Download The pelvis revisited: A pictorial review of normal anatomy and its

The pelvis revisited: A pictorial review of normal anatomy
and its correlation with MDCT images
Award:
Cum Laude
Poster No.:
C-0356
Congress:
ECR 2014
Type:
Educational Exhibit
Authors:
L. M. Cruz Hernandez, A. L. Reyes Ortiz, C. cereceda, J. M. Pinto,
A. Enríquez Puga, A. Perez Martinez, R. Morcillo; Toledo/ES
Keywords:
Pelvis, Anatomy, Abdomen, CT, Education, Education and training
DOI:
10.1594/ecr2014/C-0356
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Page 1 of 40
Learning objectives
•
To review and simplify the complex pelvic anatomy and its principal
anatomic landmarks.
•
To describe normal anatomy and its correlation with multidetector computer
tomography images (MDCT) using CT code color images.
•
To demonstrate how understanding the relevant pelvic anatomical structures
allows the diagnosis of different pathological processes.
Background
MDCT is frequently used in the evaluation of pelvic pathology. Normal anatomic
landmarks are often distorted. The relation between different pelvic structures and the
altered anatomical points, can be used to determine the nature of a pathologic process.
Detailed anatomical knowledge of the pelvis allows more accurate evaluation of
pathology to enable the radiologist to narrow the differential diagnoses. This precision
helps the clinician to define therapeutic options.
Findings and procedure details
PELVIC BONE STRUCTURE
The bony pelvis consists of innominate bones, each with three parts (ilium, isquium and
pubis), sacrum and coccyx. It protects the pelvic viscera, provides attachment for the
muscles of the trunk and lower limb, and enables stable transfer of the body weight from
the spine to the femora (Figure 1).
Page 2 of 40
Fig. 1: 3D CT Reconstructions of female pelvis. Note characteristic particularities of
female pelvic bone: Heart-shaped pelvic inlet with pelvic outlet (dashed black line),
pubic arch angle greater than 90 degrees (dashed red line), round obturator foramen
(dashed yellow line), larger and thicker bones.
References: RADIOLOGIA, COMPLEJO HOSPITALARIO DE TOLEDO, HOSPITAL
VIRGEN DE LA SALUD - Av. de Barber, 30 - Toledo/ES
Its divided into false (major) and true (minior) pelvis, by the ileopectineal line: the smaller
inferior part is the true pelvis and the larger superior part is the false pelvis. The false
pelvis is formed mainly by the iliac fossae and is largely filled by the iliopsoas muscles.
The true pelvis is bounded posteriorly by the sacrum and coccyx, laterally by the obturator
membranes, sacrospinous ligaments, and anteriorly by the pubic bones (Figure 2).
Page 3 of 40
Fig. 2: 3D CT Reconstructions of female pelvis viewed from the medial surface. The
ileopectineal line (dashed pink line) is a bony prominence, wich courses from the sacral
promontory anteriorly towards the iliopubic eminence. The false pelvis is above the
ileopectineal line, while the true pelvis is below it.
References: RADIOLOGIA, COMPLEJO HOSPITALARIO DE TOLEDO, HOSPITAL
VIRGEN DE LA SALUD - Av. de Barber, 30 - Toledo/ES
The superior aperture of the pelvis is continuous with the abdominal cavity. The
inferior aperture opens to the perineum through the greater sciatic notch and the
obturator foramen, wich are bounded by the coccyx, pubic symphysis and sacrotuberous
ligaments.
PELVIC MUSCULATURE
Anterior Pelvic Wall
The anterior pelvic wall is formed by three flat muscles and the rectus abdominis muscle;
all of them continuation of the abdominal wall (Figure 3,4).
Page 4 of 40
1. External oblique muscle
Largest and most superficial flat muscle
2. Internal oblique muscle
Middle flat muscle
3. Transversus abdiminis muscle
Inner flat muscle
4. Rectus abdominis muscle
Vertically directed strap muscle
Fig. 3: 3D CT Reconstructions of male anterior abdominal wall. The anterior pelvic
wall is formed by three flat muscles and the rectus abdominis muscle; all of them
Page 5 of 40
continuation of the abdominal wall. The course transversus abdiminis muscle, the inner
pelvic wall muscle, is represented by dashed white lines.
References: RADIOLOGIA, COMPLEJO HOSPITALARIO DE TOLEDO, HOSPITAL
VIRGEN DE LA SALUD - Av. de Barber, 30 - Toledo/ES
Fig. 4: Axial CT image of female pelvis. The flat muscles that form the lateral anterior
abdominal wall include (from external to internal) the external oblique (yellow dashed
lines), internal oblique (blue points) and transversus abdominis muscles (red line). The
rectus abdominis muscles are paired, verticallv oriented, strap-like muscle, running on
either side of the midline (green dashed lines).
References: RADIOLOGIA, COMPLEJO HOSPITALARIO DE TOLEDO, HOSPITAL
VIRGEN DE LA SALUD - Av. de Barber, 30 - Toledo/ES
Posterior Pelvic Wall
It is formed by the psoas and iliacus muscles, which fuse caudally and form the iliopsoas.
The psoas major originates along the lateral surfaces of the vertebral bodies of T12 and
L1-L5 and their associated intervertebral discs. The iliacus originates in the iliac fossa
of the pelvis (Figure 5,6).
Page 6 of 40
Fig. 5: 3D CT Reconstructions of male posterior abdominal wall. Posterior pelvic wall
is formed by the psoas and iliacus muscles, which fuse caudally and form the iliopsoas.
The psoas major (represente by green lines) originates along the lateral surfaces of the
vertebral bodies of T12 and L1 to L5 and their associated intervertebral discs.
References: RADIOLOGIA, COMPLEJO HOSPITALARIO DE TOLEDO, HOSPITAL
VIRGEN DE LA SALUD - Av. de Barber, 30 - Toledo/ES
Page 7 of 40
Fig. 6: Axial CT image of female pelvis. The psoas and iliacus muscles merge to form
the iliopsoas complex, which continues inferiorly to insert on the lesser trochanter and
serves as a powerful hip flexor.
References: RADIOLOGIA, COMPLEJO HOSPITALARIO DE TOLEDO, HOSPITAL
VIRGEN DE LA SALUD - Av. de Barber, 30 - Toledo/ES
Pelvic Floor
A strong resistant pelvic floor is necessary to maintain the pelvic viscera in proper
position. This supporting hammock - the pelvic diaphragm - is composed by three key
muscles (Figure 7).
Levator ani
•
•
•
•
Formed by the pubococcygeous, iliococcygeous and puborectalis
Covered by fascial sheath
Primary support for pelvic organs
Critical for maintaining continence, as well as normal micturition and
defecation
Page 8 of 40
Coccygeus
•
Runs from ischial spine to sacrum and coccyx
Obturator Internus
•
•
Runs from inner surface of obturator membrane to greater trochanter
Covered by thick fascia (arcus tendineus), which is origin of pelvic
diaphragm
Fig. 7: Pelvic floor muscles. The pelvic diaphragm is composed by three key muscles:
levator ani (formed by the pubococcygeous, iliococcygeous and puborectalis),
coccygeus (not represented) and obturator internus. The portion of the obturator
internus above this origin lies in the lateral wall of the false pelvis, whereas the lower
portion forms part of the lateral wall of the ischiorectal fossa.
References: RADIOLOGIA, COMPLEJO HOSPITALARIO DE TOLEDO, HOSPITAL
VIRGEN DE LA SALUD - Av. de Barber, 30 - Toledo/ES
TEACHING POINT
Page 9 of 40
An important anatomic landmark in CT evaluation of the pelvis is the obturator internus
muscle:
•
The portion of the obturator internus above this origin lies in the lateral wall
of the false pelvis, whereas the lower portion forms part of the lateral wall of
the ischiorectal fossa.
•
Between the anal canal and the urogenital diaphragm lies the central tendon
of the perineum. This fibromuscular node is important as the central junction
of most of the perineal muscles.
PERITONEUM AND VISCERAL SPACES(Figure 8,9).
The peritoneum is a fibroelastic serous membrane that divides the pelvic cavity in extra
and intraperitoneal visceral spaces.
It looks like a closed sac in the male. In the female, the ostia of the fallopian tubes allow
it to communicate with the outside. The peritoneal covering of the ovary is intact except
during ovulation when rupture of the membrane occurs allowing an oocyte to pass into
the peritoneal space and proceed to the ostium of the fallopian tube.
The inferior recesses of the peritoneal cavity usually do not project bellow the level
of the mid portion of the femoral heads. In the male pelvis, the peritoneum sweeps
anteriorly from the frontal surface of the rectum to the posterior aspect of the bladder
and superiorly to the seminal vesicles forming the rectovesical pouch. In the female, the
uterus intervenes between the rectum and bladder forming a recto-uterine pouch as well
as the utero-vesical pouch anteriorly.
Intraperitoneal Spaces
Paravesical Left And Right Spaces
With their principal stamps:
•
•
The median umbilical ligament or urachus, the embryological remnant of the
umbilical artery extending from the bladder dome to navel.
The lateral umbilical ligament, which medially limits the paravesical space
and the inguinal fossa laterally.
Posterior Bladder Spaces
Page 10 of 40
Varies from men to women:
•
•
In men we see recto-vesical space.
In women, we see anterior utero-vesical pouch and posterior recto-uterine
pouch or pouch of Douglas.
TEACHING POINT
Rectovesical pouch is most dependent recess in men
Vesicouterine pouch and rectouterine (of Douglas)
are most dependent in women
Extraperitoneal Spaces
•
Space of Retzius
Retropubic prevesical space. Separated from anterior abdominal wall by the transversals
fascia.
•
Perivesical Space
Located between the umbilico-vesical fascia and peritoneum. It contains the bladder,
umbilical arteries and the urachus.
•
Perirectal Space
•
Presacral Space
It is located between rectum and sacrum/coccyx and contains autonomic nerves from
pelvic viscera.
Page 11 of 40
Fig. 8: Schematic representation of the ligaments and spaces at the cervical/vaginal
junction. The ligaments are visceral ligaments, which are composed of specialized
endopelvic fascia and contain vessels, nerves and lymphatics. The main supporting
ligaments for the uterus are the cardinal and uterosacral ligaments. (Source Diagnostic and Surgical Imaging Anatomy. Michael Federle. Page 1051 -).
References: (Source - Diagnostic and Surgical Imaging Anatomy. Michael Federle.
Page 1051 -)
Page 12 of 40
Fig. 9: Sagittal graphic of the female pelvis shows the bladder, uterus and rectum, all
of wich are extraperitoneal. The peritoneum has been highlighted to show the cul-de
sacs. Posteriorly, the peritoneum extends along the posterior vaginal fornix, creating
the posterior cul-de-sac (pouch of Douglas), the most dependent portion of the pelvis.
Anteriorly, at the level of the lower uterine segment, the peritoneum is reflected over
the dome of the bladder, creating the anterior cul-de-sac. (Source - Diagnostic and
Surgical Imaging Anatomy. Michael Federle. Page 1053 -).
References: (Source - Diagnostic and Surgical Imaging Anatomy. Michael Federle.
Page 1053 -).
PELVIC VESSELS (Figures 10,11)
Arterial System Key Points
Abdominal Aorta
•
•
Divides into common iliac arteries at t L4-L5 level.
Testicular and ovarian arteries originate below renal arteries.
Page 13 of 40
Common iliac arteries
•
•
•
Run anterior iliac veins and inferior to vena cava.
Descend behind the ureters.
Divides into external and internal iliac arteries at the sacroiliac joint level.
Internal iliac artery (hypograstric)
•
•
•
Principal vascular support of pelvic organs
Descends toward the greater sciatic notch
Divides into anterior and posterior trunk
•
•
Anterior trunk to pelvic viscera.
Posterior trunk to pelvic musculature
External iliac artery
•
•
Exits pelvic beneath inguinal ligament
Inferior epigastric (medial) and deep iliac circumflex (lateral) arteries
demarcate junction between external iliac and common femoral arteries.
Pelvic Veins Key Points
The external and internal iliac veins correspond to their arteries. They have a medial
position with respect to the arteries and becoming posterior progressively.
External iliac vein
•
Upward continuation of femoral vein at level of inguinal ligament
Internal iliac vein
•
Begins near upper part of greater sciatic foramen
Page 14 of 40
Fig. 10: Axial CT images at L4/L5 level in portal fase and MIP angio TC
reconstruction. Note how the abdominal aorta divides into common iliac arteries at L4L5 level and how after these division these vessels run anterior iliac veins and inferior
to vena cava.
References: RADIOLOGIA, COMPLEJO HOSPITALARIO DE TOLEDO, HOSPITAL
VIRGEN DE LA SALUD - Av. de Barber, 30 - Toledo/ES
Page 15 of 40
Fig. 11: Axial CT images at S2 level showing distal pelvic vessels. The common iliac
arteries divide, at the level of L5-S1, into two branches, the external and internal iliac
(hypogastric) arteries. The external iliac artery supplies the lower extremity, while the
hypogastric artery supplies the pelvic viscera and muscles of the pelvis.
References: RADIOLOGIA, COMPLEJO HOSPITALARIO DE TOLEDO, HOSPITAL
VIRGEN DE LA SALUD - Av. de Barber, 30 - Toledo/ES
TEACHING POINT
Right gonadal vein drains into vena cava
Left gonadal vein drains into left renal vein
PELVIC STRUCTURES OF THE DIGESTIVE TRACT (Figure 12)
Sigmoid Colon
•
Variable length and morphology.
Page 16 of 40
•
•
Supplied by the inferior mesenteric artery and vein.
Coated by a double layer of peritoneum.
Rectum
•
•
•
•
Final 15-20 cm of colon.
Rectosigmoid junction at lumbo-sacral level (variable).
Lies in extraperitoneal pelvis
It has mesenteric and systemic vessels: Superior rectal branches of inferior
mesenteric artery and vein and middle and inferior rectal braches of internal
iliac vessels.
Fig. 12: Sagittal CT images at S2 level showing pelvic structures of the digestive tract.
The green dashed line divides the pelvic colon structures from abdominal portion. Note
the relationship between the male and female pelvic structures as the rectosigmoid
junction is sacral level.
References: RADIOLOGIA, COMPLEJO HOSPITALARIO DE TOLEDO, HOSPITAL
VIRGEN DE LA SALUD - Av. de Barber, 30 - Toledo/ES
LOWER URINARY TRACT STRUCTURES (Figure 13)
Page 17 of 40
Pelvic Ureters
•
•
•
•
Distal ureters enter the pelvis in front of the psoas muscle.
Lie along pelvic lateral walls near internal iliac vessels.
At the level of inferior iliac spines ureters curve anteromedially to enter
bladder at level of seminal vesicles in men and cervix in women.
Ureterovesical junction: Ureters pass obliquely through muscular wall of
bladder crating a valve effect.
Bladder
Lies in extraperitoneal (retroperitoneal) pelvis.
Surrounded by loose connective tissue and fat.
•
•
Perivesical space: contains bladder and urachus.
Prevesical space (Retzius): between bladder and symphysis pubis.
Peritoneum covers dome of bladder.
•
•
Rectovesical pouch is most dependent recess in men
Vesicouterine pouch and rectouterine (of Douglas) are most dependent in
women.
Page 18 of 40
Fig. 13: Coronal reformatted CT urogram. Distal ureters enter the pelvis in front of the
psoas muscle.Note how at inferior iliac spine level ureters curve anteromedially to enter
bladder at level of seminal vesicles in men and cervix in women.
References: RADIOLOGIA, COMPLEJO HOSPITALARIO DE TOLEDO, HOSPITAL
VIRGEN DE LA SALUD - Av. de Barber, 30 - Toledo/ES
MALE PELVIC STRUCTURES (Figure 14)
Prostate
Wal-nut sized gland located beneath bladder and in front of the rectum. It is above
superior fascia of urogenital diaphragm and surrounds the uppermost part of the urethra.
Its normal size is between 3 x 4 x 2cm (CC x TV x L diameters).
Conical in shape with base, apex and anterior, posterior and two inferolateral surfaces:
•
•
Base closely related to inferior surface of bladder.
Apex in contact with superior fascia of urogenital diaphragm.
Page 19 of 40
•
Posterior surface separated from rectum by rectovesical septum
(Denonvilliers fascia).
•
Two ejaculatory ducts enter prostate through posterior surface
•
Posterosuperiorly, seminal vesicles lie between bladder base and rectum.
•
Anterior surface separated from symphysis pubis by extraperitoneal fat and
plexus of veins and connected to pubic by puboprostatic ligaments.
Inferolateral surfaces separated from levator ani by periprostatic plexus of
veins.
•
Seminal Vesicles and Ejaculatory Ducts
•
•
SV are saclike structures located superolaterally to prostate, between
fundus of urinary bladder and rectum.
Ejaculatory Ducts are located on either side of midline, start at base of
prostate and run forward and downward through gland.
Page 20 of 40
Fig. 14: Axial CT view from principal pelvic male anatomic structures at urinary
bladder level.
References: RADIOLOGIA, COMPLEJO HOSPITALARIO DE TOLEDO, HOSPITAL
VIRGEN DE LA SALUD - Av. de Barber, 30 - Toledo/ES
FEMALE PELVIC STRUCTURES (Figure 15)
Ligaments
Supporting Uterine Ligaments
•
These are visceral ligaments and contain vessels neres and lymphatics, as
well connective tissue, makes a similar function as bowel mesentery and a
supportive role connects viscera to pelvic wall.
•
Peritoneum extends over bladder dome anterior uterus and reflects over
uterurs at lower uterine segment, creating the anterior cul-de-sac (vesicouterine pouch).
•
Over fundus, the peritoneum extends over posterior uterine surface to upper
vagina, abutting posterior vaginal fornix, crating posterior cul-de-sac (pouch
of Douglas or rectouterine pouch).
Broad Ligament
•
It is created from the two sheets of covering peritoneum and extends
laterally to pelvic sidewall covering fallopian tubes.
Ovarian Ligaments
•
Suspensory ligament of ovary attaches ovary to pelvic wall an contains
ovarian artery and vein.
•
Proper ovarian ligament attaches ovary to uterine corpus.
•
Mesosalpinx between fallopian tube and proper ovarian ligament.
Round Ligamnets
•
Arise from uterine cornu near fallopian tubes.
•
Course anteriorly, through inguinal canal to insert on labia majora
Page 21 of 40
•
Offer little support to uterus.
Uterosacral Ligaments
•
Extend from cervix and vagina to sacrum.
•
Extend around rectum and form lateral borders of pouch of Douglas.
Uterus
Located between the bladder in front and the rectum behind, it is an extraperitoneal organ.
•
Composed of myometrium and endometrium
•
It has two major divisions: body and cervix
•
•
Uterine position:
•
Flexion is axis of uterine body relative to cervix
•
Version is axis of cervix relative to vagina
•
Most uteri are anteverted and anteflexed
Cervix
•
Begins at inferior narrowing of uterus (isthmus).
•
It has a supravaginal and vaginal portion.
Fallopian Tubes
•
Connects uterus to peritoneal cavity.
•
Attached to posterior broad ligament by mesosalpinx.
•
8-10 cm in length.
•
•
Composed of four segments:
•
Interstitial
•
Isthmus, narrow portion of tube immediately adjacent to uterus.
•
Ampulla, tortuous, ecstatic portion contiguous with isthmus.
Fertilization usually occurs in this portion of tube.
•
Infundibulum, funnem-shaped opening ringed by finger-like fimbriae.
Vagina
Page 22 of 40
It is an extra-peritoneal structure, by front is related to the bladder in its most upper region
and beneath the urethra. Its back side is in contact with the pouch of Douglas. Its both
sides contacts with levator ani and urogenital diagragma.
Fig. 15: Sagittal, coronal, and axial CT scan of three different women. Note how the
enhancement of the endometrial cavity varies according to factors such as age or the
period of reproductive cycle.
References: RADIOLOGIA, COMPLEJO HOSPITALARIO DE TOLEDO, HOSPITAL
VIRGEN DE LA SALUD - Av. de Barber, 30 - Toledo/ES
Images for this section:
Page 23 of 40
Fig. 1: 3D CT Reconstructions of female pelvis. Note characteristic particularities of
female pelvic bone: Heart-shaped pelvic inlet with pelvic outlet (dashed black line), pubic
arch angle greater than 90 degrees (dashed red line), round obturator foramen (dashed
yellow line), larger and thicker bones.
Page 24 of 40
Fig. 2: 3D CT Reconstructions of female pelvis viewed from the medial surface. The
ileopectineal line (dashed pink line) is a bony prominence, wich courses from the sacral
promontory anteriorly towards the iliopubic eminence. The false pelvis is above the
ileopectineal line, while the true pelvis is below it.
Page 25 of 40
Fig. 3: 3D CT Reconstructions of male anterior abdominal wall. The anterior pelvic wall
is formed by three flat muscles and the rectus abdominis muscle; all of them continuation
of the abdominal wall. The course transversus abdiminis muscle, the inner pelvic wall
muscle, is represented by dashed white lines.
Page 26 of 40
Fig. 4: Axial CT image of female pelvis. The flat muscles that form the lateral anterior
abdominal wall include (from external to internal) the external oblique (yellow dashed
lines), internal oblique (blue points) and transversus abdominis muscles (red line). The
rectus abdominis muscles are paired, verticallv oriented, strap-like muscle, running on
either side of the midline (green dashed lines).
Page 27 of 40
Fig. 5: 3D CT Reconstructions of male posterior abdominal wall. Posterior pelvic wall is
formed by the psoas and iliacus muscles, which fuse caudally and form the iliopsoas.
The psoas major (represente by green lines) originates along the lateral surfaces of the
vertebral bodies of T12 and L1 to L5 and their associated intervertebral discs.
Page 28 of 40
Fig. 6: Axial CT image of female pelvis. The psoas and iliacus muscles merge to form
the iliopsoas complex, which continues inferiorly to insert on the lesser trochanter and
serves as a powerful hip flexor.
Page 29 of 40
Fig. 7: Pelvic floor muscles. The pelvic diaphragm is composed by three key muscles:
levator ani (formed by the pubococcygeous, iliococcygeous and puborectalis), coccygeus
(not represented) and obturator internus. The portion of the obturator internus above this
origin lies in the lateral wall of the false pelvis, whereas the lower portion forms part of
the lateral wall of the ischiorectal fossa.
Page 30 of 40
Fig. 8: Schematic representation of the ligaments and spaces at the cervical/vaginal
junction. The ligaments are visceral ligaments, which are composed of specialized
endopelvic fascia and contain vessels, nerves and lymphatics. The main supporting
ligaments for the uterus are the cardinal and uterosacral ligaments. (Source - Diagnostic
and Surgical Imaging Anatomy. Michael Federle. Page 1051 -).
Page 31 of 40
Fig. 9: Sagittal graphic of the female pelvis shows the bladder, uterus and rectum, all
of wich are extraperitoneal. The peritoneum has been highlighted to show the cul-de
sacs. Posteriorly, the peritoneum extends along the posterior vaginal fornix, creating
the posterior cul-de-sac (pouch of Douglas), the most dependent portion of the pelvis.
Anteriorly, at the level of the lower uterine segment, the peritoneum is reflected over the
dome of the bladder, creating the anterior cul-de-sac. (Source - Diagnostic and Surgical
Imaging Anatomy. Michael Federle. Page 1053 -).
Page 32 of 40
Fig. 10: Axial CT images at L4/L5 level in portal fase and MIP angio TC reconstruction.
Note how the abdominal aorta divides into common iliac arteries at L4-L5 level and how
after these division these vessels run anterior iliac veins and inferior to vena cava.
Page 33 of 40
Fig. 11: Axial CT images at S2 level showing distal pelvic vessels. The common iliac
arteries divide, at the level of L5-S1, into two branches, the external and internal iliac
(hypogastric) arteries. The external iliac artery supplies the lower extremity, while the
hypogastric artery supplies the pelvic viscera and muscles of the pelvis.
Page 34 of 40
Fig. 12: Sagittal CT images at S2 level showing pelvic structures of the digestive tract.
The green dashed line divides the pelvic colon structures from abdominal portion. Note
the relationship between the male and female pelvic structures as the rectosigmoid
junction is sacral level.
Page 35 of 40
Fig. 13: Coronal reformatted CT urogram. Distal ureters enter the pelvis in front of the
psoas muscle.Note how at inferior iliac spine level ureters curve anteromedially to enter
bladder at level of seminal vesicles in men and cervix in women.
Page 36 of 40
Fig. 14: Axial CT view from principal pelvic male anatomic structures at urinary bladder
level.
Page 37 of 40
Fig. 15: Sagittal, coronal, and axial CT scan of three different women. Note how the
enhancement of the endometrial cavity varies according to factors such as age or the
period of reproductive cycle.
Page 38 of 40
Conclusion
Accurate knowledge of pelvic anatomy helps distinguish the precise location of the
affected structures, and together with the clinical history, helps establish a differential
diagnosis, which can sometimes be crucial in patient management and secondarily in
its evolution.
Personal information
Lina Marcela Cruz Hernandez
Radiology Resident
Department of Medical Imaging Virgen de la Salud Hospital
Toledo - Spain
[email protected]
Carmen Cereceda Nieves
Consultant Radiologist
Department of Medical Imaging Virgen de la Salud Hospital
Toledo - Spain
[email protected]
References
Siddall K, et al. VMultidetector CT of the Female Pelvis.Radiol Clin N Am 43 (2005) 1097
- 1118.
Federle, et al. Diagnostic and Surgical Imaging Anatomy. 1et ed. 2004.
Fielding J, et al. MR imaging of the female pelvis. Radiol Clin N Am 41 (2003) 179-192.
Page 39 of 40
Federle, et al. Diagnostic Imaging. Abdomen. 1et ed. 2004.
Moore KL and Dalley AF. Clinically Orientated Anatomy. 1999. 4th edition.
Myron P, et al. MComputed tomography in the differential diagnosis of pelvic and
extrapelvic disease. RadioGraphics. Volume 5, Number 4 ' July, 1985.
Netter. Human Anatomy Atlas. 2007. 4th edition.
Page 40 of 40