from the anterior aspect of the aorta This line marks the almost avascular blending of the rectus
(18) posterior to the third part of the duodenum (25). This sheaths on either side and gives the surgeon rapid access
section is now caudal to the liver and the kidneys. to the abdominal cavity. The incision can, if necessary, be
The ventral ramus of the second lumbar nerve (14) is extended from the xiphoid to the pubic symphysis. The
seen in this section as it passes downwards and laterally falciform ligament (see page 154) lies to the right-hand side
➜ Orientation
into the psoas major (15). The first three lumbar nerves of the incision. Anterior
and the greater part of the fourth lumbar nerve form the Note the marked disparity between the patulous
lumbar plexus within the posterior part of the psoas major ascending colon (29) and the thick-walled, narrow
in front of the transverse processes of the lumbar vertebra. descending colon (9).
Right Left
Abdomen
Posterior
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15
152
Abdomen
1
37 3

36 21
35 28
31
30 28 22
29
33 17
32 23
34 16 26 27
13
4
14
15 11 12
18 10
24
9 25
19 20
7 8 5
6
1 Linea alba 8 Dorsal root ganglion of first 14 Left renal artery 24 Perirenal fat within renal 32 Lymph node in porta
2 Eighth costal cartilage lumbar nerve 15 Right renal artery fascia hepatis
3 Ninth rib/costal cartilage 9 Part of body of first lumbar 16 Inferior vena cava 25 Spleen 33 Hepatic artery
junction vertebra 17 Left renal vein 26 Left suprarenal gland 34 Right lobe of liver
4 Tenth rib 10 Part of intervertebral disc 18 Right renal vein 27 Splenic vein 35 Common bile duct
5 Eleventh rib between the first and 19 Kidney 28 Splenic artery 36 Quadrate lobe of medial
6 Twelfth rib second lumbar vertebrae 20 Right ureter 29 Superior mesenteric artery segment of left lobe of liver
7 Cauda equina and 11 Right crus of diaphragm 21 Body of stomach 30 Termination of splenic vein 37 Left lobe of liver, lateral
termination of spinal cord 12 Left crus of diaphragm 22 Greater omentum 31 Commencement of portal segment
within dural sheath 13 Aorta 23 Tail of pancreas vein
➜ Section level
1
37 21
31
23
16
34 11 13 26
25
L1–2
View
➜ Notes
Axial section 1
Axial sections 1 and 2 through the female abdomen lateral. Anomalies of the hepatic artery are common. In
should be compared with the male abdominal sections. 12 per cent of cases, the right hepatic artery derives from
There are wide individual variations in both the sexes, but the superior mesenteric artery. The left hepatic artery or an ➜ Orientation
a comparison of the ‘typical’ male and female abdomens accessory hepatic artery may originate from the left gastric,
reveals a greater accumulation of subcutaneous fat in the splenic or superior mesenteric artery. Occasionally, one or Anterior
female in contrast to a higher proportion of intraperitoneal other of these vessels derives directly from the aorta.
fat in the male subject. Note the caudal tip of the left suprarenal gland (26),
This section passes through the intervertebral disc which may extend down to the left renal vein.
between the first and second lumbar vertebrae. This This section demonstrates the fascial layers that enclose Right Left
section shows well the quadrate lobe of the liver (36). the kidney (19). The kidney itself is enclosed in its renal
Abdomen
Although the common bile duct (35) is usually the most capsule, which is readily stripped from the healthy organ.
anterolateral structure in the free (right) edge of the lesser Surrounding this is the perirenal fat, Ellis, Logan, Dixon:
contained withinHuman
the Sectional Anatomy
omentum, variations are common. In this elderly female, renal fascia (24). A closed rupture ofFigure
the kidney
No. is usuallyp151
the hepatic artery (33) is tortuous and thus is unusually contained and tamponaded by this fascial sheath. Posterior
Artist E Evans
Date 22 05 14
08/01/201
15
154
Abdomen
1
21
20
22
23

17 28
19 27 24
25
18 26
16
2
15 12
13 29
14
11
10 7
10 9 30
9
8
6 3
5
4
1 Linea alba 10 Ureter 19 Common bile duct 28 Body of pancreas

2 Tenth rib 11 Cisterna chyli 20 Ligamentum teres 29 Transverse colon
3 Eleventh rib 12 Aorta 21 Falciform ligament 30 Descending colon
4 Twelfth rib 13 Inferior vena cava 22 Left lobe of liver (lateral segment)
5 Quadratus lumborum 14 Caudate lobe of liver 23 Body of stomach 31 Spleen
6 Cauda equina within dural sheath 15 Right lobe of liver 24 Greater omentum 32 Right suprarenal gland
7 Body of second lumbar vertebra 16 Neck of gall bladder 25 Splenic vein
8 Psoas major 17 Left lobe of liver (medial segment) 26 Superior mesenteric artery
9 Kidney 18 Lymph node in porta hepatis 27 Splenic artery
➜ Section level
17 22 23
20
28
26
25
14 13
32 12
31
9
L2
View
➜ Notes
Axial section 2
This section lies just caudal to the left colic (splenic) flexure, segment (17). The visceral aspect of this, between the
which joins the transverse colon (29) to the descending falciform ligament and the gall-bladder bed (16), forms the
colon (30). anatomical quadrate lobe.
The tip of the papillary process of the caudate lobe of Although the left extremity of the transverse colon (29) ➜ Orientation
the liver (14) can be seen as a separate structure in the gap and the upper extremity of the descending colon (30)
Anterior
medial to the right lobe of the liver. The ligamentum teres are seen at this level, which is immediately inferior to the
(20) is the fibrotic remnant of the obliterated left umbilical splenic flexure, this is above the level of the hepatic flexure
vein. The falciform ligament divides the morphological left of the right colon, which is displaced downwards by the
lobe of the liver into a lateral segment (22) and a medial right lobe of the liver.
Right Left
Abdomen
Figure No. p153
Posterior
Artist E Evans
Date 22 05 14
09/01/201
15
Abdomen Selected images – CT colonogram
156
Selected images – CT colonogram Abdomen
1 Tube in distal ➜ Orientation

rectum
4 2 Sigmoid colon Anterior
3 Descending colon
6 4 Splenic flexure
5 Transverse colon
6 Hepatic flexure
Right Left
7 Ascending colon
8 Caecum
7 5
3
Posterior
8
2
➜ Notes
This CT colonogram was obtained in the following resulting pixels was identical. This three-dimensional
way. First, the large bowel was cleaned by the oral dataset can be analysed in a variety of ways – many
administration of a standard purgative. The bowel people find software-generated virtual colonoscopy
was then distended by air via a small tube inserted images helpful, where colour-rendered images allow
by rectum. The wall of the bowel was enhanced a ‘fly-through’ approach that simulates what the
by the use of a standard iodinated contrast agent endoscopist sees at standard colonoscopy. Others find
administered intravenously. A spiral CT dataset standard multiplanar two-dimensional reconstructions
was obtained on a multidetector CT system. Next, helpful. For all such viewing, a roadmap of the whole
the individual thin slices were loaded together to colon is a valuable tool for orientation – hence this
form a three-dimensional volume, with each voxel reconstructed image, which looks uncannily like the
isometric so that the x, y and z resolution of the double-contrast barium enema of old.
157
158
Abdomen
A B C
Coronal computed tomogram (CT) Coronal computed tomogram (CT) Coronal computed tomogram (CT)
4 4 4
5
1 5 6
2 3 5 9
18 33
8
18 7 36
13 16
34
26 7 32 26
7 33 30 10 40
19
22 14
12 21 22 38
25 31 20 27 41
15
Selected images – Coronal abdominal CTs
14 31
15
20 10 39
22
23 24 37
23 44 52
22 50 45
51
11 52
28
53
54
28 28 28
46
43
42
43
42 29
A B 48 47 C
1 Right atrium artery 28 Sigmoid colon 43 Seminal vesicle

➜ Section level
2 Right ventricle 15 Abdominal aorta 29 Rectum 44 Body of third lumbar
3 Left ventricle 16 Splenic vein 30 Body of pancreas vertebra
4 Diaphragm (right side) 17 Superior mesenteric vein 31 Head of pancreas 45 Thecal sac containing
5 Diaphragm (left side) 18 Fundus of stomach 32 Tail of pancreas cauda equina
6 Ascending aorta 19 Duodenum – cap (also 33 Gall bladder 46 Ilium (and iliac crest)
7 Right lobe of liver known as D1) 34 Left and right crus of 47 Head of femur
8 Left lobe of liver 20 Duodenum – second diaphragm 48 Acetabulum A BC
9 Inferior vena cava – part (also known as D2) 35 Right suprarenal 49 Transversus abdominis
suprahepatic 21 Duodenum – fourth (adrenal) gland 50 Internal oblique
10 Inferior vena cava – part (also known as D4) 36 Left suprarenal (adrenal) 51 External oblique
Selected images – Coronal abdominal CTs

infrahepatic joining: gland 52 Psoas major
11 Confluence of common 22 Jejunum 37 Renal (Gerota) fascia 53 Iliacus
iliac veins 23 Ileum 38 Perirenal space 54 Gluteus maximus View
12 Left renal vein 24 Colon – ascending part 39 Pararenal space
13 Coeliac trunk – hepatic, 25 Colon – hepatic flexure 40 Kidney
left gastric and splenic 26 Colon – splenic flexure 41 Renal pelvis (distended
arteries 27 Colon – descending on right)
14 Superior mesenteric part 42 Bladder (urinary)
➜ Notes
A spiral CT dataset of the abdomen was obtained on a standard investigation for a wide range of abdominal
multidetector CT system. The individual thin slices were conditions, the radiologist has to scroll through hundreds
loaded together to form a three-dimensional volume, with of axial images on a monitor. Some lesions are depicted
each voxel isometric, so that the x, y and z resolution of the better on coronal rather than axial images (e.g. asymmetry
resulting pixels is identical. This three-dimensional dataset of the pelvicalyceal systems in the two kidneys in this case). ➜ Orientation
can be analysed in a variety of ways – here in coronal To non-radiologists, such coronal views are a more intuitive
multiplanar two-dimensional reformats. method of looking at the abdomen than the source axial Superior
Now that CT of the abdomen has become such a images.
Right Left
Abdomen
Inferior
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160
1 1
6 6
5 5
L4 L4/5 2
2
Abdomen
8 L5 9
9 7 7
16 13 14
10 3 12 10 3
11 4
4 11
A A D D
1
1 6 2
6
5
5
L5
L4/5 3
2
L4 15
15
9 8
12 7
7 14 10 14
16 13 11
12
10 3
13
11 4
4
B B E E
1 16 2
6
5
L5
Selected images – Axial CTs – Lumbar spine
3
L4/5
2 17 18
8 14
15
9 9
7 7
13 19
14
12 10 3
20
4
11 4
C C F F
Axial computed tomograms (CTs) Axial computed tomograms (CTs)

Images A–B 13 Superior facet L5 10 Flaval ligament 8 Pouch for L5 root ➜ Section level
14 Capsule L4/L5 facet joint 11 Spinous process L4 9 Pedicle L5
1 Aorta 15 L4 nerve 12 Inferior facet L4 10 Superior facet L5
2 Psoas major 16 Epidural fat 13 Superior facet L5 11 Inferior facet L4
3 Quadratus lumborum 14 Epidural fat 12 Transverse process of L5
4 Erector spinae 13 Flaval ligament
5 Psoas minor Images C–D
14 Epidural fat
6 Inferior vena cava Images E–F
1 Aortic bifurcation 15 Ventral ramus L4
7 Dural sheath 2 Psoas major 1 Right common iliac 16 Confluence of common
8 Epidural vein 3 Quadratus lumborum artery iliac veins
9 Dorsal root ganglion L4 4 Erector spinae 2 Left common iliac artery 17 L5 nerve root sheath
Selected images – Axial CTs – Lumbar spine

in foramen between L4 5 Psoas minor 3 Psoas major 18 Basi-vertebral vein
and L5 6 Inferior vena cava 4 Erector spinae 19 Lamina L5
10 Lamina L4 7 Dural sheath 5 Psoas minor 20 Spinous process L5
11 Spinous process L4 8 Epidural vein 6 Inferior vena cava A
B
12 Inferior facet L4 9 Ventral ramus L4 7 Dural sheath
C
D
E
F
➜ Notes View
This series of six computed tomograms (A–F) demonstrates in which the lumbar plexus is formed. The dorsal ramus is
the key anatomical features of a segment of the lumbar too small to be resolved by CT; it would pass just lateral to
spine. Although all the features can also be demonstrated the superior facet of L5.
by magnetic resonance imaging (MRI), which is now the Image D shows a portion of the L5 endplate surrounding
preferred test, computed tomography (CT) is perhaps easier the inferior aspect of the L4/L5 disc.
to understand: bone appears white, soft tissues appear grey
and fat appears black. Images E–F
Image E transects the sclerotic endplate of L5. The
Images A–B
Image a traverses the slightly sclerotic endplate of L4. The
flaval ligaments (13) running from the L4 to L5 laminae ➜ Orientation
are shown well. Surgeons often operate through
dorsal root ganglion (9) lies in the foramen, immediately Anterior
small openings in the flaval ligaments without the full
caudal to the L4 pedicle. Note how the dorsal root ganglion
laminectomy that used to be the standard approach for
is demarcated clearly by normal epidural fat.
spinal surgery.
Images C–D Image F passes through the body of the L5 vertebra – the
Image C traverses the L4/L5 disc. Note that the posterior normal bony architecture can be appreciated. The veins Right Left
Abdomen
aspect of the disc is concave with respect to the dural running through the body converge on the basi-vertebral vein
sheath (7). A normal disc at this anatomical level has either (18), which has a small bony hood guarding its passage so
a concave or flat interface with the sheath. A convex disc that venous blood passes to the epidural veins (see 8 in image
here is indicative of an annular bulge. Note how the L4 C). The right L5 root sheath (17) hugs the medial aspect of
ventral ramus (9) is now heading towards the psoas muscle the pedicle (9). Posterior
08/01/201
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162
10 Coronal magnetic resonance image (MRI)
12 11 13
15 16
Abdomen
19
10
17
8 6 23 20
5
7
21
25
A 22 A
9 Coronal magnetic resonance image (MRI)

14
11
12
1 10
15 16
18
Selected images – Coronal MRIs – Lumbar spine
2 17
23 20
4
3
21
24
B 22 B
1 L1 vertebral body 8 Thecal sac 15 Right kidney 21 Iliacus ➜ Section level

2 L4 vertebral body 9 Aorta 16 Left kidney 22 Ilium
3 L5 vertebral body 10 Retroperitoneal fat 17 Psoas 23 Iliac crest A B
4 L4/L5 intervertebral disc 11 Crus of diaphragm 18 Lumbar vein 24 Gluteal muscles
5 Pedicle 12 Liver 19 Descending colon 25 S1 vertebral body
6 Nerve root sheath L4 13 Spleen 20 Anterior abdominal-wall
7 Dorsal root ganglion L4 14 Right adrenal gland musculature
View
Selected images – Coronal MRIs – Lumbar spine

➜ Notes
Two coronal T1-weighted images elegantly show the well; this is particularly useful in patients with lumbosacral
relationship of the lumbar spine to the psoas muscles and anomalies (around 25 per cent of people).
kidneys (within retroperitoneal fat). Note that the kidneys Also apparent are the segmental lumbar veins, which
lie in an oblique orientation, aligned to the lateral margins drain blood from the epidural veins. These run anteriorly
of the psoas muscles; thus, the upper poles lie in a more within a narrow, but important, fat plane alongside each
medial sagittal plane than the lower poles. Because of the vertebral body.
lumbar lordosis, the upper poles lie in a more posterior The psoas muscles (17) are particularly prominent in this
coronal plane than the lower poles. individual. The superior attachment to the lateral aspects
Because of the lumbar lordosis, the thecal sac and of the disc at the thoracolumbar junction is seen well.
emerging nerve root sheaths can be seen in the L4 One can appreciate how a disc-space infection (often
region, while vertebral bodies are demonstrated more tuberculous) at this level could track inferiorly in and
superiorly and inferiorly. Note the way in which each nerve around the psoas muscle down to the iliacus and eventually
root sheath hugs the medial and inferior aspects of its present as a cold abscess in the inguinal region. The close
associated pedicle (L4 root inferomedial to the L4 pedicle). relation of the adrenal to the right crus of the diaphragm
The expansion for the dorsal root ganglion can just be (labelled 11 on the left) is apparent. The adrenal gland
appreciated. The fairly constant relationship of the L4/L5 originates at this site, while the kidneys ‘ascended’ by
disc space with the level of the superior iliac crest is shown differential growth during fetal life.
➜ Orientation
Superior
Right Left
Abdomen
Inferior
08/01/201
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164
4 Sagittal T1- Sagittal T2-
weighted weighted
magnetic magnetic
5 resonance resonance
Abdomen
10 image (MRI) image (MRI)
1 10 1
9
13 8 7
6
7 17
18
2
2
3
A 3 A C C
4 Sagittal T2- Sagittal T1-

weighted weighted
magnetic magnetic
5
20 resonance resonance
image (MRI) 14 image (MRI)
1 1 15
12
8
6
11
Selected images – Sagittal MRIs – Lumbar spine
16
7
19
2 2
3 3
B B D D
1 L1 vertebral body 7 Cerebrospinal fluid 12 Right renal artery dorsal root ganglion ➜ Section level
2 L5 vertebral body within thecal sac 13 Retro-aortic left renal 17 Nerve roots within
3 S1 vertebral body 8 Epidural fat vein cerebrospinal fluid
4 Spinal cord 9 Spinous process L1 14 Crus of diaphragm 18 Spinous process L4 AB
5 Conus medullaris 10 Aorta 15 Pedicle of L1 vertebra 19 Pars interarticularis L5
6 Cauda equina 11 Inferior vena cava 16 L3 nerve root sheath/ 20 Basi-vertebral vein
D
View
➜ Notes
Selected images – Sagittal MRIs – Lumbar spine

C
Images A–B Image D
These midline sagittal magnetic resonance images are of A T1-weighted sagittal magnetic resonance image even
key importance in evaluating the lumbar spine (one of the more lateral than in image C. This is to the right of the
commonest anatomical sites examined by MRI). midline, however, as the right renal artery can be seen
The anteroposterior diameter of the spinal canal can be passing anterior to the diaphragmatic crus and posterior to
assessed readily. This normally measures around 15 mm from the inferior vena cava. This plane shows the exit foramina
the posterior aspect of the vertebral body to the anterior at several segmental levels. The classical shape has been
aspect of the laminar arch; values under 11.5 mm indicate said to resemble that of the human ear. The pedicles of two
a degree of spinal stenosis. The height of the disc spaces adjacent vertebral bodies form the superior and inferior
can be evaluated, as can the degree of hydration within. boundaries of the foramen. The anterior margin is formed
The normal disc space yields high signal intensity on T2 by the vertebral body superiorly and the posterolateral
weighting (image B); a degenerate disc returns low signal portion of the intervertebral disk inferiorly. Posteriorly lie the
intensity and becomes narrower. In these images, the L5/S1 pars interarticularis, the flaval ligament and the facet joint.
is slightly degenerate, as judged by the slight reduction of Narrowing of the disc space and degenerative changes in the
signal. There is a slight increase in fat content in the superior facet joints will reduce the capacity of the foramen, and the
portion of S1 vertebral body, suggesting a longstanding disc flaval ligament gets thicker as the disc space narrows; all of
abnormality. these changes can contribute to nerve-root compression.
These sagittal images also demonstrate clearly the slight The nerve root sheaths, dorsal root ganglion and segmental
expansion of the distal cord at the T12/L1 level (the conus nerve lie in the superior portion of the foramen. There are
medullaris). The collection of nerve roots that forms the cauda commonly two epidural veins in each foramen – a superior
equina (‘horse’s tail’) is seen well posteriorly within the canal vein between the nerve root and the body/pedicle, and a ➜ Orientation
when the patient lies supine (as during MRI). Because normal second vein that usually lies much more caudally within the
roots move freely within the cerebrospinal fluid, lumbar foramen. Remember that in the lumbar (and thoracic and
Superior
puncture is generally a very safe procedure at any level caudal sacral) spine, the segmental nerve root escapes caudal to its
to the conus medullaris. numbered vertebral body. For example, the L5 nerve root
escapes caudal to the L5 pedicle through the L5/S1 foramen.
Image C Although the L5 root can be affected by a lateral L5/S1 disc
A T2-weighted magnetic resonance image about 10 mm to herniation or facet joint degeneration, much more commonly Anterior Posterior
Abdomen
the left of the median sagittal plane shown in the images it will be affected by a more central herniation at the L4/L5
A and B. Here, the segmental roots can be seen traversing level.
the cerebrospinal fluid towards their respective nerve root
sheaths and exit foramina. The aorta can just be seen Inferior
anterior to the vertebral bodies.
08/01/201
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06-HSA-Section 6-Pelvis-cpp.indd 166
166
Pelvis
2
23
23 24
23 26
22
25

26 24
26
21
22 3
19 26 4
20
17 18 5
14 15 16
16 15 13
28 27
12 29
8
11
7
10
6
9
1 Umbilicus 11 Dorsal root ganglion of fourth 19 Aorta 28 Anterior pararenal fat of

2 Rectus abdominis lumbar nerve 20 Inferior mesenteric artery and retroperitoneum
3 External oblique 12 Ventral ramus of third lumbar vein 29 Posterior pararenal fat of
4 Internal oblique nerve 21 Right colic artery and vein retroperitoneum
5 Transversus abdominis 13 Psoas major 22 Ascending colon
6 Gluteus medius 14 Body of fourth lumbar vertebra 23 Jejunum 30 Confluence of common iliac veins
7 Ilium 15 Lumbar sympathetic chain 24 Greater omentum 31 Common iliac arteries/bifurcation
8 Iliacus 16 Ureter 25 Mesentery of small intestine of aorta
9 Erector spinae 17 Testicular artery and vein 26 Ileum
10 Cauda equina within dural sheath 18 Inferior vena cava 27 Descending colon
➜ Section level
2
26 25
23
26
22
31
4 30 16
5 27
13 14
3
29
10 7
➜ Notes L4
This section passes through the body of the fourth lumbar Axial section 2, 24). The accompanying inferior mesenteric
vertebra (14), the cranial portion of the iliac crests (7) and vein (20) has a long ascending retroperitoneal course to View
the umbilicus (1). There are wide individual variations in enter the splenic vein.
Axial section 1
these landmarks, but the umbilicus is usually around the The aorta (19) is commencing to bifurcate on both the
level of L4. section and the CT image (31). This level of bifurcation,
The inferior mesenteric artery (20) has just arisen from anterior to the fourth lumbar vertebra, is surprisingly
the aorta at the level of the third lumbar vertebra. More constant, even in subjects with gross arteriosclerosis or with ➜ Orientation
caudally, it will give rise to the superior rectal artery (see aneurysmal dilation of the aorta.
Anterior

Right Left
Figure No. p165
Pelvis
Artist E Evans
Date 22 05 14
Posterior
08/01/201
16
168
1 2
Pelvis
27
28
26
27
26
29
28

3
29 26 4
25 5
26 26
22
23 24 20
21 19 30
20 14 18
19
15 15 17
16
13
8
7
11 12
6
10
1 Linea alba 10 Cauda equina within dural sheath 16 Femoral nerve 25 Ascending colon
2 Rectus abdominis 11 Root of fifth lumbar nerve 17 Obturator nerve 26 Ileum
3 External oblique 12 Transverse process of fifth lumbar 18 Psoas major 27 Jejunum
4 Internal oblique vertebra 19 Ureter 28 Greater omentum
5 Transversus abdominis 13 Part of intervertebral disc between 20 Testicular artery and vein 29 Mesentery of small bowel
6 Gluteus medius fourth and fifth lumbar vertebrae 21 Inferior vena cava at origin 30 Descending colon
7 Ilium 14 Part of body of fourth lumbar 22 Left common iliac artery
8 Iliacus vertebra 23 Right common iliac artery
9 Erector spinae 15 Lumbar sympathetic chain 24 Superior rectal artery and vein
➜ Section level
1
27
29
25
26
4
19 23
22
3 21 5
30
7 18
8
6 10
➜ Notes
L4–5
This section transects the intervertebral disc between The inferior vena cava (21) is seen at its commencement.
the fourth and fifth lumbar vertebrae (13). The lumbar Its oval shape in the section is produced by the convergence
sympathetic chain (15) is visualized well as it lies on the of the two common iliac veins at this level.
Axial section 2
View
fourth lumbar vertebral body (14); it is overlapped on the The intervertebral discs (13) account for nearly 25 per
right by the inferior vena cava (21) and on the left by the cent of the total length of the spinal column. They are
common iliac artery (22). More cranially, it lies just lateral to composed at their circumference of laminae of fibrous
the aorta. tissue, forming the annulus fibrosus. At their centre is ➜ Orientation
The transverse processes of the fifth lumbar vertebra (12) the soft, pulpy, highly elastic nucleus pulposus, which
are bulky and all but reach the sacrum, particularly (in this is especially prominent in the lumbar region. This is Anterior
subject) on the left side. Reference to Axial section 3 shows considered to represent the remains of the fetal notochord.
partial sacralization of L5, a very common variation. With increasing age, the nucleus becomes progressively less
The superior rectal artery (24) is the continuation of the differentiated from the annulus and is gradually replaced
interior mesenteric artery after this has given off its left with fibrocartilage.
Figure No. p167 Right Left
colic branch (see Axial section 1).
Artist E Evans
Pelvis
Date 22 05 14
Posterior
08/01/201
16
170
1
2
Pelvis
36 36 38
3
36 4
40

36
35 37 5
28 25 39
41 28
30 24
7 6 8
29 26
25 34 32 27 23
22
31 9
20
33 21 10
19 14 13
18
17 12 11
16
15
1 Linea alba 11 Gluteus maximus 19 Part of lumbosacral disc 28 Ureter 36 Ileum

2 Rectus abdominis 12 Inferior gluteal artery vein 20 Part of body of fifth 29 Left common iliac vein 37 Mesentery of small bowel
3 External oblique and nerve lumbar vertebra 30 Superior rectal artery and 38 Greater omentum
4 Internal oblique 13 Sacroiliac joint 21 Ventral ramus of fifth vein 39 Descending colon
5 Transversus abdominis 14 Lateral mass of sacrum lumbar nerve 31 Superior gluteal artery and 40 Iliohypogastric nerve
6 Ilium 15 Erector spinae 22 Obturator nerve vein within pelvis 41 Ilioinguinal nerve, with
7 Iliacus 16 Spine of first segment of 23 Femoral nerve 32 Right common iliac vein deep circumflex iliac artery
8 Gluteus minimus sacrum 24 Psoas major 33 Right internal iliac vein and vein
9 Gluteus medius 17 Cauda equina within dural 25 Testicular artery and vein 34 Right common iliac artery
10 Superior gluteal artery sheath 26 Left external iliac artery at bifurcation
vein and nerve 18 Root of first sacral nerve 27 Left internal iliac artery 35 Ascending colon
1 ➜ Section level
2
36
35 28 6
26
27 24
29
7
9 18
11
15
➜ Notes
This section traverses the sacroiliac joint (13), the immediately before the CT image series, hence the intense
L5– S1
lumbosacral disc (19) and a lower part of the body of the opacification of the arteries.
fifth lumbar vertebra (20). There is some asymmetry of the The superior gluteal vessels (31) arise from the internal
Axial section 3
lateral mass of the sacrum (14) in this subject, the left side iliac vessels. Together with the superior gluteal nerve (10),
being larger. This is because there is a small articulation they emerge from the pelvis through the greater sciatic View
(just visible) between the left sacral mass and the sacralized foramen above piriformis and then run between and supply
left L5 transverse process (see also Axial section 2). These gluteus medius (9) and gluteus minimus (8). The inferior
variations are very common. gluteal artery, vein and nerve (12) emerge below piriformis ➜ Orientation
An intravenous injection of contrast medium was given and supply gluteus maximus (11).
Anterior
Right Left
Pelvis
Figure No. p169
Artist E Evans
Posterior
Date 22 05 14
08/01/201
17
172
Pelvis
2
3
3
3 4 4
4 4 4 7
4 6
5

36 36 9
38 8
4
29 13 10
37 11
30
28 35
28 12
14
27 27
31 25
34
33 26 15
26 32
22 17 14
24 21
23
18
16
20
19
1 Linea alba 12 Femoral nerve 23 Lumbosacral trunk 34 Right ureter

2 Rectus abdominis 13 Psoas major 24 Obturator nerve 35 Sigmoid colon
3 Greater omentum 14 Superior gluteal artery and vein 25 Iliolumbar vein 36 Mesentery of ileum
4 Ileum 15 Gluteus medius 26 Internal iliac vein 37 Appendix vermiformis
5 Transversus abdominis 16 Gluteus maximus 27 External iliac vein 38 Caecum
6 Internal oblique 17 Ilium 28 Internal iliac artery
7 External oblique aponeurosis 18 Sacroiliac joint 29 External iliac artery 39 Inferior epigastric artery
8 Descending colon 19 Erector spinae 30 Left ureter 40 Bladder
9 Anterior superior iliac spine 20 Filum terminale within sacral canal 31 Median sacral artery and vein
10 Gluteus minimus 21 Second sacral nerve root 32 Superior gluteal vein
11 Iliacus 22 Sacrum, second segment 33 Superior gluteal artery
➜ Section level
39
2
8
7 40 35 9
29 11 10
35 13 17 S2
28 27
15
18 View
22 16
19
➜ Notes ➜ Orientation
Anterior
This section transects the second segment of the sacrum The appendix vermiformis (37) lies posterior to the ileum
(22). Note that in this subject, the gluteal muscles on the (4) in this section – the retro-ileal position. Much more
Axial section 4
right side are smaller and paler than those on the left commonly, the post-mortem appendix lies behind the
(10, 15, 16). This subject had suffered a cerebrovascular caecum (65 per cent of cases) or descends into the pelvis
accident that resulted in a right-sided paresis. (30 per cent of cases). Right Left
The sacroiliac joint (18) is a synovial joint. Since, as can The superior gluteal vessels in their pelvic (32, 33) and
be seen in this section, the sacral component is markedly gluteal (14) course are demonstrated clearly (see also Axial
wider anteriorly than posteriorly, the weight of the body section 3).
tends to project it forward. This is resisted by the powerful Posterior
posterior sacroiliac ligament on either side.
Pelvis
Figure No. p171
Artist E Evans
Date 28 10 14
08/01/201
17
174
Pelvis
1
2
3 4
3
5 7
33 6
33

33
8 12
9
6
29
11
33 27 28 30
10 13
26
25
31 23
32 33
24 22
21 14
20
18 19
17
16 15
1 Linea alba 11 Gluteus minimus 21 Sciatic nerve 31 Sigmoid mesocolon

2 Rectus abdominis 12 Tensor fasciae latae 22 Superior gluteal artery and vein 32 Right ureter
3 Greater omentum 13 Gluteus medius 23 Obturator artery and vein 33 Ileum
4 Internal oblique 14 Gluteus maximus 24 Internal iliac vein
5 Transversus abdominis 15 Erector spinae 25 Internal iliac artery 34 Inferior epigastric artery
6 Sigmoid colon 16 Sacral canal 26 Left ureter 35 Superficial subcutaneous vein
7 Sartorius 17 Sacrum, third segment 27 Lymph node 36 Vas deferens
8 Iliacus 18 Median sacral artery and vein 28 External iliac vein
9 Femoral nerve 19 Lateral sacral artery and vein 29 External iliac artery
10 Ilium 20 Piriformis 30 Psoas major
➜ Section level
35
2
34
36
8
30 29
28
11
13 S3
10
24
6
20 14
View
17
16
Anterior
This section passes through the sacrum at its third segment vessels (22), together with the superior gluteal nerve,
(17). At this level, the sacral canal (16) lies below the pass above piriformis through the greater sciatic foramen.
Axial section 5
termination of the dural sac, which ends at the second In this subject, piriformis is paler and less bulky on the
segment of the sacrum. The sacral canal now contains only right side than on the left side as a result of a previous
the filum terminale and the lowermost sacral nerve roots, cerebrovascular accident (see Axial section 4). Piriformis Right Left
together with loose extradural fat. The sacral hiatus is, is a bulky muscle that must be traversed when using the
therefore, a useful portal of entry for the performance of greater sciatic foramen as a route for percutaneous pelvic
an extradural nerve block. aspiration.
Piriformis (20) arises from the front of the sacrum The ureter (26) descends into the pelvis characteristically Posterior
by three digitations, attached to the portions of bone immediately anterior to the internal iliac artery (25). It lies
between the pelvic sacral foramina and also to the grooves immediately deep to the pelvic peritoneum, crossed only by
leading laterally from these foramina. The superior gluteal the vas deferens, which is seen in Axial section 6.
Pelvis
Figure No. p173
Artist E Evans
Date 22 05 14
08/01/201
17
176
Pelvis
1
2 3
39
4
40
38
37 8 10
37 5 11

6 7 9
12 14
36
6 13
27
16
28 15
26
25
24 17
6 6
34
35 23
19
22 20 18
33 21
32
30 31
29
1 Linea alba 13 Psoas major and tendon 25 Obturator vein 37 Ileum

2 Rectus abdominis 14 Tensor fasciae latae 26 Obturator artery 38 Transversus abdominis
3 Inferior epigastric artery and vein 15 Iliofemoral ligament 27 Obturator nerve 39 Internal oblique
4 Greater omentum 16 Gluteus minimus 28 Acetabulum (ilial portion) 40 External oblique
5 Sigmoid colon 17 Gluteus medius 29 Sacrum, fourth segment
6 Vas deferens 18 Gluteus maximus 30 Median sacral artery and vein 41 Perirectal (mesorectal) fat
7 External iliac vein 19 Sciatic nerve 31 Superior rectal artery and vein 42 Pararectal fat (with branches of
8 External iliac artery 20 Piriformis 32 Lateral sacral artery and vein internal iliac artery and vein)
9 Femoral nerve 21 Inferior gluteal artery and vein 33 Rectum 43 Perirectal (mesorectal) fascia
10 Sartorius 22 Pudendal nerve 34 Rectosigmoid junction
11 Iliacus 23 Internal pudendal artery 35 Seminal vesicle
12 Rectus femoris straight head tendon 24 Obturator internus 36 Fundus of bladder
➜ Section level
8
10 3
11 7
14
13 36
28 16
17
35
24
S4
20
42 33 18
43 41
View
Anterior
This section passes through the fourth segment of the The vas deferens (6) is the most medial structure crossing
sacrum (29), the superior portion of the acetabulum (28) the side wall of the pelvis immediately deep to the pelvic
Axial section 6
and the fundus of the bladder (36). The rectum (33) lies peritoneum. More caudally, it will join the seminal vesicle
immediately in front of the sacrum, separated by the (35) to form the ejaculatory duct.
Right Left
median sacral vessels (30); it commences just cranial
to this line of section on the third sacral segment. The
rectosigmoid junction is also seen (34).
Posterior
Pelvis
08/01/201
17
178
Pelvis
1
2 3 8
40 12
4 6 7
5
9 11
13 14
10

37 17 15
39 16
38 18 19
35 21
20 22
36
26 23
34
28 25
30
29 27
24
33 32
31
pjwstk|402064|1435431632
1 Linea alba 14 Tensor fasciae latae 26 Gemellus superior 35 Obturator internus

2 Rectus abdominis 15 Gluteus minimus 27 Inferior gluteal artery and vein 36 Seminal vesicle
3 Spermatic cord 16 Gluteus medius 28 Pudendal nerve and inferior 37 Bladder
4 Vas deferens 17 Acetabulum (pubic portion) pudendal artery and vein 38 Obturator nerve
5 Femoral vein 18 Ligamentum teres 29 Sacrospinous ligament 39 Obturator artery and vein
6 Femoral artery 19 Femoral head 30 Perirectal (mesorectal) fascia 40 Patent processus vaginalis (indirect
7 Femoral nerve 20 Ischium, leading to ischial spine separating perirectal fat from inguinal hernia sac)
8 Lymph node (arrowed) pararectal fat
9 Pectineus 21 Obturator internus tendon 31 Sacrum, fifth segment 41 Ischio-anal (ischio-rectal) fossa
10 Psoas major and tendon 22 Greater trochanter 32 Lateral sacral artery and vein 42 Prostate
11 Iliacus 23 Trochanteric bursa 33 Superior rectal artery and vein in
12 Sartorius 24 Gluteus maximus perirectal (mesorectal) fat
13 Rectus femoris 25 Sciatic nerve 34 Rectum
➜ Section level
1
2 5
9 6 12
11 13
15 37 17 14
16
35 19
42
20
34 22
41
S5
24
View
Axial magnetic resonance image (MRI)
Anterior
This section traverses the last (fifth) segment of the sacrum The superior rectal vessels (33) can be seen as they lie in
Axial section 7
(31). The sacrospinous ligament (29) is transected as it the loose perirectal (mesorectal) fat, which also contains
passes forward to the ischial spine (20). lymphatic vessels, lymph nodes and the pelvic plexuses lying
This section gives an excellent illustration of the hip joint on the rectal wall. The perirectal fat is separated from the
Right Left
at the level of the ligamentum teres (18). The ligamentum pararectal fat by the perirectal (mesorectal) fascia (30).
teres (18) transmits an artery, a branch of the obturator Note that this subject has an indirect inguinal hernia sac
artery, to the femoral head, which is its sole source of on the right side (40).
blood in childhood. Damage to this vessel (Perthes’ disease
or slipped femoral epiphysis) may lead to avascular necrosis Posterior
of the femoral head.
Pelvis
Figure No. p177
Artist E Evans
Date 22 05 14
08/01/201
17
180
Pelvis
1
3
39
2 7
40 5 6
38 4
37 10
34 9 11

36 8
13
35 12
41 31
32 33 14
15
28 27
30 17
16
29
25 26
18
23 24 20 19
21
22
1 Spermatic cord 13 Vastus lateralis 24 Ischio-anal (ischio-rectal) fossa 36 Obturator externus

2 Vas deferens 14 Femoral neck 25 Pudendal (Alcock’s) canal 37 Pectineus
3 Great saphenous vein 15 Greater trochanter 26 Obturator internus tendon 38 Superior ramus of pubis
4 Femoral vein 16 Trochanteric bursa 27 Ischium 39 Extraperitoneal fat related to
5 Femoral artery 17 Quadratus femoris 28 Obturator internus hernia sac
6 Femoral nerve 18 Sciatic nerve 29 Levator ani (puborectalis portion) 40 Inguinal lymph node
7 Sartorius 19 Inferior gluteal artery and vein 30 Rectum 41 Lateral circumflex femoral artery
8 Psoas major and tendon 20 Internal pudendal artery and vein 31 Prostatic urethra and vein
9 Iliacus and pudendal nerve (see also 25) 32 Prostate
10 Rectus femoris 21 Gluteus maximus 33 Prostatic venous plexus 42 Inferior rectal artery
11 Tensor fasciae latae 22 Coccyx 34 Symphysis pubis 43 Body of penis
12 Hip joint capsule 23 Mesorectum 35 Obturator artery and vein
1/2
1/2 34 ➜ Orientation ➜ Section level
43 5 4
3
75 4 Anterior
37
10 37
11 9 34
8 36
14 32 32
15 30 28 28 Right Left
29 27 17 27 30
24 42 42
21 24
22 29 25
Posterior
A B
21
View
A B
Axial section 8
➜ Notes
This section passes through the coccyx (22) and levator ani, laterally by the tuberosity of the canal of Alcock (25). This canal comprises a special
the symphysis pubis (34). In the standing position, ischium and the obturator fascia, and posteriorly sheath of fascia fused with the lower part of the
the horizontal plane that passes through the by the lower border of gluteus maximus (21) and obturator fascia.
coccyx corresponds to the superior margin of the the sacrotuberous ligament. Anteriorly lies the The left common femoral artery (5) is about to
symphysis. urogenital diaphragm, but the fossa is prolonged as divide into the superficial femoral and profunda
The ischio-anal (ischio-rectal) fossa (24) is a narrow recess above this diaphragm, where it is femoris on the section. On the CT image, this has
wedge-shaped; its base points to the surface limited by the fusion between the inferior fascia of already taken place.
of the perineum, while its apex is the junction the pelvic diaphragm and the superior fascia of the The spermatic cord (1) and vas deferens (2) are
Pelvis
of obturator internus (28) and levator ani (29), urogenital diaphragm. seen clearly on the left-hand side. On the right,
covered respectively by the obturator fascia and The internal pudendal vessels and the pudendal these are compressed by extraperitoneal fat related
the inferior fascia of the pelvic diaphragm. Medially nerve (20) enter the perineum through the lesser to this subject’s indirect inguinal hernia (39). This
it is bounded by the external anal sphincter and sciatic foramen and then traverse the pudendal hernia is seen well in Axial section 7.
08/01/201
18
182
Pelvis
1
6
5 12
2
7
9

3 36 8 13
4 34 10
11 14
35
16 15
33 31
32 17
30
29 18
19
28 24
23
26
27 22
21
25
20
1 Spermatic cord 10 Profunda femoris artery 19 Trochanteric bursa 28 Pudendal canal

2 Vas deferens 11 Lateral circumflex femoral vein 20 Gluteus maximus 29 Obturator internus
3 Tunica albuginea of penis 12 Sartorius 21 Sciatic nerve 30 Obturator externus
4 Corpus cavernosum (body) 13 Rectus femoris 22 Biceps femoris tendon 31 Pubis-inferior ramus
5 Inguinal lymph node 14 Tensor fasciae latae 23 Ischial tuberosity 32 Corpus cavernosum (crus)
6 Great saphenous vein 15 Vastus lateralis 24 Quadratus femoris 33 Urethra (in distal prostate)
7 Superficial femoral artery 16 Iliacus 25 Ischio-anal fat 34 Adductor brevis
8 Femoral vein 17 Tendon of psoas major 26 Levator ani 35 Pectineus
9 Femoral nerve 18 Greater trochanter 27 Anorectal junction 36 Adductor longus

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04-HSA-Section 4-Thorax-cpp.

Axial section 3 – Male

This section, through the intervertebral disc Date

Axial section 4 – Male

Axial section 5 – Male

Axial section 6 – Male

2 ➜ Orientation ➜ Section level

Axial section 7 – Male

➜ Orientation ➜ Section level

➜ Notes Artist E Evans

Axial section 8 – Male

➜ Orientation ➜ Section level

Axial section 9 – Male

1 Fifth costal cartilage 14 Left atrium 27 Serratus anterior 40 Azygos vein

➜ Orientation ➜ Section level

Ellis, Logan, Dixon: Human Sectional Anatomy

Figure No. p119b

Axial section 10 – Male

43 ➜ Orientation ➜ Section level

Ellis, Logan, Dixon: Human Sectional Anatomy

Axial section 1 – Female

1 Breast 14 Fifth rib 29 Oesophagus 41 Left ventricle

Axial computed tomogram (CT)

Axial computed tomogram (CT) Axial computed

Images A–B 7 Tricuspid valve 10 Left atrioventricular 15 Aorta

Selected images – Mediastinum – Axial CTs

Images A–D 12 Aortic arch (with fleck of ➜ Orientation ➜ Section level

Selected images – Mediastinum – Axial CTs

Selected images – Coronal MRIs

1 Falx cerebri 25 Brachiocephalic vein ➜ Orientation ➜ Section level

Selected images – Coronal MRIs

Sagittal computed tomogram (CT) Sagittal computed tomogram (CT)

Right Left Anterior Posterior

1 Heart 9 Twelfth thoracic vertebra ➜ Orientation

Axial section 1 – Male

Axial computed tomogram (CT)

Axial section 2 – Male

➜ Orientation ➜ Section level

Axial computed tomogram (CT)

Ellis, Logan, Dixon: Human Sectional Anatomy

Axial section 3 – Male

Axial computed tomogram (CT) T12

Axial section 4 – Male

Axial computed tomogram (CT) T12–L1

Axial section 5 – Male

➜ Orientation ➜ Section level

Axial computed tomogram (CT) Axial magnetic resonance image (MRI)

Axial section 6 – Male

1 ➜ Orientation ➜ Section level

Axial computed tomogram (CT) Axial magnetic resonance image (MRI)

Axial section 7 – Male

1 ➜ Orientation ➜ Section level

Axial computed tomogram (CT) Axial computed tomogram (CT)

Axial section 8 – Male

Axial computed tomogram (CT)

Axial section 1 – Female

Axial section 2 – Female

1 Linea alba 10 Ureter 19 Common bile duct 28 Body of pancreas

1 Tube in distal ➜ Orientation

1 Right atrium artery 28 Sigmoid colon 43 Seminal vesicle

Selected images – Coronal abdominal CTs

Axial computed tomograms (CTs) Axial computed tomograms (CTs)

Selected images – Axial CTs – Lumbar spine

9 Coronal magnetic resonance image (MRI)