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Step by Step®
Cross-sectional
Anatomy
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Jaypee
Step by Step®
Cross-sectional
Anatomy
Second Edition
D Karthikeyan DMRD DNB

Consultant Radiologist
Bengaluru, Karnataka, India
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Step by Step Cross-sectional Anatomy

© 2011, Jaypee Brothers Medical Publishers
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First Edition: 2005

Reprint: 2007
Second Edition: 2011
ISBN 978-93-80704-88-3
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
To
Our teachers and patients
Preface to the Second Edition
Multislice computed tomography has changed the way of

looking at the human anatomy dramatically. Knowledge
and understanding of cross-sectional and 3D anatomy is
essential for all those involved in performing CT scans.
Designed for easy reference, this illustrated manual is a
practical first-step guide towards interpretation of CT
studies.
D Karthikeyan
Preface to the First Edition
Computed tomography has changed the way of looking

at the human anatomy dramatically. Knowledge and
understanding of cross-sectional anatomy is essential for
all those involved in performing CT scans. Designed for
easy reference this illustrated manual is a practical first-
step guide towards interpretation of CT studies.
D Karthikeyan
Deepa Chegu
Contents
1. Brain ............................................................. 1
2. Temporal Bone ............................................ 41
3. Paranasal Sinuses ........................................ 59
4. Neck ............................................................ 69
5. Lungs .......................................................... 95
6. Abdomen ................................................... 123
7. Lower Limb ............................................... 175
8. Upper Limb ............................................... 213
9. Skull Base ................................................. 243
10. Spine ......................................................... 257
11. Orbits ........................................................ 267
12. Cardiac CT Anatomy ................................. 277
Index .................................................................... 299

Chapter 1
2 STEP BY STEP CROSS-SECTIONAL ANATOMY
BRAIN—AN OVERVIEW
Structure Description Significance
Forebrain Prosencephalon Comprised of: telencephalon or

cerebral hemispheres and
diencephalon; site of termination
of cranial nerves I and II; contains
lateral and third ventricles
Midbrain Mesencephalon Connects forebrain and

hindbrain; site of origin of cranial
nerves III and IV; contains cerebral
aqueduct
Hindbrain Rhombencephalon Comprised of: metencephalon or

pons and cerebellum and
myelencephalon or medulla
oblongata; site of origin for
cranial nerves V-XII (except spinal
part of accessory nerve); contains
fourth ventricle
Telencephalon Rostral part of Comprised of: cerebral

forebrain hemispheres and basal ganglia;
contains lateral ventricles
Diencephalon Caudal portion of Comprised of: thalamus,

forebrain metathalamus, subthalamus,
epithalamus; contains third
ventricle
Mesencephalon Midbrain Contains the corpora
quadrigemina
Metencephalon Rostral part of Comprised of: pons and
rhombencephalon cerebellum
Myelencephalon Caudal part of Comprised of: medulla

rhombencephalon oblongata; medulla becomes
continuous with the spinal cord
at the level of the foramen
magnum
BRAIN 3
FEATURES OF THE BRAIN—LATERAL VIEW
Cerebral Telencephalon Comprised of: cortex

hemispheres featuring gyri, sulci,
fissures and lobes;
commissures connecting
parts; basal ganglia;
contains lateral ventricles;
termination of the
olfactory tract
Longitudinal Midline, sagittal Contains the falx

fissure cleft separating the cerebri
paired cerebral
hemispheres
Frontal pole The most anterior Frontal pole is part of the

part of the cerebral frontal lobe
hemisphere
Temporal pole The most anterior

part of the temporal
lobe
Occipital pole The most posterior Occipital pole is part of the

part of the cerebral occipital lobe; composed of
hemisphere primary visual cortex
Central sulcus Separates frontal Separates the precentral

and parietal lobes gyrus (motor) from the
postcentral gyrus (sensory)
Frontal lobe Rostral to central Contains prefrontal

sulcus (emotions, personality)
and precentral (primary
and secondary motor)
areas
Contd...
Contd...
Parietal lobe Separated from the frontal Contains the primary and
lobe by the central sulcus, secondary somatosensory
separated from occipital areas
lobe by line through parieto-
occipital sulcus
Temporal lobe Separated from the frontal Primarily concerned with

lobe by the lateral sulcus hearing and memory/
learning
Occipital lobe Posterior to an imaginary Contains the primary

line through parieto- and secondary visual
occipital sulcus cortex
Precentral Most caudal gyrus of the Contains the primary

gyrus frontal lobe; it lies rostral motor cortex
to the central sulcus
Postcentral Most rostral gyrus of the Contains the primary

gyrus parietal lobe; it lies caudal sensory cortex
to the central sulcus
Superior Gyrus between the lateral Contains the primary

temporal sulcus and the superior auditory cortex
gyrus temporal sulcus
Middle Gyrus between the superior

temporal gyrus and inferior temporal sulci
Inferior Gyrus between the inferior
temporal temporal sulcus and the
gyrus inferior margin of the
temporal lobe
Insula Portion of the cerebrum Also known as the island of
located deeply within the Reil
lateral sulcus
Straight gyrus Gyrus located on the Also known as: gyrus rectus
medial side of the
olfactory tract
Contd...
BRAIN 5
Contd...
Uncus Portion of the cerebral Contains olfactory cortex

cortex on the medial side
of the parahippocampal
gyrus and overlying the
amygdala; located near
the free edge of the
tentorium cerebelli
Longitudinal Midline, sagittal cleft Also known as: longitudinal

sulcus separating the paired fissure
cerebral hemispheres
Precentral The sulcus anterior to the In conjunction with the

sulcus precentral gyrus central sulcus, it defines the
precentral gyrus (motor)
Postcentral The sulcus posterior to the In conjunction with the

sulcus postcentral gyrus central sulcus, it defines the
postcentral gyrus (sensory)
Lateral sulcus Separates frontal lobe and The insula lies in the floor
temporal lobe of this sulcus
Superior Sulcus between the superior Used to define the superior
temporal sulcus and middle temporal gyri and middle temproal gyri
Inferior Sulcus between thIe middle Used to define the middle
temporal sulcus and inferior temporal gyri and inferior temporal gyri
Parieto-occipital Sulcus between the parietal Landmark used to define

sulcus and occipital lobes the borders of the parietal
and occipital lobes when
viewing the cerebral
hemisphere from a medial
perspective
Preoccipital A shallow notch in the A surface landmark for
sulcus inferior surface of the defining the border
cortex (superior to the between the parietal and
cerebellum) as seen in occipital lobes
lateral view
Contd...
Contd...
Brainstem Comprised of: midbrain, Origin of most of the

pons and medulla cranial nerves
oblongata

hindbrain; the site of origin
of cranial nerves III and IV;
contains cerebral aqueduct
Pons Anterior portion of The site of origin of cranial

the metencephalon nerves V, VI, VII and VIII;
forms part of the anterior
wall of the fourth ventricle
Medulla Also known as: It is continuous with the

oblongata myelencephalon; most spinal cord at the foramen
caudal portion of the magnum; upper portion
brainstem forms the floor of the fourth
ventricle; the site of origin
for cranial nerves VIII, IX,
X, XI (cranial root), and
XII
FEATURES OF THE BRAIN—INFERIOR VIEW

hemispheres featuring gyri, sulci, fissures
and lobes; commissures
connecting parts; basal
ganglia; contains lateral
ventricles; termination of
the olfactory tract (cranial
nerve I)
Contd...
BRAIN 7
Contd...
Longitudinal Midline, sagittal cleft Longitudinal sulcus

fissure separating the paired
Frontal The most anterior part Frontal pole is part of the

pole of the cerebral hemisphere frontal lobe
Temporal The most anterior part

pole of the temporal lobe
Occipital The most posterior part Occipital pole is part of the

pole of the cerebral hemisphere occipital lobe; composed of
primary visual cortex
Frontal Rostral to central sulcus Contains prefrontal

pole (emotions, personality)
motor) areas
Temporal Separated from the Primarily concerned with

lobe frontal lobe by the hearing and memory/
lateral sulcus learning
Occipital Posterior to an imaginary Contains the primarily
lobe line through parieto- visual cortex
occipital sulcus
Limbic Structures on the medial Primarily concerned with
lobe surface of the cerebral emotions and memory
hemisphere which
surround the rostral
brainstem; includes the
subcallosal gyrus, cingulate
gyrus and parahippo-
campal gyrus
Parahippocam- Gyrus on the inferior The uncus is a medial
pal, gyrus surface of the temporal projection of the
lobe that lies lateral to parahippocampal gyrus
the midbrain
Contd...
Contd...
Straight Gyrus located on the Gyrus rectus

gyrus medial side of the
olfactory tract
Lingual gyrus Gyrus lying inferior to Contains primary visual

the calcarine sulcus cortex
Uncus Portion of the cerebral Contains olfactory cortex

cortex on the medial side
of the parahippocampal
gyrus and overlying the
amygdala; located near
the free edge of the
tentorium cerebelli
Apex of cuneus Portion of the cuneus Contains part of the visual

seen in an inferior view cortex
of the cerebral hemisphere
Longitudinal Midline, sagittal cleft Longitudinal

sulcus separating the paired fissure
Olfactory Sulcus that defines the Contains the olfactory bulb

sulcus lateral margin of the and tract
straight gyrus
Mamillary body Part of the hypothalamus; Involved with memory and

a small spherical projection learning
on the inferior surface of
the floor of the third
ventricle posterior to the
hypophysis

oblongata
Contd...
BRAIN 9
Contd...

Pons Anterior portion of the The site of origin of cranial

metencephalon nerves V, VI, VII and VIII;
Medulla Myelencephalon; It is continuous with the

oblongata most caudal portion spinal cord at the foramen
of the brainstem magnum; upper portion
forms the floor of the fourth
XII
Olfactory bulb Flattened, oval enlargement Contains the olfactory

at the anterior tip of the mitral cells which are the
olfactory tract origin of the axons that
course through the
olfactory tract; the
olfactory nerve begins at
the bipolar olfactory cells
in the nasal mucosa and
courses through the
cribriform plate to the
olfactory bulb
Olfactory tract Ribbon-like nerve tract Carries the sense of smell

that courses from the
olfactory bulb to the
cerebral cortex; it courses
in the olfactory sulcus
Contd...
Contd...
Optic chiasm Crossover point for the Lateral visual fields (medial
nasal fibers of both retinas retinal fibers) project to the
contralateral occipital lobe
Hypophysis Midline projection of Also known as: pituitary
neural and endocrine gland
tissue attached to the
floor of the diencephalon
FEATURES OF THE BRAIN—MID-SAGITTAL VIEW

hemispheres featuring gyri, sulci, fissures
and lobes; commissures
connecting parts; basal
ganglia; contains lateral
ventricles; termination of
the olfactory tract (cranial
nerve I)
Longitudinal Midline, sagittal cleft Longitudinal sulcus;
fissure separating the paired contains the falx
cerebral hemispheres cerebri
Frontal lobe Rostral to central sulcus Contains prefrontal
(emotions, personality)
motor) areas
Parietal lobe Separated from the Contains the primary and

frontal lobe by the secondary somatosensory
central sulcus, separated areas
from occipital lobe by line
through parieto-occipital
sulcus
Contd...
BRAIN 11
Contd...
Occipital lobe Posterior to line through Contains the primary and

parieto-occipital sulcus secondary visual cortex
Limbic lobe A border (limbus = Latin Part of the brain responsible

for border) of cortical tissue for behavior and emotions
surrounding the third
ventricle; comprised of:
cingulate gyrus, parahippo-
campal gyrus, uncus and
other small portions of the
adjacent cortex
Cingulate gyrus The portion of the limbic Cingulate gyrus is bounded

lobe that lies superior to by the callosal sulcus and
the corpus callosum the cingulate sulcus
Straight gyrus Gyrus located on the Gyrus rectus

medial side of the
olfactory tract
Lingual gyrus The portion of the Cortical projection of the

occipital lobe that lies upper half of the
inferior to the calcarine contralateral visual field
sulcus
Cingulate sulcus The sulcus that lies superior

to the cingulate gyrus
Central sulcus Separates the frontal lobe Fissure of Rolando

from the parietal lobe;
separates sensory cortex
from motor cortex
Parieto- Sulcus on the medial Forms the boundary

occipital surface of the cerebral between the parietal lobe
sulcus hemisphere that lies and the occipital lobe
between the precuneus
and the cuneus
Contd...
Contd...
Calcarine sulcus Sulcus between the Primary visual cortex is

lingual gyrus and the both superior and inferior
cuneus to it
Cuneus Part of the cerebral cortex Cortical projection of the

that forms the upper wall lower half of the
of the calcarine fissure contralateral visual field
Pineal gland Pineal body Represents an endocrine

gland attached to
diencephalon
Corpus callosum Midline part of great Connects paired cerebral

cerebral commissure hemispheres
Anterior A bundle of association Connections between the

commissure fibers located anterior left and right temporal lobes
to the third ventricle
Posterior A bundle of association Connections between
commissure fibers located posterior to various areas of the right
the third ventricle, just and left sides of the
inferior to the pineal gland midbrain
Optic chiasm Crossover point for the Lateral visual fields (medial
nasal fibers of both retinas retinal fibers) project to the
contralateral occipital lobe
Thalamus An egg-shaped collection Distributes information to
of nuclei forming part of appropriate areas of the
the lateral wall of the cerebral cortex
third ventricle
Hypothalamus A collection on nuclei Controls visceral activity
forming the anterior and elicits phenomena
portion of the lateral associated with the
wall of the third ventricle emotions
Body of fornix A group of nerve cell Main efferent fiber system
fibers arching beneath of the hippocampal
the corpus callosum formation
Contd...
BRAIN 13
Contd...
Hypophysis Midline projection of Pituitary gland
neural and endocrine tissue
attached to the floor of the
diencephalon
oblongata
Pons Anterior portion of the The site of origin of cranial
Medulla Myelencephalon; most It is continuous with the
oblongata caudal portion of the spinal cord at the foramen
brainstem magnum; upper portion
XII
Cerebellum Posterior part of Largest part of hindbrain;
metencephalon important for coordination
of movement
FEATURES OF THE BRAINSTEM

hindbrain; site of origin of
cranial nerves III and IV;
Contd...
Contd...
Pons Anterior portion of Site of origin of cranial

Medulla Myelencephalon; most Continuous with the spinal

oblongata caudal portion of cord at the foramen
brainstem magnum; upper portion
ventricle; site of origin for
cranial nerves IX, X, XI
(cranial root), and XII
SURFACE FEATURES OF THE BRAINSTEM AS

SEEN ON MID-SAGITTAL VIEW
Midbrain
Tectum The roof of the midbrain, Also known as:

formed by the superior quadrigeminal plate
and inferior colliculi;
located dorsal to the
cerebral aqueduct
Superior Paired elevations of Part of corpora

colliculus midbrain tectum quadrigemina; important
for reflex movements of
eye, head and neck
Inferior Paired elevations of Part of corpora

colliculus midbrain tectum quadrigemina; important
for auditory reflexes
Tegmentum The collection of cells Gives rise to the middle

and nerve fibers located cerebellar peduncle
ventral to the ventricle
Contd...
BRAIN 15
Contd...
system in the midbrain,

pons and medulla
Cerebral Canal connecting third Also known as: aqueduct

aqueduct and fourth ventricles, of Sylvius
passing through midbrain
Pons
Fourth Midline space between Communicates

ventricle cerebellum posteriorly and anterosuperiorly with third
pons and upper medulla ventricle via cerebral
anteriorly aqueduct; drains CSF via
median aperature and
lateral aperatures
Central canal Small opening in the Continuous with the

of spinal cord center of the spinal cord central canal of the medulla
and, through it, with the
fourth ventricle of the brain
VENTRICULAR SYSTEM OF THE BRAIN
Lateral Paired spaces within They drain cerebrospinal

ventricle cerebral hemispheres fluid to the third ventricle
via the interventricular
foramina (of Monro)
Third Midline space within Communicates

ventricle the diencephalon between rostrolaterally with paired
the paired dorsal thalami lateral ventricles via
and the hypothalamus interventricular foramina,
communicates
posteroinferiorly with
fourth ventricle via cerebral
aqueduct
Contd...
Contd...
Fourth Midline space between Communicates

ventricle cerebellum posteriorly anterosuperiorly with third
and pons and upper ventricle via cerebral
medulla anteriorly aqueduct; drains CSF via
median aperature and
lateral aperatures
Choroid plexus Vascular membranes that Production of

occur within the ventricles cerebrospinal fluid
Interventricular Communication between Also known as: foramina

foramen the lateral ventricle and the of Monro
third ventricle; paired,
one on each side
Cerebral Canal connecting third Also known as: aqueduct

aqueduct and fourth ventricles, of Sylvius
passing through midbrain
Median Midline, irregular foramen Also known as: foramen of

aperature draining fourth ventricle Magendie
posteroinferiorly into
cerebellomedullary cistern
Lateral Paired foramina draining Also known as: foramina

aperature fourth ventricle laterally of Luschka
into cerebellomedullary
cistern
Central canal Small opening in the center Continuous with the

of spinal cord of the spinal cord central canal of the medulla
and, through it, with the
fourth ventricle of the brain
BRAIN 17
BLOOD SUPPLY TO THE BRAIN

Artery Source Branches Supply to Notes
Anterior spinal Contributions Pial arterial Meninges; spinal Anterior spinal

received from plexus cord; medulla artery
several arteries (dorsal motor anastomoses
(vertebral, nucleus of with the nterior
posterior cranial nerve X, radicular brs. of
intercostal, nucleus the spinal rami
subcostal, ambiguous, of the vertebral,
lumbar, lateral spinal accessory posterior
sacral aa.) nucleus and intercostal,
hypoglossal subcostal,
nucleus) lumbar and
lateral sacral
artery
Formed by the Pontine brs., Pons (motor Basilar a.
Basilar
joining of the anterior inferior nucleus of contributes
two vertebral aa. cerebellar a., cranial nerve V, blood to the
superior chief sensory cerebral arterial
cerebellar a., two nucleus of circle
posterior cranial nerve V,
cerebral aa. abducens
(terminal brs.) nucleus, facial
nucleus,
superior
salivatory
nucleus);
oculomotor
nucleus; nucleus
of Edinger-
Westphal;
cerebellum;
posterior
cerebrum
Cerebellar, Basilar a. Labyrinthine a. Pons (motor Anterior
anterior inferior (usually) nucleus of inferior
cranial nerve V, cerebella a.
chief sensory shares its region
nucleus of of supply with
cranial nerve V, branches of the
abducens basilar a.
nucleus, facial
nucleus,
superior
salivatory
nucleus);
cerebellum;
inner ear
Contd...
Contd...
Cerebellar, Vertebral a. Posterior spinal Part of Posterior

posterior a. cerebellum; inferior
inferior medulla cerebellar a.
(cochlear shares its region
nucleus, of supply with
vestibular the vertebral a.
nucleus, dorsal and anterior
motor nucleus of spinal a.
cranial nerve X, (watershed
nucleus region)
ambiguous)
Cerebellar, Basilar a. No named Upper There may be
superior branches cerebellum; more than one
trochlear superior
nucleus cerebellar a.
arising from the
basilar a. on
each side
Cerebral, Internal Anterior Medial and The anterior

anterior carotid a. communicating inferior portions communicating
a., medial of the frontal a. unites the two
frontobasal a., lobe; medial side anterior cerebral
polar frontal a., of the parietal aa. across the
callosomarginal lobe; corpus midline
a., precuneal a. callosum and
part of the limbic
lobe; olfactory
bulb and tract;
optic nerve,
optic chiasm and
optic tract
Cerebral An anastomotic This is an Brain and Also known as:

arterial circle circle of blood anastomotic midbrain arterial circle of
vessels formed loop; major Willis
by portions of named vessels
the following connect here, but
vessels: posterior there are no
cerebral aa. (2); named branches
posterior of the arterial
communicating circle
aa. (2); internal
carotid aa. (2);
anterior cerebral
aa. (2); anterior
communicating
a.
Contd...
BRAIN 19
Contd...
Middle cerebral Internal Lateral Frontal, parietal The middle
carotid a. frontobasal a.; and temporal cerebral a. is the
prefrontal sulcal lobes, especially direct
a.; precentral on their lateral continuation of
sulcal a.; central surfaces the internal
sulcal a.; anterior carotid a.
parietal a.;
posterior
parietal a.;
anterior, middle
and posterior
temporal aa.
Posterior Basilar a. Posterior Part of the The two

cerebral cerebral a.; brainstem posterior
anterior and (oculomotor cerebral aa. are
posterior nucleus, nucleus the terminal brs.
temporal brs.; of Edinger- of the basilar a.
medial occipital Westphal,
a. trochlear
nucleus); medial
and inferior
portions of the
temporal lobe;
occipital lobe
Anterior Anterior Perforating aa. An anastomotic Anterior

communicating cerebral a. connection communicating
a. is a short
vessel of
anastomosis
which crosses
the midline to
join the paired
anterior cerebral
aa.; it is part of
the Circle of
Willis
Posterior Internal Perforating aa. An anastomotic A vessel of
communicating carotid a. connection anastomosis
which connects
the internal
carotid a. to the
posterior
cerebral a.; part
of the cerebral
arterial circle (of
Willis)
Contd...
Contd...
Ophthalmic Internal carotid Central retinal a., Optic nerve, Ophthalmic a.
a. lacrimal a., optic chiasm provides the
muscular brs., optic tract, only artery to
anterior retina, the retina
ethmoidal a., extraocular mm., (central retinal
posterior eyelids, a.)
ethmoidal a., forehead,
medial palpebral ethmoidal air
a., supraorbital cells, lateral
a., supratro- nasal wall,
chlear a., dorsal dorsum of the
nasal a. nose
Vertebral Subclavian a. Spinal brs., Deep neck, Vertebral a.
(1st part) muscular brs., cervical spinal anastomoses
anterior spinal cord, spinal with the internal
a., posterior cord; medulla carotid a. in the
inferior (dorsal motor cerebral arterial
cerebellar a., nucleus of circle (of Willis);
medullary brs., cranial nerve X, it courses
meningeal brs., nucleus through the
basilar a. ambiguus, spinal transverse
accessory foramina of
nucleus and vertebrae C1-C6
hypoglossal
nucleus)
Anterior spinal Contributions Pial arterial Meninges; spinal The anterior
received from plexus cord; medulla spinal a.
several arteries (dorsal motor anastomoses
(vertebral, nucleus of with the
posterior cranial nerve X, anterior
intercostal, nucleus radicular brs. of
subcostal, ambiguous, the spinal rami
lumbar, lateral spinal accessory of the vertebral,
sacral aa.) nucleus and posterior
hypoglossal intercostal,
nucleus) subcostal,
lumbar and
lateral sacral aa.
BRAIN 21
FIGURE 1.1: Diagram showing the circle of Willis
FIGURE 1.2: Schematic diagram for neck veins

FIGURE 1.3: 3D VR image showing the anterior circulation
FIGURE 1.4: 3D VR image showing circle of Willis

BRAIN 23
VENOUS DRAINAGE OF THE BRAIN
Vein Tributaries Drains into Regions Drained
Great cerebral Formed by the Straight sinus Deep portions of

union of the paired the cerebrum
internal cerebral vv.
Inferior cerebral Tributaries are Cavernous sinus, Inferior aspect of

unnamed transverse sinus, the cerebral
superior petrosal hemispheres
sinus
Superiorc cerebral Tributaries are Superior sagittal Superior aspect of

unnamed sinus the cerebral
hemispheres
Inferior sagittal Unnamed Unites with the Medial surfaces fo

sinus tributaries from the great cerebral v. to the cerebral
falx cerebri and form the straight hemispheres
cerebral sinus
hemispheres
Inferior petrosal Cavernous sinus Sigmoid sinus, at All regions drained
sinus its distal end by the cavernous
sinus, including the
orbit and brain
Occipital sinus No named Confluens of Cerebellum

tributaries sinuses
Superior petrosal Cavernous sinus Sigmoid sinus, at its All regions drained
sinus proximal end by the cavernous
sinus, including the
orbit and brain
Superior sagittal V. of the foramen Confluens of Cerebral

sinus cecum; superior sinuses hemispheres
cerebral vv.
Straight sinus Inferior sagittal Confluens of Deep parts of the

sinus, great cerebral sinuses cerebrum,
vein, superior cerebellum
cerebellar vv.
Transverse Confluence of Sigmoid sinus Brain

sinus sinuses, inferior
cerebral vv.
FIGURE 1.5: 3D VR fusion image showing the circle of Willis

BRAIN 25
FIGURE 1.6: Schematic diagram showing dural venous sinuses
FIGURE 1.7: 3D integral projection of cerebral sinuses

FIGURE 1.8: Frontal radiograph of skull

1. Frontal sinus
2. Crista galli
3. Cribriform plate
4. Lesser wing of sphenoid
5. Superior orbital fissure
6. Superior border of petrous part of temporal bone
7. Dense shadow of petrous part of temporal bone
8. Perpendicular plate of the ethmoid
9. Vomer
10. Maxillary sinus
11. Inferior concha
12. Ramus of mandible
13. Body of mandible
BRAIN 27
FIGURE 1.9: Lateral radiograph of skull

1. Frontal sinus
2. Ethmoidal sinus
3. Sphenoidal sinus
4. Maxillary sinus
5. Anterior clinoid processes
6. Hypophyseal fossa
7. Posterior clinoid processes
8. Clivus
9. Great density of the petrous part of the temporal bone
10. External acoustic meatus
11. Mastoid cells
12. Nasopharynx
13. Angle of mandible
14. Anterior arch of the atlas
15. Dens of axis
16. Posterior arch of the atlas
17. Internal occipital protuberance
A. Coronal suture
B. Lambdoid suture
C. The grooves for the branches of the middle meningeal vessels
AXIAL ANATOMY—BRAIN
FIGURE 1.10: Digital scanogram brain

BRAIN 29
FIGURE 1.11 Axial CT at the level of medulla
FIGURE 1.12: Axial CT at the level of pons

FIGURE 1.13: Axial CT at the level of sella
FIGURE 1.14: Axial CT at the level of suprasellar cistern

BRAIN 31
FIGURE 1.15: Axial CT at the level of circle of Willis
FIGURE 1.16: Axial CT at the level of tentorial hiatus

FIGURE 1.17: Axial CT at the level of optic chiasma
FIGURE 1.18: Axial CT at the level of ambient cistern

BRAIN 33
FIGURE 1.19: Axial CT at the level of third ventricle
FIGURE 1.20: Axial CT at the level of basal ganglia

FIGURE 1.21: Axial CT at the level of lateral ventricle
FIGURE 1.22: Axial CT at the level of corona

BRAIN 35
FIGURE 1.23: Axial CT at the supraventricular level
FIGURE 1.24: Axial CT at the level of central fissure

FIGURE 1.25: Axial CT at the level of centrum
FIGURE 1.26: Schematic diagram showing the various sulci and gyri
BRAIN 37
FIGURE 1.27: Axial sections showing important sulci and gyri

FIGURE 1.28: Coronal section showing orbital sulci and gyri
FIGURE 1.29: Mid-sagittal section showing

cingulate and callosal region
BRAIN 39
FIGURE 1.30: Axial section showing thalami and basal ganglia

CAU—Caudate, GB—Globus pallidum, TH—Thalamus, PU—Putamen,
ICa—Internal capsule anterior limb, ICp—Internal capsule posterior limb
NAMED GYRI AND SULCI

AnG angular gyrus cerebellum
FP frontal pole
IFG inferior frontal gyrus
IOG inferior occipital gyrus
ITG inferior temporal gyrus
LOG lateral occipital gyrus
MFG middle frontal gyrus
MTG middle temporal gyrus
OG orbital gyrus pons
oper pars opercularis (IFG)
orb pars orbitalis (IFG)
tri pars triangularis (IFG)
poCG postcentral gyrus
preCG precentral gyrus
SFG superior frontal gyrus

SOG superior occipital gyrus
SPL superior parietal lobe
STG superior temporal gyrus
SmG supramarginal gyrus
TP temporal pole
cs central sulcus (Rolandic)
hr horizontal ramus
ifs inferior frontal sulcus
ios inferior occipital sulcus
ips intraparietal sulcus
syl lateral fissure (Sylvian)
los lateral occipital sulcus
ls lunate sulcus
pof parieto-occipital fissure
pocs postcentral sulcus
precs precentral sulcus
sfs superior frontal sulcus
tos transoccipital sulcus
vr vertical ramus
ac anterior commissure
cals calcarine sulcus
cings cingulate sulcus
CingG cingulate gyrus
ccb corpus callosum (body)
ccg corpus callosum (genu)
ccs corpus callosum (splenium)
cuneus
fornix
lingual lingual gyrus
mb mamillary bodies
PL paracentral lobule precuneus
q quadrigeminal plate
The temporal bone contains the sensory organs of hearing

and balance, and structurally contributes to the cranial
vault. The temporal bone consists of five parts: the squa-
mous, the mastoid, the tympanic, zygomatic and petrous
segment. It contains portions of the carotid artery and
jugular venous drainage system, and is intimately related
to the dura of the middle and posterior fossa. Anteriorly, it
articulates with the condyle of the mandible. Posteriorly,
and superiorly, the mastoid air cell system communicates
with the middle ear. The facial nerve passes through the
temporal bone en route to the muscles of facial expression.
FIGURE 2.1: Diagram showing structure of auditory apparatus
THE EAR
Both functionally and anatomically, the ear can be divided
into three parts.
TEMPORAL BONE 43
EXTERNAL EAR
That portion external to the tympanic membrane. It serves
chiefly to protect the tympanic membrane, but also collects
and directs sound waves and plays a role in sound
localization. The skin of the external ear normally migrates
laterally from the umbo of the malleus in the tympanic
membrane to the external auditory meatus (at a rate of 2-
3 mm per day). This is a unique and essential mechanism
for maintaining patency of the canal.
The Auricle
Elastic cartilage covered with closely adherent skin. The
configuration is intricate, and extremely difficult to
duplicate.
External Auditory Canal

• Lateral portion—Cartilaginous with thick, loosely
applied skin containing ceruminous and sebaceous
glands.
• Medial portion—Very thin skin directly over bone,
no skin appendages. Curves anteriorly and medially in
adults, which may obscure the anterior tympanic
membrane. It comprises two-thirds of the total canal in
adults, less in infants and children.
THE MIDDLE EAR

This is an air-containing space which communicates with
the nasopharynx via the eustachian tube. It is normally
sealed laterally by the tympanic membrane. Its function is
FIGURE 2.2: Schematic diagram of middle ear structures
to transmit and amplify sound waves from tympanic memb-

rane to the stapes footplate converting energy from air
medium to a fluid medium of the membranous labyrinth.
The relationship of the three ossicles is depicted below.
LEFT EAR VIEWED POSTERIORLY

• The tympanic membrane is an ovoid, three-layered
structure consisting of squamous epithelium laterally,
respiratory mucosa medially, and an intervening fibrous
layer. It normally has a conical shape, with the apex
maintained medially by the support of the malleus. The
fibrous layer thickens laterally to form the annulus, an
incomplete ring which is attached to surrounding bone.
Superior to the lateral process of the malleus, this ring
TEMPORAL BONE 45
FIGURE 2.3: Schematic diagram of tympanic membrane
is deficient, and this area is known as the pars flaccida.

The majority of the drum is composed of the pars tensa.
• Ossicles—Three small bones which are involved in
sound conduction. From lateral to medial, these are
the malleus, the incus, and the stapes. The handle and
lateral process of the malleus is attached to the tympanic
membrane and can be easily seen on physical exam.
The long process of the incus can often be seen through
the posterior superior quadrant of the membrane. The
stapes is attached to a footplate which is in direct contact
with the fluid of the inner ear (See Figures 2.1 and
2.3).
• Spaces—The middle ear cleft is wider than the

tympanic membrane, and is conventionally divided into
spaces in reference to the annulus.
• Epitympanum—Superior to the tympanic mem-
brane. Contains the body of the incus and the head
of the malleus. Communicates with the mastoid via
the aditus.
• Mesotympanum—On a level with the eardrum.
The oval and round windows, located postero-
superiorly on the medial wall, communicate with
the inner ear. The long process of the incus projects
into the posterior quadrant to articulate with the
stapes which sits in the oval window. The facial
nerve, usually covered by a bony canal, crosses the
posterior superior quadrant superior to the stapes,
then courses inferiorly between the middle ear and
mastoid air cells.
• Protympanum—In this anterior recess of the
middle ear, the eustachian tube exits to communi-
cate with the nasopharynx. This tube runs in close
proximity to the carotid artery.
• Hypotympanum—The jugular bulb curves through
the hypotympanum. It is usually covered by bone,
but may be dehiscent and extend into the middle
ear space.
INNER EAR
Consists of a fluid-filled labyrinth which functions to convert
mechanical energy into neural impulses. The bony labyrinth
TEMPORAL BONE 47
FIGURE 2.4: Diagram of vestibulo-cochlear apparatus
FIGURE 2.5: 3D VR showing cochlea and semicircular canals

is subdivided into smaller compartments by the membra-

nous labyrinth. Fluid surrounding the membranous
labyrinth is called perilymph; fluid within is called
endolymph. There are three main divisions of the bony
labyrinth.
• Vestibule—Just medial to the oval window, and
contains the utricle and the saccule, two organs of
balance. The vestibule is an antechamber, leading to
both the cochlear and the semicircular canal.
• The cochlea—A snail-shaped chamber anterior to the
vestibule. It bulges into the middle ear and its bony
covering is the promontory. The cochlea also com-
municates with the middle ear via the round window.
In this organ, sound waves are converted into neural
impulses with elaborate coding.
• The Semicircular canals—Three in number; project
posteriorly from the vestibule. These organs detect
angular acceleration. They consist of a superior,
posterior and lateral, or horizontal canals.
The nerve fibers from the labyrinth make up the audi-
tory nerve which consists of a cochlear nerve and a
superior and inferior vestibular with both afferent and
efferent fibers from the respective sensory end organs.
This nerve enters the cranial cavity via the internal
auditory canal.
TEMPORAL BONE 49
FIGURE 2.6: Curved minimum intensity projection (MINIP) image

showing cochlea
FIGURE 2.7: Oblique MINIP images showing the semicircular canals
AXIAL HRCT OF TEMPORAL BONE

Mastoids have three important landmarks.
1. The antrum
2. Aditus and antrum
3. Koerner’s septum.
The aditus connects the epitympanum (attic) to the

mastoid antrum. Koerner’s septum is part of the petro-
squamous suture that runs posterolaterally through the
mastoid air cells.
Middle ear cavity—is divided to epitympanum (attic),
mesotympanum (tympanic cavity proper) hypotympanum.
The roof of middle ear cavity is the tegmen tympani, the
tympanic membrane forms the lateral wall of the middle-
ear cavity. Inferiorly the middle ear is in relation to the
jugular bulb. The medial wall is the labyrinthine wall were
the oval window, round window and the cochlear
promontory is situated the anterior wall is in relation to the
carotid canal the posterior wall is formed by the mastoid.
Epitympanum on coronal section is that portion of the
middle ear cavity above the line drawn between the inferior
tip of scutum and the tympanic portion of the facial nerve
canal. This is the site for the malleus and incus giving rise
to the icecone sign.
Prussak’s space— area between the incus and the lateral
side wall of the epitympanum within the mesotympanum
lies the rest of the ossicles.
Inner ear—the bony labyrinth houses the cochlea, vestibule
semicircular canals, the vestibular and cochlear aqueducts.
The cochlea is situated anteroinferiorly to the vestibule and
resembles a snail shell with two and three quarter turns the
cochlear aqueduct runs medial to lateral from the basal turn
of the cochlea to the lateral border of the jugular foramen.
TEMPORAL BONE 51
Vestibule is seen as a rounded lucency in the bony

labyrinth situated lateral and posterior to the fundus of the
aim the semicircular canal projects from the superior,
posterior and lateral aspect of the vestibule the superior
semicircular canal projects on the petrous pyramid producing
the arcuate eminence. The vestibular aqueduct is seen
coursing posteroinferiorly to the posterior wall of the petrous
pyramid as hockey stick lucency.
TEMPORAL BONE–AXIAL HIGH RESOLUTION

SECTIONS
See Figures 2.8 to 2.19.
FIGURE 2.8: Axial CT at the level of stylomastoid foramina

FIGURE 2.9: Axial CT at the level of fascial nerve canal
FIGURE 2.10: Axial CT at the level of external auditory canal

TEMPORAL BONE 53
FIGURE 2.11: Axial CT at the level of tympanic cavity
FIGURE 2.12: Axial CT at the level of round window

FIGURE 2.13: Axial CT at the level of malleus/incus
FIGURE 2.14: Axial CT at the level of semicircular canals

TEMPORAL BONE 55
FIGURE 2.15: Coronal CT at the level of external auditory canal
FIGURE 2.16: Coronal CT at the level of internal auditory meatus

FIGURE 2.17: Coronal CT at the level of jugular foramen
FIGURE 2.18: Coronal CT at the level of styloid process

TEMPORAL BONE 57
FIGURE 2.19: Coronal CT at the level of stylomastoid foramen

The paransal sinuses are air containing spaces within the

facial bones which in part form the floor of the anterior
cranial fossa and skull base. These air containing spaces
are located in the frontal bones (frontal sinuses), maxillary
bone (maxillary sinuses) sphenoid bone (sphenoid sinuses)
ethmoid bones (ethmoid sinuses). These air sinuses
communicate with each other and with the nasal passages
through openings under the superior and middle turbu-
nates.
The radiological evaluation of nasal cavity and the
paranasal sinuses should stress the display of osteomeatal
units (omu) omu comprises of the maxillary sinus ostium,
the ethmoid infundibulum, anterior ethmoid cells, and the
FIGURE 3.1: Schematic showing the osteomeatal complex

PARANASAL SINUSES 61
frontal recess. These aerated channels provide airflow to

and mucociliary clearance from the frontal, maxillary,
anterior, middle ethmoidal and sphenoid sinuses.
The lateral nasal walls contain three bulbous projec-
tions—the superior, middle, and inferior turbinate. The
turbinates serve to divide the passages into superior, middle
and inferior meatus.
Superior meatus—drains the posterior ethmoid cells,
and the sphenoid sinus (via the sphenoethmoidal recess)
the middle meatus receives drainage from the frontal sinus
(via frontal recess) maxillary sinus (via the maxillary ostium
and ethmoid infundibulum) and the anterior ethmoid
aircells (via ethmoid ostia and frontal recess) the inferior
meatus receives drainage from the nasolacrimal duct.
FIGURE 3.2: 3D VR showing paranasal sinuses

FIGURE 3.3: Coronal CT at the level of frontal sinus
FIGURE 3.4: Coronal CT at the level of nasolacrimal duct

FIGURE 3.5: Coronal CT at the level of maxillary sinus
FIGURE 3.6: Coronal CT at the level of cribriform plate

FIGURE 3.7: Coronal CT at the level of planum sphenoidale
FIGURE 3.8: Coronal CT at the level of orbital apex

FIGURE 3.9: Coronal CT at the level of sphenoid sinus
FIGURE 3.10: Coronal CT at the level of foramen ovale

FIGURE 3.11: Coronal CT at the level of maxillary sinus
FIGURE 3.12: Coronal CT at the level of sphenoid sinus

FIGURE 3.13: Coronal CT at the level of ethmoid sinus
FIGURE 3.14: Coronal CT at the level of cribriform plate

The neck contains important communications between the

head and the body, including air and food passages, major
blood vessels and nerves, and the spinal cord. Many vital
structures are compressed into a narrow area which is
engineered for maximal mobility to permit variation in head
position relative to body.
SKELETON
Primarily composed of the vertebral column. Anteriorly,
the hyoid bone, and laryngeal and tracheal cartilages
support the aerodigestive spaces. These are suspended
from the mandible and base of skull by a system of muscles
and ligaments.
MUSCLES
Anteriorly, strap muscles connect the respiratory skeleton
and sternum. There are also muscular attachments from the
hyoid to the tongue, mandible, and styloid. The digastric
muscle passes forward from the mastoid, attaches to the
hyoid, then ascends to the anterior mandible. The sterno-
cleidomastoid (SCM) divides the neck into anterior and
posterior triangles. The posterior triangle is largely muscular.
The anterior triangle which contains most of the vital
structures, can be divided into smaller triangles by muscles.
The anterior and posterior bellies of the digastric form
the submandibular triangle. The submental triangle is in
the midline, between the anterior bellies. The vascular or
carotid triangle is inferior to the digastric and hyoid.
NECK 71
The omohyoid is a small muscle, running at roughly

90 degrees to the SCM, from the hyoid to the scapula.
NERVES
The neck contains major branches of cranial nerves, as
well as cervical roots.
CRANIAL NERVES
• VII—The marginal mandibular branch dips down into
the neck in the fascia overlying the submandibular
gland. In addition to the muscles of facial expression,
branches of VII innervate the platysma, the stylohyoid
and the posterior belly of the digastric.
• X—The vagus nerve exits the jugular foramen and
travels inferiorly in the carotid sheath. It carries the
parasympathetic fibers of the thoracic cavity and much
of the GI tract, as well as laryngeal and pharyngeal
sensory and motor branches.
• The Spinal Accessory Nerve (XI)—Supplies the
trapezius and sternocleidomastoid muscles. It exits the
jugular foramen, then runs posteriorly.
• The Hypoglossal Nerve (XII)—Supplies the muscles
of the tongue. The nerve exits the skull through its own
canal, runs downward in the carotid sheath, then curves
forward superficially to the carotid at the level of the
occipital artery to reach the tongue.
CERVICAL NERVES
• Cervical plexus—anterior roots of C1-4
• Ansa cervicalis—to strap muscles (some travel with
XII)
• Branches to phrenic nerve
• Sensory
• Phrenic nerve - C3-5
• Brachial Plexus C5-T1
• Posterior rami - to posterior muscles and skin
• Cervical sympathetic chain - travels in carotid sheath
MAJOR VASCULAR STRUCTURES

• Carotid artery—bifurcates into:
• Internal (intracranial)—no branches in the neck
• External (extracranial)—branches:
• Superior thyroid
• Ascending pharyngeal
• Lingual
• Facial
• Occipital
• Post-auricular
• Superficial temporal
• Internal maxillary
• Thyrocervical trunk
• Suprascapular
• Transverse cervical
• Inferior thyroid
• Vertebral artery
NECK 73
• Internal jugular vein (within carotid sheath)

• External jugular vein
VISCERAL COLUMN
Pharynx, larynx, trachea, and esophagus.
THYROID GLAND
• Developmentally derived from pharyngeal floor
• Located anterior and lateral to the trachea
• Closely related to recurrent laryngeal nerve and
parathyroid glands
• Blood supply
• Arterial
• Superior thyroid artery (branch of external
carotid)
• Inferior thyroid artery (branch of thyrocervical
trunk)
• Thyroid “ima” artery (variable)
• Venous
• Superior thyroid vein
• Middle thyroid vein
• Inferior thyroid vein
PARATHYROID GLANDS
• Four glands: two on each side
• Derived from branchial pouches III and IV: Superior
parathyroid glands from pouch IV and inferior
parathyroid gland from pouch III.
• Glands usually related to posterior surface of thyroid

gland, but may be found as inferior as mediastinum
ANATOMIC TRIANGLES (superimposed on

superficial neck anatomy)
FIGURE 4.1: Schematics of triangles of neck
The neck can be divided into two major triangles, with

multiple smaller triangles:
ANTERIOR TRIANGLE
Bordered by the anterior border of the SCM, midline of
the neck, and the mandible
• Muscular triangle—formed by the midline, superior
belly of the omohyoid, and SCM
• Carotid triangle—formed by the superior belly of
the omohyoid, SCM, and posterior belly of the digastric
NECK 75
• submental triangle—formed by the anterior belly

of the digastric, hyoid, and midline
• submandibular triangle—formed by the mandible,
posterior belly of the digastric, and anterior belly of the
digastric
POSTERIOR TRIANGLE
Bordered by the posterior border of the SCM, trapezius,
and clavicle:
• Supraclavicular triangle—formed by the inferior
belly of the omohyoid, clavicle, and SCM
• Occipital triangle—formed by inferior belly of the
omohyoid, trapezius, and SCM
Lymphatic Drainage
Major head and neck lymph node groups.
The lymph nodes of the neck can be divided into six levels
within the defined anatomic triangles. These groups and
the areas that they drain are particularly important when
locating and working up a “neck mass” or possible
malignancy. The groups and drainage areas are as follows:
FIGURE 4.2: Diagram showing level of neck nodes
• I—Submental and submandibular nodes

• II—Upper jugulodigastric group
• III—Middle jugular nodes draining the naso- and oropharynx, oral
cavity, hypopharynx, larynx.
• IV—Inferior jugular nodes draining the hypopharynx, subglottic larynx,
thyroid, and esophagus.
• V— Posterior triangle group
• VI—Anterior compartment group
NECK 77
Individual Lymph Nodes in the Head and Neck
FIGURE 4.3: Diagram showing level of head and neck nodes

FIGURE 4.4: Axial CT section at the level of trachea
FIGURE 4.5: Axial CT section at the level of thyroid

NECK 79
FIGURE 4.6: Axial CT section at the level of cricoid cartilage
FIGURE 4.7: Axial CT section at the level of thyroid cartilage

FIGURE 4.8: Axial CT section at the level of false cord
FIGURE 4.9: Axial CT section at the level of AE folds

NECK 81
FIGURE 4.10: Axial CT section at the level of base of epiglottis
FIGURE 4.11: Axial CT section at the level of pyriform sinus

FIGURE 4.12: Axial CT section at the level of hyoid bone
FIGURE 4.13: Axial CT section at the level of tongue base

NECK 83
FIGURE 4.14: Axial CT section at the level of oropharynx
FIGURE 4.15: Axial CT section at the level of uvula

FIGURE 4.16: Axial CT section at the level of naxopharynx
FIGURE 4.17: 3D VR
showing the air column
NECK 85
NECK SPACES
Fascial layers of the neck are divided into:
• Superficial cervical fascia (SCF)
FIGURE 4.18: Investing layer of DCF

Superiorly
• Nuchal line of occipital bone (a)
• Spinous processes of cervical vertebrae & nuchal lig. (b)
• Mastoid processes (c)
• Zygomatic arches (d)
• Inferior border of mandible (e)
• Hyoid bone (f)
Inferiorly
• Manubrium (g)
• Clavicles (h)
• Acromion (i)
FIGURE 4.19: Prevertebral layer of DCF

• Superiorly—from base of skull
• Inferiorly—superior mediastinum
• Anteriorly—merges with the ALL up to T3-T4
• Posteriorly—from cervical spinous processes (a) and the ligamentum
nuchae (b)
• Deep cervical fascia (DCF)

• Superficial
• Middle layer (Visceral/pharyngomucosal)
• Deep (Prevertebral)
NECK 87
DCF—AXIAL PLANE
FIGURE 4.20: Deep cervical fascia—axial view

FIGURE 4.21: Diagram showing deep layers of

cervical fascia—sagittal view
NECK 89
FIGURE 4.22: Diagram showing extent of neck

spaces in sagittal view
FIGURE 4.23: Diagram showing alar fascia

NECK 91
FIGURE 4.24: Diagram showing neck spaces—axial view

SPACES OF NECK
A B
FIGURES 4.25A AND B: Pharyngeal mucosa space
A B
FIGURES 4.26A AND B: Retropharyngeal space

NECK 93
A B
FIGURES 4.27A AND B: Parapharyngeal space
A B
FIGURES 4.28A AND B: Carotid space

A B
FIGURES 4.29A AND B: Masticator space
A B
FIGURES 4.30A AND B: Submandibular space

LUNGS
Organ Location/Description Notes
Pleura Serous membrane lining There are two types of pleura:
the pleural cavity visceral pleura covers the
lungs, parietal pleura lines the
inner surfaces of the walls of
pleural cavity; parietal pleura
is sensitive to pain but visceral
pleura is not sensitive to pain
Cervical Serous membrane lining Cervical parietal pleura is
parietal the pleural cavity which continuous inferiorly with the
pleura extends above the level costal and mediastinal parietal
of the 1st rib into the root pleurae
of the neck
Costal parietal Serous membrane lining Costal parietal pleura is
pleura the pleural cavity on the continuous anteriorly with the
inner surfaces of the ribs, mediastinal parietal pleura at
costal cartilages, and the costomediastinal reflection;
intercostal mm. it is continuous posteriorly with
the mediastinal parietal pleural
at the vertebral bodies; it is
continuous inferiorly with the
diaphragmatic parietal pleura
at the costodiaphragmatic ref-
lection; it is continuous supe-
riorly with the cervical parietal
pleura at the level of the 1st rib
Mediastinal Serous membrane lining Mediastinal parietal pleura is
parietal pleura the pleural cavity on the continuous anteriorly with the
lateral surface of the costal parietal pleura at the
mediastinum costomediastinal reflection; it is
continuous inferiorly with the
diaphragmatic pleura at the
inferomedial borders of the
pleural cavities; it is continuous
posteriorly with the costal parie-
tal pleura lateral to the verte-
bral bodies; it is continuous
superiorly with the cervical
pleura at the level of the 1st rib
Contd...
LUNGS 97
Contd...
Visceral pleura Serous membrane lining Visceral pleura extends into the
the surfaces of the lungs oblique and horizontal fissures
of the lungs; it does not have
pain fibers
Pulmonary Fold of pleura located Pulmonary ligament is where
ligament below the root of the the visceral pleura and the
lung mediastinal parietal pleura are
continuous with each other
Bronchi The air conducting Bronchi may be classified as
passages of the lungs primary, secondary (lobar),
and tertiary (segmental)
Primary First branch of the air Paired, right and left; one
bronchus conducting system aris- primary bronchus enters the
ing from the bifurcation hilus of each lung; the right
of the trachea at T4/T5 primary bronchus is shorter,
intervertebral disc larger in diameter and more
vertically oriented than the left
Secondary A branch of the air There are 3 secondary bronchi
bronchus conducting system in the right lung: upper, middle,
arising from the lower; there are 2 secondary
primary bronchus bronchi in the left lung: upper,
lower; also known as: lobar
bronchi
Tertiary A branch of the air con- There are 10 tertiary bronchi in
bronchus ducting system arising the right lung: branching from
from the secondary the right superior lobar
(lobar) bronchus bronchus—apical, anterior,
posterior; branching from the
right middle lobar bronchus—
medial, lateral; branching from
the right inferior lobar
bronchus—superior, anterior
basal, posterior basal, medial
basal, lateral basal; there are 8
tertiary bronchi in the left lung:
branching from the left superior
lobar bronchus—apicopos-
terior, anterior; branching from
the lingular bronchus (off of the
Contd...
Contd...
superior lobar bronchus)—
superior lingular, inferior
lingular; branching from the
inferior lobar bronchus—
superior, anteromedial basal,
posterior basal, lateral basal;
also known as segmental
bronchi
Segmental A branch of the air con- There are 10 tertiary bronchi
bronchus ducting system arising in the right lung: branching
from the secondary from the right superior lobar
(lobar) bronchus bronchus—apical, anterior,
posterior; branching from the
right middle lobar bronchus—
medial, lateral; branching from
the right inferior lobar bron-
chus—superior, anterior basal,
posterior basal, medial basal,
lateral basal; there are 8 tertiary
bronchi in the left lung: branch-
ing from the left superior lobar
bronchus—apicoposterior,
anterior; branching from the
lingular bronchus (off of the
superior lobar bronchus)—
superior lingular, inferior
lingular; branching from the
inferior lobar bronchus—
superior, anteromedial basal,
posterior basal, lateral basal;
also known as tertiary bronchi
Carina Keel-shaped cartilage Carina trachealis is an impor-
lying within the tracheal tant landmark during endo-
bifurcation scopy of the bronchial tree
Lung The portion of the respi- Paired; right lung is divided
ratory system where into three lobes: superior,
exchange of gasses middle and inferior; left lung
occurs between the air has two lobes: superior and
and the blood; located in inferior
the thoracic cavity
Contd...
LUNGS 99
Contd...
Oblique Deep groove in the Oblique fissure extends from

fissure surface of the lung that the level of the T3 vertebra
separates the upper lobe posteriorly to the 6th costo-
from the lower lobe (both chondral junction anteriorly
lungs), and the middle
lobe from the lower lobe
(right lung)
Horizontal Deep groove in the Horizontal fissure extends from
fissure surface of the lung that the 5th rib at the mid-axillary
separates the middle line along the 4th rib to the
lobe from the upper lobe sternum anteriorly
(right lung only)
Inferior lobe The portion of the lung Inferior lobe of the right lung:
supplied by the inferior possesses 5 bronchopulmo-
lobar bronchus nary segments—superior, ante-
rior basal, posterior basal,
medial basal, lateral basal;
inferior lobe of the left lung:
possesses 4 bronchopulmo-
nary segments—superior,
anteromedial basal, posterior
basal, lateral basal
Middle lobe The portion of the right Middle lobe is found in the
lung supplied by the right lung only; it possesses 2
middle lobar bronchus bronchopulmonary segments:
medial and lateral; lingula of
the inferior lobe of the left lung
is equivalent to the middle
lobe of the right lung
Superior lobe The portion of the lung Superior lobe of the right lung:
supplied by the superior possesses three bronchopul-
lobar bronchus monary segments—apical, an-
terior and posterior; superior
lobe of the left lung: possesses
four bronchopulmonary seg-
ments—apicoposterior, ante-
rior, superior lingular, inferior
lingular
ARTERIES
Artery Source Branches Supply Notes
Left Descending Right bronchial a. Lower There are usually
bronchial thoracic (occasionally) trachea, two left bronchial
aorta bronchial artery
tree
Right 3rd right No named Lower Right bronchial
bronchial posterior branches trachea, artery may arise
intercostal bronchial from the left
tree bronchial artery
Pulmonary Pulmonary Right: superior Lungs Each pulmonary
artery trunk lobar a. to the artery carries
superior lobe and deoxygenated
inferior lobar a. to blood to the
the middle and hilum of one lung
inferior lobes; left:
superior lobar a.
to the superior
lobe, inferior lobar
a. to the inferior
lobe
Pulmonary Right Right pulmonary Lungs The pulmonary
trunk ventricle artery, left trunk carries de-
pulmonary artery oxygenated blood
from the heart to
the right and left
pulmonary artery;
each pulmonary
artery carries de-
oxygenated blood
to the hilum of one
lung; bronchial aa.
supply oxygenated
blood to the tissues
of the lung as far
distally in the bron-
chial tree as the
respiratory bron-
chioles
LUNGS 101
VEINS
Vein Tributaries Drains into Region Notes

drained
Pulmonary Lobar Left atrium Lungs Usually two
veins pulmonary veins
per side, superior
and inferior; all
empty into the left
atrium
PULMONARY ARTERY
The pulmonary artery conveys the venous blood from
the right ventricle of the heart to the lungs. It is a short,
wide vessel, about 5 cm in length and 3 cm in diameter,
arising from the conus arteriosus of the right ventricle. It
FIGURE 5.1: 3D VR showing MPA, RPA, LPA

extends obliquely upward and backward, passing at first

in front and then to the left of the ascending aorta, as far
as the under surface of the aortic arch, where it divides,
about the level of the fibrocartilage between the fifth and
sixth thoracic vertebræ, into right and left branches of
nearly equal size.
The right branch of the pulmonary artery longer
and larger than the left, runs horizontally to the right, behind
the ascending aorta and superior vena cava and in front
of the right bronchus, to the root of the right lung, where it
divides into two branches. The lower and larger of these
goes to the middle and lower lobes of the lung; the upper
and smaller is distributed to the upper lobe.
FIGURE 5.2: 3D VR and MIP images showing

pulmonary artery branches
The left branch of the pulmonary artery shorter

and somewhat smaller than the right, passes horizontally
in front of the descending aorta and left bronchus to the
LUNGS 103
FIGURE 5.3: 3D VR showing left pulmonary artery bronchus
root of the left lung, where it divides into two branches,

one for each lobe of the lung.
The pulmonary veins return the arterialized blood
from the lungs to the left atrium of the heart. They are four
in number, two from each lung, and are destitute of valves.
They commence in a capillary network upon the walls of
the air sacs, where they are continuous with the capillary
ramifications of the pulmonary artery, and, joining together,
Form one vessel for each lobule. These vessels uniting
successively, Form a single trunk for each lobe, three for
the right, and two for the left lung. The vein from the middle
lobe of the right lung generally unites with that from the
upper lobe, so that ultimately two trunks from each lung
are formed.
FIGURES 5.4A AND B: 3D VR showing the superior,

middle and inferior pulmonary veins
LUNGS 105
FIGURE 5.4C: 3D VR showing pulmonary veins
FIGURE 5.5: 3D VR showing pulmonary artery and veins

FIGURE 5.6: Anterior view of heart and lungs. (1) Upper lobe of right
lung, (2) Middle lobe of right lung, (3) Lower lobe of right lung, (4) Upper
lobe of left lung, (5) Lower lobe of left lung, (6) Heart in pericardial
sac, (7) Trachea, (8) Oesophagus, (9) Aorta, (10) Superior vena cava,
(11) Inferior vena cava, (12) Phrenic nerve, (13) Diaphragm,
(14) Pulmonary trunk, (15) Pulmonary arteries, (16) Pulmonary veins,
(17) Brachiocephalic trunk, (18) Common carotid arteries, (19) Subclavian
arteries, (20) Innominate veins, (21) Internal jugular veins, (22) Subclavian
veins
LUNGS 107
FIGURE 5.7: General arrangement of the bronchial tree. (1) Upper lobe
of right lung, (2) Middle lobe of right lung, (3) Lower lobe of right lung,
(4) Upper lobe of left lung, (5) Lower lobe of left lung, (6) Pharynx,
(7) Trachea, (8) Principle bronchi, (9) Lobar bronchi, (10) Segmental
bronchi, (11) Bronchioles
FIG. 5.8
FIG. 5.9
FIGURES 5.8 AND 5.9: (A) Right lung—medial view, (B) Left lung—
medial view (For legends see Figure 5.11)
LUNGS 109
FIGURE 5.10: Lungs-anterior view, (1) Upper lobe of right lung, (2) Middle
lobe of right lung, (3) Lower lobe of right lung, (4) upper lobe of left lung,
(5) Lower lobe of left lung, (6) Interlobar fissures
FIGURE 5.11: Segments of right lung. (7a) Apical, (7b) Posterior, (7c)
Anterior, (7d) Lateral, (7e) Medial, (7f) Superior (apical), (7g) Medial basal,
(7h) Anterior basal, (7i) Lateral basal, (7j) Posterior basal, (8) Segments
of left lung, (8a) Apical, (8b) Posterior, (8c) Anterior, (8d) Superior lingular,
(8e) Inferior lingular, (8f) Superior (apical), (8g) Medial basal, (8h) Anterior
basal, (8i) Lateral basal, (8j) Posterior basal
FIGURE 5.12: Sagittal high resolution sections of

lung showing the lobes
FIGURE 5.13: 3D SSD image showing the lobes and fissure

LUNGS 111
AXIAL SECTION OF LUNGS
FIGURE 5.14A: Axial CT at the level of trachea
FIGURE 5.14B: Axial CT at the level of arch of aorta

FIGURE 5.15A: Axial CT at the level of carina
FIGURE 5.15B: Axial CT at the level of ventricles

LUNGS 113
Segment Bronchus
Right Upper Lobe

Apical S1 B1
Posterior S2 B2
Anterior S3 B3
Right Middle Lobe
Lateral S4 B4
Medial S5 B5
Right Lower Lobe
Superior S6 B6
Medial basal S7 B7
Anterior basal S8 B8
Lateral basal S9 B9
Posterior basal S10 B10
Left Upper Lobe

Apical posterior S1+2 B1+2
Anterior S3 B3
Superior lingular S4 B4
Inferior lingular S5 B5
Left Lower Lobe
Superior S6 B6
Anterior medial basal S8 B8
Lateral basal S9 B9
Posterior basal S10 B10
FISSURAL ANATOMY OF LUNGS
FIGURES 5.16A AND B: Axial high resolution showing the major fissure
LUNGS 115
MEDIASTINUM AXIAL VIEWS

See Figures 5.17 to 5.25.
These are axial views of the chest with emphasis on
the mediastinum as seen by Computed Tomography. Struc-
tures to be identified are:
1. Trachea
2. Esophagus
3. Trapezius muscle
4. Clavicle
5. Subscapularis muscle
6. Infraspinatus muscle
7. Supraspinatus muscle
8. Pectoralis major muscle
9. Pectoralis minor muscle
10. Serratus anterior muscle
11. Latissimus dorsi muscle
12. Erector spinae muscles
13. Subclavian arteries
14. Common carotid arteries
15. Internal jugular veins
16. Scapula
17. Rib
18. Manubrium of sternum, body of sternum xiphoid—
process of sternum
19. Aortic arch, ascending aorta, descending aorta
20. Azygous vein, arch of the azygous
21. Brachiocephalic veins
22. Superior vena cava
23. Thymus gland

24. Teres major muscle
25. Teres minor muscle
26. Left subclavian vein/axillary vein
27. Brachiocephalic artery
28. Inferior vena cava
29. Pulmonary trunk
30. Pulmonary arteries
31. Thoracic duct
32. Carina of trachea
33. Right ventricle
34. Right atrium
35. Left atrium
36. Left ventricle
37. Pulmonary vein
38. Interventricular septum
39. Coronary sinus
LUNGS 117
FIGURE 5.17: Axial section at the level of the trachea
FIGURE 5.18: Axial section at the level of brachiocephalic vessels

FIGURE 5.19: Axial CT at the level of SVC formation
FIGURE 5.20: Axial CT at the level of AP window

LUNGS 119
FIGURE 5.21: Axial CT at the level of arch of aorta
FIGURE 5.22: Axial CT at the level of MPA

FIGURE 5.23: Axial CT at the arterial level
FIGURE 5.24: Axial CT at the ventricular level

LUNGS 121
FIGURE 5.25: Axial CT at the level of diaphragmatic dome

AXIAL ANATOMY— ABDOMEN

Structure to be identified
(1) Liver, (2) Spleen, (3) Pancreas, (4) Gallbladder,
(5) Right adrenal gland, (6) Adrenal glands, (7) Inferior
vena cava, (8) Aorta, (9) Portal vein, (10) Superior
mesenteric artery, (10*) Superior mesenteric vein,
(11) Ascending, (12) Descending colon, (13) Transverse
colon, (14) Stomach, (15) Duodenum, (16) Right kidney,
(17) Left kidney, (18) Inferior mesenteric artery,
(19) Duodenum, 2nd part, (19*) Duodenum, 3rd part,
(20) Left renal vein, (20*) Left renal artery, (21) Right renal
vein, (21*) Right renal artery, (22) Small intestine, (23)
Splenic artery, (24) Celiac trunk, (25) Splenic vein, (26)
Anterior and posterior abdominal wall muscles.
PELVIS AND UPPER THIGH

Structure to be identified
(1) Aorta, (2) Inferior vena cava, (3) Ureter, (5) Small
bowel, (6) Cecum appendix 7) Descending colon,
(8) Psoas muscle, (9) Erector spinae muscle, (10) Rectus
abdominus muscle, (11) External oblique muscle,
(12) Internal oblique muscle, (13) Transversus abdominus
muscle, (14) Quadratus lumborum muscle, (15) Vertebra,
(body), (16) Vertebra (spinous process), (17) Common
iliac arteries, (17a) Common iliac veins, (18) Iliac wing,
(19) External iliac vessels, (20) Common femoral artery
and vein, (21) Superficial femoral artery, (22) Deep femoral
artery, (23) Iliacus muscle, (24) Gluteus maximus muscle,
ABDOMEN 125
(25) Gluteus medius muscle, (26) Gluteus minimus muscle,

(27) Sacrum, (28) Urinary bladder, (29) Sigmoid colon,
(30) Rectum, (31) Seminal vesicle, (32) Prostate gland,
(33) Base of penis, (34) Piriformis muscle, (35) Ischial spine,
(36) Femoral head, (37) Greater trochanter, (38) Rectus
femoris muscle, (39) Internal obturator muscle, (40)
External obturator muscle, (41) Ischiorectal fossa, (42)
Symphysis pubis, (43) Inferior pubic ramus, (44) Ischial
tuberosity, (45) Gracilis muscle, (46) Sartorius muscle, (47)
Adductor magnus muscle, (48) Adductor longus muscle
(49) Vastus lateralis muscle, (50) Vastus intermedius
muscle, (51) Vastus medialis muscle, (52) Semimem-
branosus and semitendinosus muscles, (53) Tensor fascia
latae, (54) Pectineus muscle.
FIGURE 6.1A: Digital scanogram for planning axial slices

FIGURE 6.1B: Axial CT sections showing

abdominal wall muscles
FIGURE 6.2: Schematic for anterior abdominal wall muscle planes

ABDOMEN 127
LIVER SEGMENTS
FIGURE 6.3: Axial CT at the level of hepatic vein confluence. RHV—

Right hepatic vein, MHV—Middle hepatic vein; LHV—Left hepatic vein.
IVC—Inferior vena cava
FIGURE 6.4: Axial CT at level of caudate lobe. A—Anterior, P—

Posterior, M—Medial, L—Lateral segments
FIGURE 6.5: Axial CT at the level of porta
FIGURE 6.6: Axial CT at the level of GB

ABDOMEN 129
SURFACE REFORMATION
FIGURES 6.7A AND B: Surface rendering of liver segments
I. caudate
II. left posterolateral segment
III. left anterolateral segment
IVa. left superomedial segment
IVb. left inferomedial segment
V. right anteroinferior segment
VI. right posteroinferior segment
VII. right posterosuperior segment
VIII. right anterosuperior segment
SEGMENTS OF LIVER
FIGURE 6.8: Schematic showing liver segments
PANCREAS
FIGURE 6.9: Axial CT of pancreas

ABDOMEN 131
FIGURE 6.10: Axial section at the celiac axis level
FIGURE 6.11: Axial sections at the level of SMA

FIGURE 6.12: Axial sections at the level of renal hilum
INTRAHEPATIC BILE DUCTS
FIGURE 6.13: Axial CT showing dilated right and left hepatic ducts
ABDOMEN 133
DOUBLE DUCTS PD, CBD
FIGURE 6.14: Axial CT showing dilated CBD and pancreatic duct
FIGURE 6.15: Axial CT at the level of third part of duodenum

FIGURE 6.16: Curved reformat of pancreas showing PD and CBD
FIGURE 6.17: Coronal image showing ampulla

PD—Pancreatic duct; CBD—Common bile duct
ABDOMEN 135
FIGURE 6.18: Axial CT at the level of IVC origin
FIGURE 6.19: Axial CT at the level of aortic bifurcation

FIGURE 6.20: Axial CT at the level of caecum
FIGURE 6.21: Axial CT at the level of sigmoid colon

ABDOMEN 137
FIGURE 6.22: Axial CT at the level of rectosegmoid junction
FIGURE 6.23: Axial CT at the level of urinary bladder
FIGURE 6.24: Axial CT at the level of pubic symphysis

FIGURE 6.25: Axial CT at the level of ischium
FIGURE 6.26: Axial CT at the level of inferior pubic ramus

ABDOMEN 139
UTERUS AND OVARIES
FIGURES 6.27A AND B: Axial CT in a patient with ascites

showing ovaries and uterus
MUSCLES AND PELVIC STRUCTURES
FIGURE 6.28: Axial CT at the level of acetabular roof showing

muscles of pelvis
RA—Rectus Abdominis PS—Psoa S
GMIN—Gluteus Minimus GMED—Gluteus Medius
GM—Gluteus Maximus Pl—Piriformis
FIGURE 6.29: Axial CT at the level of pubic symphysis showing muscles

Ol—Obturator Internus OE—Obturator Externus
PEC—Pectineus SA—Sartorius
PS—Psoa S RF—Rectus Femoris
TFL—Tensor fascia lata
ABDOMEN 141
INDIVIDUAL BOWEL PATTERNS
FIGURES 6.30A AND B: Axial CT showing the fundus and

antrum of stomach
FIGURES 6.31A AND B: Axial CT showing the body of stomach and

third, fourth part of duodenum
ABDOMEN 143
FIGURE 6.32: Axial CT showing the jejunal and ileal bowel patterns
FIGURE 6.33: Axial CT showing the ascending colon

FIGURE 6.34: Axial CT showing the sigmoid colon
FIGURE 6.35A
ABDOMEN 145
FIGURE 6.35B
FIGURES 6.35A AND B: Images showing 3D VR of colon
CT PERITONEOGRAM—SHOWING PERITONEAL
SPACES
PERITONEAL SPACES
The peritoneal cavity is divided into two main compart-
ments, the supramesocolic and the inframesocolic, by the
transverse colon and its mesentery connecting it to the
posterior abdominal wall The root of the transverse meso-
colon subextends across the infra-ampullary segment of
the descending duodenum, the head of the pancreas, and
continues along the lower edge of the body and tail of the
pancreas.
The Supramesocolic Compartment

The supramesocolic compartment can be arbitrarily divided
into right and left supramesocolic peritoneal spaces. These
regions can also be divided into a number of subspaces,
which are normally in communication, but often become
separated by inflammatory membranes in disease.
Right Supramesocolic Space

The right supramesocolic space has three subextends
spaces: (a) the right subphrenic space; (b) the right
subhepatic space, which can be further divided arbitrarily
into anterior and posterior areas; and (c) the lesser sac.
The right subphrenic space extends over the diaphragmatic
surface of the right lobe of the liver to the right coronary
ligament posteroinferiorly and the falciform ligament
medially, which separates it from the left subphrenic space
In the presence of infected fluid, pyogenic membranes may
divide the right subphrenic space into anterior and posterior
compartments.
The right subhepatic space can be arbitrarily divided into
anterior and posterior spaces. The anterior right subhepatic
space is limited inferiorly by the transverse colon and its
mesentery. The posterior right subhepatic space, also known
as the hepatorenal fossa or Morison’s pouch, extends
posteriorly to the parietal peritoneum overlying the right
kidney. Superiorly the right subhepatic space is bounded by
the inferior surface of the right lobe of the liver.
ABDOMEN 147
FIGURE 6.36: Coronal CT reformation after CT peritoneogram revealing

the peritoneal spaces. RSP—Right subphrenic space, SHS—Right sub-
hepatic space, RPCS—Right paracolic space, LPCS—Left paracolic space
It communicates freely with the right subphrenic space

and the right paracolic gutter. In the supine patient, the
posterior right subhepatic space (the hepatorenal fossa or
Morison’s pouch) is more dependent than the right
paracolic gutter, and thus under the force of gravity, fluid
collections are common in this location.
The lesser sac extends to the left, behind the stomach
and anterior to the pancreas It is considered to be part of
the right supramesocolic space, as embryologically the

growth of the liver into the right peritoneal space stretches
the dorsal mesentery and forms the future lesser sac
posterior to the stomach. It communicates with the rest of
the peritoneal cavity through a narrow inlet, the epiploic
foramen (foramen of Winslow), between the inferior vena
cava and the free margin of the hepatoduodenal ligament.
The lesser sac lies posterior to the lesser omentum, stomach,
duodenal bulb and gastrocolic ligament.
A prominent oblique fold of peritoneum is raised on the
posterior wall of the lesser sac by the left gastric artery,
dividing it into two major recesses. The smaller superior
recess completely encloses the caudate lobe of the liver. At
the porta hepatis this recess lies posterior to the portal vein.
Superiorly it extends deep into the fissure for the ligamentum
venosum and posteriorly lies adjacent to the right
diaphragmatic crus. The larger inferior recess lies between
the stomach and the pancreas. It is bounded inferiorly by
the transverse colon and its mesentery, but can extend for
a variable distance between the leaves of the greater
omentum. To the left it is bounded by the gastrosplenic and
splenorenal ligaments which meet at the splenic hilum.
Left Supramesocolic Space

The left supramesocolic space has four arbitrary subspaces,
which are in communication in normal anatomy : (a) the
anterior left peri-hepatic space; (b) the posterior left
perihepatic space, surrounding the lateral segment of the
ABDOMEN 149
FIGURE 6.37: CT peritoneuogram showing right subphrenic space

(RSP), Left subphrenic space (LSP), phrenico colic ligament (PCL)
FIGURE 6.38: CT peritoneogram showing superior recess of lesser sac

FIGURE 6.39: CT peritoneogram showing pouch of inferior recess
left hepatic lobe; (c) the anterior left subphrenic spaces;and

(d) the posterior left subphrenic (perisplenic) space, superior
to gastric fundus and spleen.
The left anterior perihepatic space is bounded medially
by the falciform ligament, posteriorly by the liver surface
and left coronary ligament, and anteriorly by the diaph-
ragm. It communicates superiorly and to the left with The
left anterior perihepatic space is bounded medially by the
falciform ligament, posteriorly by the liver surface and left
coronary ligament, and anteriorly by the diaphragm. It
communicates superiorly and to the left with the left anterior
subphrenic space, and inferiorly with the greater peritoneal
cavity over the surface of the transverse mesocolon.
ABDOMEN 151
The Inframesocolic Compartment

The inframesocolic compartment is divided into two
unequal spaces posteriorly by the root of the small bowel
mesentery, as this runs from the duodenojejunal flexure in
the left upper quadrant to the ileocaecal valve in the right
lower quadrant. It also contains the right and left
paratherecolic gutters lateral to the ascending and
descending colon.
The Right Inframesocolic Space

This triangular space is smaller than its counter-part on
the left. It is bounded by the transverse surcolon superiorly
and to the right, and by the root of the small bowel
mesentery, as this runs from the duodenojejunal flexure to
the ileocaecal junction inferiorly and to the left.
The Left Inframesocolic Space

This space is larger than its counterpart on the right and is
in free communication with the pelvis on the right of the
midline. The sigmoid colon and its associated mesentery
form a partial barrier on the left of the midline.
The Paracolic Gutters

These are the peritoneal recesses on the posterior gastro-
abdominal wall lateral to the ascending and descending
colon. The right paracolic gutter is continuous superiorly
with the right subhepatic and subphrenic spaces. It is larger
than the left paracolic gutter, which is partially separated

from the left subphrenic spaces by the phrenicocolic
ligament. Both paracolic spaces are in continuity with the
pelvic peritoneal spaces.
The Pelvic Peritoneal Spaces

Inferiorly the peritoneum is reflected over the fundus of
the bladder, the anterior and posterior surface of the uterus
and upper posterior vagina in females, and on to the front
of the rectum at the junction of its middle and lower thirds.
The urinary bladder subdivides the pelvis into right and
left paravesical spaces. In men parathere is only one
potential space for fluid collection posterior to the bladder,
the rectovesical pouch.
In women there are two potential spaces posterior to
the bladder, the uterovesical pouch, and posterior to the
uterus the deeper rectouterine pouch (pouch of Douglas)
The layers of peritoneum on the anterior and posterior
surcolon faces of the uterus are reflected laterally to the
pelvic side walls as the broad ligaments, containing the
uterine (Fallopian) tubes.
Omentum
• This is a double-layered sheet or fold of perito-
neum.
• The lesser and greater omentum attach the stomach to
the body wall or to other abdominal organs.
ABDOMEN 153
FIGURE 6.40: Schematic diagram of peritoneal space
The Lesser Omentum

• This fold of peritoneum connects the lesser curvature
of the stomach and the proximal part of the
duodenum to the liver.
• Individually, these connections are referred to as the
gastrohepatic ligament and the hepatoduodenal
ligament.
• The lesser omentum lies posterior to the left lobe
of the liver and is attached to the liver in the fissure
for the ligamentum venosum.
• It is also attached to the porta hepatis, the transverse

fissure or gate (L. porta) on the inferior surface of the
liver through which the bile duct, vessels, and nerves
enter or leave the liver.
The Greater Omentum
• This is a fat-laden fold of peritoneum that hangs down
from the greater curvature of the stomach and
connects the stomach with the diaphragm, spleen,
and transverse colon.
• This double-layered peritoneal fold normally fuses
during the foetal period, thereby obliterating the
inferior recess of the omental bursa.
• As a result, the apron-like greater omentum is
composed of four layers of peritoneum.
• After passing inferiorly as far as the pelvis, the greater
omentum loops back on itself, overlying and
attaching to the transverse colon.
Peritoneal Ligaments
• A peritoneal ligament is a double layer of peri-
toneum that connects an organ with another organ or
with the abdominal wall.
• Ligaments may contain blood vessels or remnants of
vessels (e.g. the falciform ligament contains the
ligamentum teres, a remnant of the fetal umbilical vein).
• The greater omentum is divided into 3 parts:
1. The apron-like part, called the gastrocolic
ligament, is attached to the transverse colon.
ABDOMEN 155
2. The left part, called the gastrosplenic ligament

(gastrolienal ligament), connects the hilum of the
spleen to the greater curvature and fundus of the
stomach.
3. The superior part called the gastrophrenic
ligament is attached to the diaphragm and the
posterior aspect of the fundus and the oesophagus.
• The falciform ligament extends from the liver to the
anterior abdominal wall and the diaphragm.
• The ligamentum teres is the obliterated remnant of
the left umbilical vein, lying in the free edge of the
falciform ligament and extending from the groove for
the ligamentum teres to the umbilicus.
• The superior (anterior) and inferior (posterior)
layers of the coronary ligament are reflections of
the peritoneum, which surround the bare area of the
liver.
• The left and right triangular ligaments are where
the layers of the coronary ligament meet to the left and
right respectively.
• The falciform, coronary and triangular ligaments are
derived from that part of the ventral mesogastrium
connecting the liver to the body wall.
• The gastrohepatic and hepatoduodenal ligaments are
derived from that part of the ventral mesogas-trium
connecting the stomach and the liver.
• The gastrosplenic and gastrophrenic, as well as the
lienorenal and phrenicolienal ligaments are derived
from the dorsal mesogastrium.
FIGURE 6.41: CT peritoneogram showing

folds of mesentery
The Peritoneal Folds

• A peritoneal fold (L. plica) is a reflection of peritoneum
with more or less sharp borders.
• Often it is formed by peritoneum that covers blood
vessels, ducts, and obliterated fetal vessels.
• Several folds are visible on the parietal peritoneum
on the interior of the anterior abdominal wall.
• The median umbilical fold contains the urachus,
which extends from the urinary bladder to the umbilicus.
• The medial umbilical folds are raised by the
obliterated umbilical arteries, extending from the
internal iliac arteries to the umbilicus.
• The lateral umbilical folds are raised by the inferior
epigastric arteries, extending from the deep inguinal
rings on each side to the arcuate lines.
Peritoneal Pouches
• The rectouterine pouch (in females) separating the
rectus from the bladder.
ABDOMEN 157
• The rectovesical pouch (in males) separating the

rectum from the bladder.
• The vesicouterine pouch (in females) separating the
bladder from the uterus
FIGURE 6.42: CT peritoneogram showing pelvic spaces
FIGURE 6.43: Schematic diagram showing perigastric ligaments

• falciform ligament FL • lienorenal ligament LR
• gastrolienal ligament GL • lesser omentum LO
RETROPERITONEUM
Extraperitoneal space is divided in to the anterior and
posterior pararenal space and the perinephric space by the
anterior and posterior layers of the renal fascia. Both these
fascia fuse to form the lateral conal fascia behind the
descending colon.
ANTERIOR PARARENAL COMPARTMENT

The anterior pararenal compartment lies between the
anterior renal fascia and the posterior parietal peritoneum.
The lateral border is defined by the lateroconal fascia and
the compartment is potentially contiguous across the midline.
Contents include pancreas, the descending, horizontal and
terminal portions of duodenum. The ascending and
descending colon.
FIGURE 6.44: Anterior pararenal space

ABDOMEN 159
PERINEPHRIC COMPARTMENT
Formed by fusion of the anterior (gerotas ) and posterior
(zuckercandles) fascia superiorly it fuses with the diaphrag-
matic fascia and laterally with the lateroconal fascia.
The inferior portion of the space is open towards the
iliac fossa medially the posterior renal fascia fuses with the
quadratus and psoas fascia.
Contents include adrenals, kidneys, renal vasculature,
proximal part of renal collecting system.
FIGURE 6.45: Perinephric space

FIGURE 6.46: Posterior pararenal space
POSTERIOR PARARENAL COMPARTMENT

Lies between the posterior renal fascia and the transversalis
fascia, it contains fat tissue and continues laterally as the
propertoneal fat. The space is open inferiorly at the iliac
crest. Medially the space is contained by the fusion of the
transversallis and psoas fascias.
ABDOMEN 161
VASCULAR ANATOMY OF ABDOMINAL VESSELS
ABDOMINAL AORTA
Abdominal aorta begins at the aortic hiatus of the
diaphragm, in front of the lower border of the body of the
last thoracic vertebra, and, descending in front of the
vertebral column, ends on the body of the fourth lumbar
vertebra, commonly a little to the left of the middle line,
by dividing into the two common iliac arteries.
FIGURE 6.47: 3D VR showing abdominal vessels CA—celiac artery,

HA—hepatic artery, SPL—splenic, RA—renal, ACRA—accessory renal,
IMA—inferior mesenteric. SMA—superior mesenteric
BRANCHES
The branches of the abdominal aorta may be divided into
three sets: visceral, parietal, and terminal.
Visceral branches Parietal branches Terminal branches
Celiac Inferior phrenics Common iliacs
Superior mesenteric Lumbars
Inferior mesenteric Middle Sacral
Middle suprarenals
Renals
Internal Spermatics
Ovarian
FIGURE 6.48: 3D VR showing abdominal aortic branches

ABDOMEN 163
FIGURES 6.49A AND B: 3D VR and MIP veins showing SMA,

celiac and IMA branches
The celiac artery is a short thick trunk, about

1.25 cm in length, which arises from the front of the aorta,
just below the aortic hiatus of the diaphragm, divides into
three large branches, the left gastric, the hepatic, and
the Splenic arteries.
FIGURE 6.50: 3D VR showing branches of celiac artery
1. The left gastric artery passes upward and to the left,

posterior to the omental bursa, to the cardiac orifice of the
stomach.
ABDOMEN 165
FIGURE 6.51: 3D VR showing celiac branches
2. The hepatic artery It is first directed forward and to

the right, to the upper margin of the superior part of the
duodenum, forming the lower boundary of the epiploic
foramen It then crosses the portal vein anteriorly and
ascends between the layers of the lesser omentum, and in
front of the epiploic foramen, to the porta hepatis, where
it divides into two branches, right and left, which supply
the corresponding lobes of the liver.
FIGURE 6.52: 3D VR showing branches of gastroduodenal artery

ASPD/PSPD—Anterior and posterior superior pancreaticoduodenal artery
ABDOMEN 167
GASTRODUODENAL ARTERY
Its branches are: Right gastric, gastroduodenal, right
gastroepiploic, superior pancreaticoduodenal, cystic.
3. Splenic artery is the largest branch of the celiac

artery,. It passes horizontally to the left side, behind the
stomach and the omental bursa of the peritoneum, and
along the upper border of the pancreas
Its branches are: Pancreatic, short gastric, left
gastroepiploic.
FIGURE 6.53: 3D VR showing branches of splenic artery

The superior mesenteric artery is a large vessel

which supplies the whole length of the small intestine,
except the superior part of the duodenum; it also supplies
the cecum and the ascending part of the colon and about
one-half of the transverse part of the colon. It arises from
the front of the aorta, about 1.25 cm below the celiac artery.
Branches: Inferior pancreaticoduodenal, ileocolic, right
colic, middle colic.
FIGURE 6.54: 3D VR showing SMA branches

ABDOMEN 169
The inferior mesenteric artery supplies the left half

of the transverse part of the colon, the whole of the
descending and iliac parts of the colon, the sigmoid colon,
and the greater part of the rectum. arises from the aorta,
about 3 or 4 cm above its division into the common iliacs
and close to the lower border of the inferior part of the
duodenum.
Left colic artery, superior hemorrhoidal artery, sigmoid
arteries.
FIGURE 6.55: 3D VR showing IMA vessel

COLLATERAL CIRCULATION
The collateral circulation would be carried on by the
anastomoses between the internal mammary and the
inferior epigastric; by the free communication between the
superior and inferior mesenterics.
FIGURES 6.56A AND B: 3D VR images showing the ARC of Rolon

ABDOMEN 171
FIGURE 6.57: 3D VR showing pancreaticoduodenal arcade
ABDOMINAL AORTA
• Subphrenic T12 → supply diaphragm
• Celiac trunk T12/L1
— L gastric
— Splenic
— Common hepatic
• SMA L1
• Renal and gonadals L2
• IMA L3
• Bifurcation → iliac L4
• Others: median sacral/ lumbar
FIGURES 6.58A AND B: 3D VR showing pancreatic arcade

ABDOMEN 173
ARTERIAL SUPPLY TO GUT

• Celiac trunk:
— Foregut → esophagus to D2
• Superior mesenteric
— Midgut → D3 to distal 1/3 transverse colon
• Inferior mesenteric
— Hindgut → distal 1/3 transverse colon to upper 2/3
of rectum.
PORTAL VEINS
FIGURE 6.59: 3D VR image of portal vein

HEPATIC VEINS AND PORTAL VEINS
FIGURE 6.60: 3D VR showing hepatic vein, IVC in torqouise and

portal vein in blue
ANKLE JOINT (ANTEROPOSTERIOR)
FIGURE 7.1: Ankle joint (Anteroposterior). (1) Fibula, (2) Tibia, (3) Distal
tibiofibular joint, (4) Malleolar fossa, (5) Lateral malleolus, (6) Ankle joint,
(7) Medial malleolus, (8) Talus
LOWER LIMB 177
ANKLE JOINT (LATERAL)
FIGURE 7.2: Ankle joint (lateral) (1) Fibula, (2) Tibia, (3) Ankle joint, (4)
Promontory of tibia, (5) Trochlear surface of talus, (6) Talus, (7) Posterior
tubercle of talus, (8) Calcaneus, (9) Sustentaculum tali, (10) Tarsal tunnel,
(11) Navicular, (12) Cuneiforms, (13) Cuboid
FOOT (DORSO-PLANTAR)
FIGURE 7.3: Foot (Dorso-plantar) (1,3) Distal phalanx, (4) Middle phalanx,
(2,5) Proximal phalanx, (6) Interphalangeal joints, (7) Metatarsophalangeal
joints, (8) Sesamoids, (9) Head of metatarsal, (10) Shaft (body) of
metatarsal, (11) Base of metatarsal, (12) Cuneiforms, (13) Navicular, (14)
Cuboid, (15) Talus, (16) Calcaneus, (17) Tibia, (18) Fibula, (19) Tarso-
metatarsal joints, (20) Transverse midtarsal joint
LOWER LIMB 179
HIP JOINT (ANTEROPOSTERIOR)
FIGURE 7.4: Hip joint (Anteroposterior). (1) Anterior superior iliac spine,
(2) Ilium, (3) Anterior inferior iliac spine, (4) Pelvic brim, (5) Acetabular
fossa, (6) Head of femur, (7) Fovea, (8) Superior ramus of pubis, (9)
Obturator foramen, (10) Inferior ramus of pubis, (11) Pubic symphysis,
(12) Ischium, (13) Lesser trochanter, (14) Intertrochanteric crest, (15)
Greater trochanter, (16) Neck of femur
KNEE JOINT (LATERAL)
FIGURE 7.5: Knee joint (lateral). (1) Femur, (2) Lateral condyle of femur,
(3) Medial condyle of femur, (4) Fabella, (5) Patella, (6) Base of patella,
(7) Apex of patella, (8) Intercondylar eminence, (9) Apex of fibula, (10)
Fibula, (11) Tibia, (12) Tibial tuberosity
LOWER LIMB 181
FIGURE 7.6: 3D VR showing ankle articulation

FIGURE 7.7: Axial CT showing talar dome
FIGURE 7.8: Axial CT showing calcaneum,

cuboid and cuneiforms bones
LOWER LIMB 183
OSTEOLOGY
Bone Structure Description
Tibia The bone on the medial side of the leg
Medial condyle The prominence on the medial side
of the proximal end of the tibia
Lateral condyle The prominence on the lateral side
of the proximal end of the tibia
Intercondylar The ridge of bone on the proximal end of
eminence the tibia that projects between the
condyles
Tibial tuberosity The roughened protuberance on the
anterior surface of the tibia located just
distal to the condyles
Body The long, robust shaft of the tibia
Interosseous The sharp ridge that runs longitudinally
border along the junction of the lateral surface
and the posterior surface of the tibia
Soleal line A ridge of bone that descends obliquely
from lateral to medial on the posterior
surface of the tibia
Medial malleolus The large bony prominence on the medial
side of the ankle
Fibula The slender bone on the lateral side of
the leg
Head The enlarged proximal end of the fibula
Neck The constricted portion of the fibula
located just inferior to the head
Body The long slender shaft of the fibula
Interosseous The sharp ridge that runs longitudinally
border along the medial surface of the fibula
Lateral malleolus The enlarged distal end of the fibula
Tarsal bones The bones of the ankle

Talus The most proximal of the tarsal bones
Body The proximal part of the talus
Trochlea The superior portion of the body of the
talus that lies between the two malleoli
Head The portion of the talus that projects
anteriorly
Contd...
Contd...
Neck The constricted part of the talus located

proximal to the head
Calcaneus The tarsal bone which forms the heel

Calcaneal The posterior roughened area of the
tuberosity calcaneus which contacts the ground
during weight-bearing
Sustentaculum The shelf-like medial projection of bone
tali located inferior to the medial malleolus
Navicular The tarsal bone located distal to the talus

and proximal to the three cuneiform
bones
Cuneiform, The most medial bone in the distal row

Medial of tarsal bones
Cuneiform, The intermediate bone of the three

Middle cuneiform bones
Cuneiform, The bone that is located between the

Lateral middle cuneiform and the cuboid bone
Cuboid The most lateral bone in the distal row of

tarsal bones
Metatarsals The bones located between the tarsal

bones and the phalanges
Base The proximal end of the metatarsal
Body The slender shaft of the metatarsal
Head The rounded distal end of the metatarsal
Phalanx The distal two or three bones in the digits

(phalanges) of the foot
Base The proximal end of the phalanx
Body The slender shaft of the phalanx
Head The distal end of the phalanx
LOWER LIMB 185
MUSCLES
Muscle Origin Insertion
Extensor Superolateral surface of Extensor expansion of toes
digitorum brevis the calcaneus 1-4
Extensor Lateral condyle of the Dorsum of the lateral 4 toes

digitorum tibia, anterior surface of via extensor expansions
longus the fibula, lateral portion (central slip inserts on base
of the interosseous of middle phalanx, lateral
membrane slips on base of distal
phalanx)
Extensor Superolateral surface of Dorsum of base of proximal
hallucis brevis the calcaneus phalanx of the great toe
Extensor Middle half of the anterior Base of the distal phalanx of
hallucis longus surface of the fibula and the great toe
the interosseous
membrane
Fibularis Lower one-third of the Tuberosity of the base of the
(peroneus) lateral surface of the fibula 5th metatarsal
brevis
Fibularis Upper two-third of the After crossing the plantar
(peroneus) lateral surface of the fibula surface of the foot deep to
longus the intrinsic muscles, it
inserts on the medial
cuneiform and the base of
the 1st metatarsal bone
Fibularis Distal part of the anterior Dorsum of the shaft of the
(peroneus) surface of the fibula 5th metatarsal bone
tertius
Flexor digitorum Middle half of the posterior Bases of the distal phalanges
longus surface of the tibia of digits 2-5
Flexor hallucis Lower 2/3rd of the Base of the distal phalanx of

longus posterior surface of the the great toe
fibula
Contd...
Contd...
Gastrocnemius Femur; medial head: Dorsum of the calcaneus via

above the medial femoral the calcaneal (Achilles’)
condyle; lateral head: tendon
above the lateral femoral
condyle
Plantaris Above the lateral femoral Dorsum of the calcaneus
condyle (above the lateral medial to the calcaneal
head of gastrocnemius) tendon
Popliteus Lateral condyle of the Posterior surface of the tibia

femur above soleal line
Soleus Posterior surface of head Dorsum of the calcaneus via

and upper shaft of the the calcaneal (Achilles’)
fibula, soleal line of the tendon
tibia
Tibialis Lateral tibial condyle and Medial surface of the medial

anterior the upper lateral surface of cuneiform and the 1st
the tibia metatarsal
Tibialis Interosseous membrane, Tuberosity of the navicular

posterior posteromedial surface of and medial cuneiform,
the fibula, posterolateral metatarsals 2-4
surface of the tibia
LOWER LIMB 187
VEINS
Vein Tributaries Drains into Regions drained
Dorsal Dorsal digital vein) Great Dorsum of the digits

venous arch and dorsal metatarsal saphenous and the superficial
of the foot vein vein, structures of the
medially, dorsum of the foot
small
saphenous
vein laterally
Greater Medial end of dorsal Femoral Skin and superficial

saphenous venous arch of foot, vein fascia of the medial
vein perforating side of the foot and
communications with leg; skin and
deep veins, superficial fascia of
superficial epigastric most of the thigh;
vein, superficial lower abdominal wall;
circumflex iliac vein, perineal region
superficial external
pudendal vein
Lesser Lateral end of the Popliteal Skin and superficial

saphenous dorsal venous arch vein fascia of the lateral
vein of foot side of the foot and
leg
Metatarsal, Dorsal digital vv. Dorsal Dorsal apects of the
dorsal of the venous arch digits of the foot
foot of the foot
FIGURE 7.9: Diagram showing veins of lower limb

LOWER LIMB 189
TOPOGRAPHIC ANATOMY
Structure/Space Significance
Anterior compartment, leg Anterior compartment of the leg contains

the tibialis anterior muscle, extensor hallucis
longus muscle, extensor digitorum longus
muscle, fibularis tertius muscle; it also
contains the anterior tibial a) and the deep
fibular nerve; also known as: extensor
compartment of the leg
Fascia, crural Crural fascia is continuous with the fascia
lata at the level of the knee; it is connected
to the fibula by the anterior and posterior
intermuscular septa; crural fascia is
thickened near the ankle to form the
extensor and flexor retinacula
Lateral compartment, leg Lateral compartment of the leg contains:
fibularis longus muscle, fibularis brevis
muscle; superficial fibular nerve; also
known as: evertor compartment of the leg
Posterior compartment, leg Posterior compartment of the leg contains:
superficially—gastrocnemius muscle,
soleus muscle, plantaris muscle; deeply—
popliteus muscle, tibialis posterior muscle,
flexor digitorum longus muscle, flexor
hallucis longus muscle; it also contains the
posterior tibial a) and v) and the tibial nerve
JOINTS
Joint or ligament Description
Ankle joint The articulation between the distal tibia,

the medial malleolus of the tibia, the
lateral malleolus of the fibula and the
talus
Anterior talofibular ligament A ligament that connects the lateral
malleolus of the fibula with the
anterolateral surface of the talus
Anterior tibiofibular ligament The ligament that connects the distal
ends of the tibia and the fibula anteriorly
Anterior tibiotalar ligament Part of the deltoid ligament connecting
the medial malleolus of the tibia with
the talus
Calcaneofibular ligament A ligament that connects the lateral
calcaneus
Deltoid ligament The ligament that connects the medial
malleolus of the tibia with the talus,
navicular and calcaneus
Posterior talofibular ligament A ligament that connects the lateral
posterolateral surface of the talus
Posterior tibiofibular ligament The ligament that connects the distal
ends of the tibia and the fibula
posteriorly
Posterior tibiotalar ligament Part of the deltoid ligament connecting
the talus posteriorly
Tibiocalcaneal ligament Part of the deltoid ligament connecting
the sustentaculum tali
Tibionavicular ligament Part of the deltoid ligament connecting
the navicular
LOWER LIMB 191
ARTERIES OF THE LOWER LIMB

Artery Source Supply to
Anterior tibial Popliteal artery Anterior leg; dorsum

of foot and deep foot
Aorta, The continuation of Abdominal wall;

abdominal the descending gastrointestinal tract;
thoracic aorta body below the level
of the respiratory
diaphragm
Arch, plantar Lateral plantar artery Deep foot; its plantar
arterial metatarsal brs) and
their brs) supply the
toes, including the
dorsum of the distal
phalangeal segment
Circumflex Deep femoral artery Lateral thigh and hip
femoral,
lateral
Circumflex Deep femoral artery Medial thigh and hip

femoral,
medial
Circumflex Anterior tibial Proximal portion of
fibular lateral leg
Circumflex Femoral artery Superficial fascia of

iliac, lower abdomen and
superficial thigh
Deep Femoral artery Origins of pectineus

external m., adductor longus
pudendal m.; scrotum/labium
majus
Deep femoral Femoral artery Hip joint, proximal
thigh, posterior thigh
Contd...
Contd...
Descending Femoral artery Skin and superficial

genicular structures of the
medial aspect of the
knee and upper leg
Digital, Plantar metatarsal Plantar aspect of each
proper artery, from the digit
plantar plantar arterial arch
Dorsal Dorsalis pedis (1st), Dorsum of digits,
metatarsal arcuate (2nd-4th) excluding the distal
phalangeal segment
Dorsalis pedis Anterior tibial artery Dorsal aspect of the
foot;
External iliac Common iliac artery Lower limb
External Femoral artery Origins of pectineus m.,
pudendal, adductor longus m.;
deep scrotum/labium majus
External Femoral artery Skin and superficial
pudendal, fascia of the upper
superficial medial thigh, skin of
the pubic region
Femoral External iliac artery Thigh, leg and foot
Femoral, Femoral artery Hip joint, proximal

deep thigh, posterior thigh
Femoral, Deep femoral artery Lateral thigh and hip
lateral
circumflex
Femoral, Deep femoral artery Medial thigh and hip
medial
circumflex
Fibular Posterior tibial artery Muscles and fascia of
the lateral leg ankle
Genicular, Femoral artery Skin and superficial
descending structures of the
medial aspect of the
knee and upper leg
Contd...
LOWER LIMB 193
Contd...
Gluteal, Internal iliac artery, Gluteus maximus m.,

inferior anterior division hip joint
Gluteal, Internal iliac, Gluteus maximus m.,
superior posterior division gluteus medius m.,
gluteus minimus m.,
hip joint
Iliac, Abdominal aorta Pelvis, lower limb
common
Iliac, external Common iliac artery Inferior Lower limb
epigastric
artery, deep
circumflex
iliac artery,
femoral artery
Iliolumbar Internal iliac artery, Iliac br., Iliacus m., psoas
posterior division lumbar br. major m., quadratus
lumborum m.
Inferior External iliac artery Cremasteric Lower rectus

epigastric artery abdominis m.,
pyramidalis m., lower
abdominal wall
Inferior Internal iliac artery, Unnamed Gluteus maximus m.,
gluteal anterior division muscular hip joint
branches
Inferior Popliteal artery No named Lateral aspect of the

lateral branches knee
genicular
Inferior Popliteal artery No named Medial aspect of the
medial branches knee
genicular
Contd...
Contd...
Metatarsal, Dorsalis pedis (1st), Dorsal digital Dorsum of digits,

dorsal arcuate (2nd-4th) aa) (2) excluding the distal
phalangeal segment
Metatarsal, Plantar arterial arch Perforating Interosseous mm.,

plantar br., plantar deep portions of the
digital aa) foot; digits including
(2) the dorsum of the
distal phalangeal
segment
Obturator Internal iliac artery, Medial thigh and hip
anterior division
Plantar Lateral plantar artery Deep foot; its plantar

arterial arch metatarsal brs) and
toes, including the
phalangeal segment
Plantar, deep Dorsalis pedis Deep foot; its plantar

metatarsal brs) and
toes, including the
phalangeal segment
Plantar, Posterior tibial artery Deep foot; the plantar
lateral arterial arch and its
brs) supply the toes,
including the distal
phalangeal segment
dorsally
Plantar, Posterior tibial artery Medial side of the sole
medial of the foot
Popliteal Femoral artery Knee, leg and foot
Contd...
LOWER LIMB 195
Contd...
Posterior Popliteal artery Posterior and lateral

tibial leg, plantar aspect of
the foot
Pudendal, Femoral artery Skin and superficial

superficial fascia of the upper
external medial thigh, skin of
the pubic region
Contd...
FIGURE 7.10: Arteries of lower limb

Contd...
Superficial Femoral artery Superficial fascia and

epigastric skin of the lower
abdominal wall
Superficial Femoral artery Skin and superficial
external fascia of the upper
pudendal medial thigh, skin of
the pubic region
Tarsal, Dorsalis pedis artery Tarsal bones and
lateral joints of the lateral
foot
Tarsal, Dorsalis pedis artery Tarsal bones and
medial joints of the medial
side of the foot
Tibial, Popliteal artery Anterior leg; dorsum

anterior of foot and deep foot
Tibial, Popliteal artery Posterior and lateral

posterior leg, plantar aspect of
the foot
LOWER LIMB 197
LOWER EXTREMITY ARTERIES

The abdominal aorta divides, on the left side of the body
of the fourth lumbar vertebra, into the two common iliac
arteries. Each is about 5 cm in length. They diverge from
the termination of the aorta, pass downward and lateral-
ward, and divide, opposite the intervertebral fibrocartilage
between the last lumbar vertebra and the sacrum, into two
branches, the external iliac and internal iliac.
BRANCHES
The common iliac arteries give off small branches to the
peritoneum, psoas major, ureters, and the surrounding
areolar tissue, and occasionally give origin to the iliolumbar,
or accessory renal arteries.
FIGURES 7.11A AND B: 3D VR and MIP showing aortic bifurcation

FIGURE 7.12: 3D VR of internal iliac arteries
Branches of Internal Iliac

From the anterior trunk From the posterior trunk
Superior vesical Iliolumbar
Middle vesical Lateral sacral
Inferior vesical Superior gluteal
Middle hemorrhoidal
Obturator
Internal pudendal
Inferior gluteal
Uterine
Vaginal In the Female
LOWER LIMB 199
Branches of External Iliac Artery

Besides several small branches to the psoas major and the
neighboring lymph glands, the external iliac gives off two
branches of considerable size:
Inferior epigastric Deep iliac circumflex
FIGURE 7.13: 3D VR shows external iliac artery branches

Femoral
FIGURE 7.14: 3D VR showing superficial femoral artery

LOWER LIMB 201
The branches of the femoral artery are:

Superficial epigastric Deep external pudendal
Superficial iliac circumflex Muscular
Superficial external pudendal Profunda femoris
Highest genicular
FIGURE 7.15: MIP of superficial femoral arteries

POPLITEAL
FIGURE 7.16: MIP showing trifurcation of the leg vessels

LOWER LIMB 203
BRANCHES
The branches of the popliteal artery are:
Muscular Superior Lateral superior genicular
Sural Middle genicular
Cutaneous Medial inferior genicular
Medial superior genicular Lateral inferior genicular
The branches of the anterior tibial artery are:
Posterior tibial recurrent Muscular
Fibular Anterior medial malleolar
Anterior tibial recurrent Anterior lateral malleolar
The branches of the posterior tibial artery are:
Peroneal Posterior medial malleolar
Nutrient Communicating
Muscular Medial calcaneal
FIGURE 7.17: 3D VR showing dorsalis pedis

FIGURE 7.18: Axial sections at the level of acetabular roof. RA—Rectus

abdominus, PS—Psoa S, Gmed—Gluteus medius, GM—Gluteus
maximus, Pl—Piriformis, Gmin—Gluteus minimus
FIGURE 7.19: Axial CT at the level of proximal thigh. SA—Sartorius,

RF—Rectus femoris, AL—Adductor longus, AM—Adductor magnus,
ST—Semitendinosus, Gm—Gluteus maximus, VL—Vastus lateralls, Vl—
Vastus intermedius
LOWER LIMB 205
FIGURE 7.20: Axial CT at the level of distal thigh. RF—Rectus femoris,

VM—Vastus medialis, GR—Gracilis, AM—Adductor magnus, VL—Vastus
lateralis, VI—Vastus intermedius, ST—Semitendinosis, SM—
Semimembranosis
FIGURE 7.21: Axial CT at the suprapatellar level. VM—Vastus Medialis,

Quadri—Quadriceps, VL—Vastus Lateralis, BF—Biceps Femoris, SM—
Semimembranosus
FIGURE 7.22: Axial CT at the patellar level. SAR—Sartorius, ITT—iliotitrial

tract, BF—Biceps femoris, MGAS—Medial head of gastrocnemius,
LGAS—Lateral head of gastrocnemius, MPR—Medial patellar retinaculum
FIGURE 7.23: Axial CT at the level of tibial plateu: POP—Popletius,

BF—Biceps femoris, LGAS—Lateral head of gastrocnemius, MGAS—
Medial head of gastrocnemius, PL—Peroneus longus
LOWER LIMB 207
FIGURE 7.24: Cross-section at the mid thigh level
FIGURE 7.25: Axial CT at mid leg level. TA—Tibialis anterior, TP—Titrialis

posterior, PL—Peroneus longus, SOLI—Soleus, MG—Medial gastrocne-
mius, LGM—Lateral gastrocnemius
FIGURE 7.26: Axial CT at lower leg level. EHL—Extensor hallucis

longus, EDL—Extensor digitorum longus
FIGURE 7.27: Axial (cross) section lower leg

LOWER LIMB 209
FIGURE 7.28: Axial (cross) section through right ankle
FIGURE 7.29: Axial section of distal leg. TA—Tibialis anterior, TP—Tibialis

posterior, EDL—Extensor digitorium longus, PL, B—Peroneus longus
and brevius, FDL—Flexor digitorium longus, FHL—Flexor hallucis longus,
SO—Soleus, GAT—Medial gastrocnemius
BONES OF FOOT
FIGURE 7.30: Cu—Cuneiform
FIGURE 7.31: MM—Medial Malleolus, LM—Lateral Malleolus

LOWER LIMB 211
FIGURE 7.32: AT—Achillestendon
FIGURE 7.33: Cuboid

FIGURE 7.34: Calcaneum
FIGURE 7.35: Bones of foot. N—Navicular,

S—Sustentaculum tali, Talus
OSTEOLOGY OF THE ARM AND ELBOW REGION
Bone Structure Description
Humerus The humerus articulates proximally

with the scapula at the glenoid fossa;
it articulates distally with the radius
and ulna at the elbow joint
Head It articulates with the glenoid cavity of
the scapula to form the shoulder joint
Anatomical neck It is located at the circumference of
the smooth articular surface of the
head
Surgical neck It is located inferior to the greater and
lesser tubercles; it is a site of frequent
fracture; fractures of the surgical neck
of the humerus endanger the axillary
nerve and the posterior circumflex
humeral vessels
Greater tubercle It is the attachment site of the supra-
spinatus, infraspinatus and teres minor
mm. which are three members of the
rotator cuff group
Lesser tubercle It is the insertion site of the subscapularis
muscle, a member of the rotator cuff
group
Crest of the greater It forms the lateral lip of the inter-
tubercle tubercular groove; it is the attachment
site for the transverse humeral ligament
and the pectoralis major muscle.
Crest of the lesser It forms the medial lip of the inter-
tubercle tubercular groove; it is the attachment
site for the transverse humeral ligament
and the teres major muscle.
Intertubercular It is occupied by the tendon of the
groove long head of the biceps brachii muscle;
the transverse humeral ligament spans
the intertubercular groove and holds the
tendon of the long head of the biceps
in place; it is the attachment site for the
Contd...
UPPER LIMB 215
Contd...
tendon of the pectoralis major (lateral

lip), teres major (medial lip), and
latissimus dorsi (floor)
Deltoid tuberosity It is the insertion site of the deltoid m.
Radial groove It is a depression for the radial n. and
the deep brachial vessels; fracture of the
humerus at mid-shaft can injure the
radial nerve and deep brachial vessels
because they are in contact with bone
at this location
Lateral epicondyle It is the site of attachment of the
common extensor tendon which is the
origin of several forearm extensor
muscles (extensor carpi radialis brevis
m., extensor digitorum m., extensor
digiti minimi m. and extensor carpi
ulnaris m.); inflammation of the
attachment of the common extensor
tendon is called lateral epicondylitis
which is also known as “tennis elbow”
Medial epicondyle It is the attachment site of the common
flexor tendon which is the origin for the
superficial group of forearm flexor
muscles (pronator teres m., flexor carpi
radialis m., palmaris longus m., flexor
carpi ulnaris m. and flexor digitorum
superficialis m.); inflammation of the
attachment of the common flexor
tendon is called medial epicondylitis; the
ulnar nerve is in contact with bone as it
courses posterior to the medial
epicondyle where it is susceptible to
injury from blunt trauma or fracture
Medial supra- The pronator teres m. takes origin
condylar ridge from the common flexor tendon near
the most inferior part of the medial
supracondylar ridge
Lateral supra- It is the site of origin of the brachio-
Contd...
Contd...
condylar ridge radialis m. and the extensor carpi

radialis longus m.
Coronoid fossa It accommodates the coronoid process
of ulna when the elbow is flexed
Radial fossa It accommodates the head of the radius
when the elbow is flexed
Olecranon fossa It accommodates the olecranon process
of the ulna when the elbow is extended
Capitulum It articulates with the head of the radius;
capitulum means “little head”
Trochlea It articulates with the trochlear notch of
the ulna; the shape of the trochlea and
the trochlear notch limits side-to-side
movement and guarantees a hinge
action; trochlea means “pulley”
Ulna The ulna articulates proximally with the
trochlea of the humerus and the head
of the radius; it articulates distally with
the ulnar notch of the radius
Olecranon It is the insertion site of the tendon of
the triceps brachii m.; when the elbow
is extended, the olecranon of the ulna
engages the olecranon fossa of the
humerus
Trochlear notch It is located between the olecranon and
the coronoid process; it articulates with
the trochlea of the humerus; a ridge
within the trochlear notch fits into the
groove in the trochlea of the humerus
which limits side-to-side movement and
guarantees a hinge action
Coronoid process It is the insertion site of the brachialis
m.
Radial notch It accommodates the head of the radius;
the ends of the annular ligament attach
to the anterior and posterior edges of
the radial notch of the ulna to encircle
the head of the radius
Body It is also called the shaft or diaphysis;
Contd...
UPPER LIMB 217
Contd...
the interosseous membrane attaches to

the entire length of the interosseous
border of the body of the ulna
Head It is small and rounded for articulation
with the radius
Styloid process It is the site of attachment of the articular
disk of the distal radioulnar joint
Radius The radius pivots on its long axis and
crosses the ulna during pronation
Head It has a smooth, rounded surface for
articulation with the ulna; the head of
the radius is encircled by the annular
ligament (4/5 of a circle) and the radial
notch of the ulna (1/5 of a circle)
Neck The annular ligament of the radius
surrounds the head of the radius, not
the neck of the radius
Radial tuberosity It is the insertion site of the tendon of
the biceps brachii m.
Body It is also known as the shaft or diaphysis;
the interosseous membrane attaches to
the entire length of the body of the
radius along its interosseous border; a
fracture of the distal end of the body of
the radius with a dorsal displacement
of the distal fragment is quite common
and is called a Colles’ fracture
Ulnar notch It articulates with the head of the ulna
Styloid process The radial styloid process projects lateral
to the proximal row of carpal bones
MUSCLES OF THE ARM

Muscle Origin Insertion
Anconeus Lateral epicondyle of the Lateral side

humerus of the
olecranon
and the
upper one-
fourth of the
ulna
Biceps brachii Short head: tip of the Tuberosity of
coracoid process of the the radius
scapula; long head:
supraglenoid tubercle of
the scapula
Brachialis Anterior surface of the Coronoid
lower one-half of the process of the
humerus and the ulna
associated intermuscular
septa
Coracobrachialis Coracoid process of the Medial side of
scapula the humerus
at mid-shaft
Triceps brachii Long head: infraglenoid Olecranon

tubercle of the scapula; process of the
lateral head: posterolateral ulna
humerus and lateral
intermuscular septum;
medial head:
posteromedial surface of
the inferior 1/2 of the
humerus
UPPER LIMB 219
ARTERIES OF THE ARM AND ELBOW REGION

Artery Source Branches Supply to
Anterior Axillary artery, 3rd Unnamed muscular Deltoid muscle;
circumflex part branches arm muscles near
humeral the surgical neck
of the humerus
Brachial Axillary artery Deep brachial Arm, forearm
(brachial artery is artery, superior and hand
the continuation ulnar collateral
of the axillary artery, nutrient
artery distal to the artery, inferior
teres major ulnar collateral
muscle) artery; terminal
branches are the
radial artery and
the ulnar artery
Brachial, deep Brachial artery Ascending branch.; Muscles and
terminal branches tissues of the
are the middle posterior
collateral artery compartment of
and radial collateral the arm
artery
Collateral, Brachial artery Unnamed muscular Lower medial
inferior ulnar branches arm
Collateral, Deep brachial Unnamed muscular Medial head of
middle artery branches triceps, anconeus
Collateral, Deep brachial Unnamed muscular Lower lateral arm
radial artery branches
Collateral, Brachial artery Unnamed muscular Medial arm
superior ulnar branches muscles
Posterior Axillary artery, 3rd Unnamed muscular Deltoid; arm
circumflex part branches muscles near the
humeral surgical neck of
the humerus
FIGURE 8.1: Schematic diagram for upper limbs arteries
VEINS OF THE ELBOW REGION

Vein Tributaries Drains into Regions drained
Basilic vein Medial end of the It unites with the Superficial parts
dorsal venous arch brachial vein(s) to of the medial
of the hand; super- form the axillary side of the hand
ficial veins of the vein and medial side
forearm; median of the forearm
cubital vein
Cephalic vein Lateral side of the Axillary vein
dorsal venous
arch of the hand;
superficial veins of
the forearm
Median cubital Cephalic Basilic
vein
UPPER LIMB 221
FIGURE 8.2: Schematic diagram of upper limb veins

JOINTS—ELBOW AND PROXIMAL RADIOULNAR
Joint or ligament Description

Elbow joint The joint between
the distal humerus
and the proximal
radius and ulna
Radioulnar joint, The articulation

distal between the head
of the ulna and the
ulnar notch of the
radius
Radioulnar joint, The articulation
intermediate formed by the
interosseous
membrane
Radioulnar joint, The proximal

proximal articulation
between the radius
and ulna that is
contained within
the capsule of the
elbow joint
UPPER LIMB 223
ELBOW JOINT (ANTEROPOSTERIOR)
FIGURE 8.3: Elbow Joint (Anteroposterior). (1) Lateral supracondylar

ridge, (2) Medial supracondylar ridge, (3) Olecranon fossa, (4) Medial
epicondyle, (5) Lateral epicondyle, (6) Capitulum, (7) Olecranon, (8)
Trochlea, (9) Coronoid process of ulna, (10) Proximal radioulnar joint,
(11) Head of radius, (12) Neck of radius, (13) Tuberosity of radius, (14)
Ulna
ELBOW JOINT (LATERAL)
FIGURE 8.4: Elbow joint (lateral). (1) Supracondylar ridge, (2) Trochlea,
(3) Olecranon, (4) Trochlear notch, (5) Coronoid process of ulna, (6)
Head of radius, (7) Neck of radius, (8) Tuberosity of radius, (9) Ulna
UPPER LIMB 225
FOREARM (ANTEROPOSTERIOR)
FIGURE 8.5: Forearm (Anteroposterior. (1) Scaphoid, (2) Lunate, (3)

Styloid process of radius, (4) Styloid process of ulna, (5) Head of ulna,
(6) Radius, (7) Ulna, (8) Tuberosity of radius, (9) Neck of radius, (10)
Head of radius, (11) Proximal radioulnar joint
FOREARM (LATERAL)
FIGURE 8.6: Forearm (lateral). (1) Scaphoid, (2) Lunate, (3) Distal end of
radius, (4) Styloid process of ulna, (5) Head of ulna, (6) Ulna, (7) Radius,
(8) Olecranon, (9) Tuberosity of radius, (10) Neck of radius, (11) Head of
radius, (12) Trochlea
UPPER LIMB 227
SHOULDER JOINT (ANTEROPOSTERIOR)
FIGURE 8.7: Shoulder joint (Anteroposterior) (1) Clavicle, (2) Acromio-

clavicular joint, (3) Acromion, (4) Greater tubercle of humerus, (5) Head
of humerus, (6) Lesser tubercle of humerus, (7) Surgical neck of humerus,
(8) Coracoid process, (9) Glenoid fossa, (10) Shoulder joint, (11) Lateral
border of scapula
AXIAL SECTIONS THROUGH THE WRIST—CARPAL

BONE LEVEL
FIGURE 8.8: Axial section at scaphoid level
FIGURE 8.9: Axial section at the level of hook of hamate

UPPER LIMB 229
FIGURE 8.10: Axial sections at metacarpal level
FIGURE 8.11: Axial section at the level of radius and ulna

UPPER LIMB ARTERIES

On the right side the subclavian artery arises from the
innominate artery behind the right sternoclavicular
articulation; on the left side it springs from the arch of the
aorta. The two vessels, therefore, in the first part of their
course, differ in length, direction, and relation with
neighboring structures.
Subclavian artery is divided into three parts. The first
portion extends from the origin of the vessel to the medial
border of the Scalenus anterior; the second lies behind
this muscle; and the third extends from the lateral margin
of the muscle to the outer border of the first rib, where it
becomes the axillary artery.
Branches The branches of the subclavian artery are
vertebral, internal mammary, thyrocervical, costocervical.
FIGURE 8.12: 3D VR showing subclavian branches

UPPER LIMB 231
FIGURE 8.13: 3D VR showing axillary artery branches
The axillary artery the continuation of the subclavian,

commences at the outer border of the first rib, and ends at
the lower border of the tendon of the Teres major, where it
takes the name of brachial. The vessel it is divided into
three portions; the first part lies above, the second behind,
and the third below the Pectoralis minor.
First part Highest thoracic

Subscapular
From second part Thoracoacromial
Lateral thoracic
From third part Posterior humeral circumflex
Anterior humeral circumflex
FIGURE 8.14: 3D VR showing axillary branches
The brachial artery commences at the lower margin

of the tendon of the Teres major, and, passing down the
arm, ends about 1 cm below the bend of the elbow, where
it divides into the radial and ulnar arteries.
Branches: The branches of the brachial artery are:
Profunda brachii Superior ulnar collateral
Nutrient Inferior ulnar collateral
Muscular
UPPER LIMB 233
FIGURE 8.15: 3D VR showing brachial artery/bifurcation
RADIAL
Branches The branches of the radial artery may be divided
into three groups, corresponding with the three regions in
which the vessel is situated.
In the forearm At the wrist In the hand
Radial recurrent Dorsal carpal Princeps pollicis
Muscular First dorsal Volaris indicis
metacarpal radialis
Volar carpal Volar metacarpal
Superficial volar Perforating
Recurrent
FIGURE 8.16: 3D VR showing vessels at wrist
ULNAR
Branches The branches of the ulnar artery may be
arranged in the following groups:
In the Forearm Anterior recurrent
Posterior recurrent
Common interosseous
Muscular
At the Wrist Volar carpal
Dorsal carpal
In the Hand Deep volar
Superficial volar arch
UPPER LIMB 235
FIGURE 8.17: Schematic diagram at the level of wrist
FIGURE 8.18: Axial sections of proximal forearm

FIGURE 8.19: Axial sections at the level of radial head
FIGURE 8.20: Axial sections through distal humerus

UPPER LIMB 237
FIGURE 8.21: Axial CT at the level of olecranon
FIGURE 8.22: Axial section at the level of humeral head

FIGURE 8.23: Axial section through midarm
FIGURE 8.24: Schematic diagram at the level of midarm

UPPER LIMB 239
AXIAL SECTIONS THROUGH THE SHOULDER JOINTS
FIGURE 8.25: Axial section at the level of humeral head
FIGURE 8.26: Axial section at the level of shoulder joint

MUSCLES AROUND THE SHOULDER JOINT

Subscapularis Muscle
This is one of the muscles of the rotator cuff, which is a
group of four muscles also including the supraspinatus,
infraspinatus, and teres minor. These four muscles are
responsible for providing stability for the shoulder joint by
holding the head of the humerus in the glenoid cavity of
the scapula. The subscapularis sits anterior to the scapula
and posterior to the serratus anterior muscle. The origin of
this muscle is located at the subscapular fossa of the
scapula. The muscle inserts in the lesser tubercle of the
humerus. The action of the muscle is medial rotation and
adduction of the arm. The muscles is enervated by the
lower subscapular nerve (C5-C7).
Infraspinatus Muscle
This muscle is also one of the members of the rotator cuff
group. It originates from the dorsal aspect of the scapula
and inserts into the greater tubercle of the humerus. It also
sits inferior to the spine of the scapula. Its action is to
laterally rotate the arm and also help stabilize the shoulder
joint. It is enervated by the subscapular nerve.
Supraspinatus Muscle
It originates in the supraspinatus fossa of the scapula, which
is located above the spine of the scapula. The muscle inserts
into the superior aspect of the greater tubercle of the
humerus. It is innervated by the subscapular nerve. The
actions of the muscle include helping the deltoid muscles
UPPER LIMB 241
to abduct the arm. As with other rotator cuff muscles, it

helps stabilize the shoulder joint.
Teres Minor Muscle

It originates from the superior part of the lateral border of
the scapula and inserts in the greater tubercle of the
humerus. Like the teres major, the teres minor is located
also below the spine of the scapula. It serves to adduct
and medially rotate the arm. It is enervated by the axillary
nerve. It sits superior to the teres major muscle.
INTRODUCTION
The skull base is formed of the membranous bones and
cartilage perforated by nerves, arteries and veins. Skull base
consists of anterior, middle and posterior compartments.
ANTERIOR CRANIAL FOSSA

• Boundaries
• Contents
• Orbital plate of frontal bone
• Cribriform plate of the ethmoid bone
• Crista galli of the ethmoid bone
• Lesser wing of the sphenoid bone
• Foramen cecum
MIDDLE CRANIAL FOSSA

• Boundaries
• Contents
• Body of the sphenoid bone
• Sella turcica
• Anterior clinoid processes
• Dorsum sellae
• Posterior clinoid processes
• Greater wing of sphenoid
• Squamous part of the temporal bone
• Carotid canal and groove
• Petrous part of the temporal bone
• Orbital fissures
• Superior
• Inferior
SKULL BASE 245
• Foramina
• Rotundum
• Ovale
• Spinosum
• Optic canal
• Hiatus of the facial canal
FIGURE 9.1: Schematic diagram showing skull base
POSTERIOR CRANIAL FOSSA

• Boundaries
• Contents
• Occipital bone
• Petrous part of the temporal bone
• Dorsum sellae
• Clivus
• Jugular foramen
• Hypoglossal canal
• Internal auditory meatus
• Foramen magnum
• Condyloid canal
• Grooves for:
• Sigmoid sinus
• Transverse sinus
• Superior sagittal sinus
• Occipital sinus
SKULL BASE FORAMINA

On the inner aspect of middle cranial fossa 3 foramina are
oriented along an oblique line in the greater sphenoidal
wing from anteromedial behind the superior orbital fissure
to the posterolateral.
FIGURE 9.2: Axial CT showing skull base foramina

SKULL BASE 247
FIGURE 9.3: Axial CT showing skull base foramina
FIGURE 9.4:: Axial CT at the level of maxillary sinus

FIGURE 9.5: Coronal CT showing the foramina
SCHEMATIC OF THE CRANIAL NERVES
FIGURE 9.6: Schematic diagram showing cranial nerve foramina

SKULL BASE 249
CORONAL CECT AT THE LEVEL OF CAVERNOUS

SINUS (ARROW)
FIGURE 9.7: Schematic and coronal CT showing

cavernous sinus contents
CORONAL AND AXIAL CT SECTIONS SHOWING

THE FORAMEN OVALE
FIGURE 9.8: Contents – fifth nerve third division, lesser petrosal

nerve, accessory meningeal artery, emissary veins
FIGURE 9.9: Axial CT section showing foramen ovale
CORONAL SECTIONS AT THE LEVEL OF

FORAMEN ROTUNDUM
FIGURE 9.10: Contents—fifth nerve second division,

emissary veins, artery of foramen of rotundum
SKULL BASE 251
AXIAL SECTIONS OF THE INFRAORBITAL CANAL
FIGURE 9.11: Axial sections showing infraorbital canal
AXIAL SECTION AT THE LEVEL OF THE

PTERYGOPALATINE FOSSA
FIGURE 9.12: Axial section at the level of the pterygopalatine fossa

Coronal sections showing (1) superior orbital

fissure (2) inferior orbital fissure
FIGURE 9.13
AXIAL SECTIONS SHOWING THE OPTIC CANAL
FIGURE 9.14
SKULL BASE 253
AXIAL SECTIONS SHOWING THE SKULL BASE

ARTICULATION
FIGURE 9.15
RED —TEMPORAL VIOLET –OCCIPITAL
GREEN –SPHENOID ORANGE –PETROUS BONE
FIGURE 9.16: 3D VR showing the skull base foramina

FIGURE 9.17: 3D VR showing the base of skull vasculature

SKULL BASE 255
Foramen Site From To Contents
Optic canal Basi Apex of Middle Optic nerve and

sphenoid orbit cranial fossa artery
Superior In between Apex of Middle 3rd, 4th, 5th1, 6th

orbital lesser and orbit cranial fossa cranial nerves,
fissure greater sphe- sov, branches
noid wings of MMA
Foramen Greater Middle Pterygo- 5th2

rotundum sphenoid cranial palatine
wing fossa fossa
Pterygoid Body of Foramen Pterygo- Vidian nerve

canal sphenoid lacerum palatine fossa and artery
Foramen Great wing Middle Infratempo- 5th3, veins

ovale of sphenoid cranial fossa ral fossa
Foramen Great wing Middle Infratempo- Middle

spinosum of sphenoid cranial fossa ral fossa meningeal artery
Carotid Petrous Skull base Middle Internal carotid

canal temporal cranial fossa artery
Internal Petrous Posterior Inner ear 7th,,8th nerve

auditory temporal cranial fossa
meatus (IAM)
Jugular Between Posterior Jugular Pars nervosa,

foramen basiocciput cranial fossa extra- 9th, inf petrosal
and petrous fossa cranially sinus, pars
vascularis, 10th,
11th nerves and
int jugular veins
Foramen Basiocciput Posterior Cervical Medulla, 11th

magnum cranial fossa spinal canal spinal roots,
vertebral and
spinal arteries
Hypoglossal Occipital Foramen Medial to 12th, br of asc

canal condyle magnum jugular fossa pharyngeal art
INTRODUCTION
The first and second cervical vertebrae are functionally
and morphologically distinct, atlas is an osseous ring with
paired articulating facets for matching articular surfaces of
the occipital bone c2 has an elongated body that continues
superiorly as dens. dens articulates anteriorly with anterior
arch of c1, c3 – c7 vertebrae have moderate wedge shape
in mid saggital sections c5 body is smallest.
The lateral margins of the superior end plate of c3 to
c7 form a short bony wall that extend anteroposteriorly
and curves around the posterolateral corner of each
endplate (uncinate process). There is an articulating facet
on the lateral side of the inferior end plates usually c2-c6,
that articulate with the uncinate process of the next caudad
cervical body to form the uncovertebral joint of Luschka.
The transverse process of each cervical vertebrae contains
the foramen transversorium anterolaterally through which
the vertebral artery passes through.
The cervical facetal joints are oriented in their anterior
portions at a 10-20 degree tilt to the vertical in the cervical
spine the facetal joints are situated on the posterior aspect
of each neural foraminae. The cervical neural foramina
are located 45 degrees to the sagittal plane.
DORSAL SPINE
The thoracic vertebral bodies are usually somewhat flatter
anteroposteriorly than the cervical bodies the vertebrae
gradually increase in width and height from the upper to
the lower thoracic level, on mid sagittal cross sections they
SPINE 259
FIGURE 10.1: Axial section at the level of c1
FIGURE 10.2: Axial sections at the level of body and neural foramina
are moderately wedge shaped. The basivertebral vein is

fairly prominent in the thoracic region.
An important feature of the dorsal vertebrae is the
costocentral articulation between each rib and the body,
FIGURE 10.3: Axial sections at inferior endplate
FIGURE 10.4: Coronal reformation of craniovertebral junction

SPINE 261
costotransverse articulation between the rib and the

transverse process.
Neural foramina extend from the spinal canal at an
angle of 90 degress to the sagittal.
Facetal joints have an oblique axial orientation in the
upper thoracic region and gradually becomes oblique
coronal orientation.
FIGURE 10.5: Axial sections of dorsal spine level of body
FIGURE 10.6: Axial sections at the level of facetal joint

LUMBAR SPINE
Lumbar vertebral bodies increase in size from L1-L4. The
posterior surfaces of L1-L3 vertebrae have a distinct axial
concavity in the middle. The posterior sufaces of l4 and l5
may be flat or convex, neural foraminae are oriented in
the coronal plane, facetal joints are in an oblique plane.
the anterolateral portion of the spinal canal is called the
lateral recess.
AXIAL SECTIONS AT THE LEVEL OF BODY
FIGURE 10.7: Lumbar vertebrae
FIGURE 10.8: Axial sectons at the level of disc space

SPINE 263
FIGURE 10.9: Axial sections of CT myelogram at the L1 level

showing the nerve roots of cauda equina
SACRUM
The sacrum is formed by the fusion of five sacral vertebrae.
The spinal canal continues as the central canal of sacrum.
The sacral neural foramina are situated lateral to the sacral
canal.
FIGURE 10.10: Axial sections at the level of s1 vertebrae

FIGURE 10.11: 3D VR of cervical spine
FIGURE 10.12: 3D VR of dorsal spine

SPINE 265
FIGURE 10.13: 3D VR of lumbar spine
FIGURE 10.14: Curved reformation showing

the exiting nerve at L4- L5 level
FIGURE 10.15: 3D VR showing the intervertebral disc

Orbital volume and dimensions: = 30 cc, 35 (Height)

× 45 (Width) × 45 mm(medial wall depth), globe 25 ×
25 mm
Bones: (F)rontal, (M)axillary, (Z)ygomatic, (L)acrimal,
(E)thmoid, (P)alatine, (S)phenoid
ROOF
• Bones
• Frontal
• Lesser wing of sphenoid
• Contents
• Lacrimal gland fossa
• Trochlea 4 mm posterior to margin for superior
oblique tendon
• Supraorbital notch/foramen
• Clinical Correlations
• Subperisteal abscess
MEDIAL WALL
• Bones
• Maxillary
• Lacrimal
• Ethmoid-thinnest
• Sphenoid
• Contents
• Lacrimal sac fossa
• Cribiform plate is medial to anterior orbit at the level
of fronto-ethmoidal suture
ORBITS 269
FLOOR
• Bones
• Maxillary- second thinnest, thins posteriorly
• Zygoma
• Palatine
• Contents
• Infraorbital foramen
• Inferior oblique origin
• Slopes 20 degrees down
• Suspensory ligament of eyeball
LATERAL WALL
• Bones
• Zygomatic bone
• Greater wing of sphenoid
• Contents
• Lateral orbital tubercle is 11 mm below F-Z suture,
• Serves as attachment of check ligament of lateral
rectus
HOLES AND FISSURES

• Fissures
• Superior orbital fissure (SOF):
• 22 mm long
• Separates greater wing of sphenoid from lesser
wing of sphenoid
• Transmits third, fourth, sixth and V1 and
sympathetic fibers
• lateral rectus origin separates into superior and

inferior divisions
• Superior division transmits lacrimal, frontal
and trochlear nerves
• Inferior division transmits superior and
inferior divisions of CN III, nasociliary branch
of CN V, CN IV, superior ophthalmic vein,
and sympathetic nerve plexus
• Venous system: superior ophthalmic vein
• Inferior orbital fissure (IOF)
• Located between lateral orbital wall and the
orbital floor
• Transmits V2 (maxillary), pterygoid nerv e s
nerve arising from pterygopalatine ganglion
• Infraorbital nerve (a branch of V2) enters the
infraobital groove and infraorbital canal for
sensation to lower eyelid, cheek, upper lid, upper
teeth
• Venous system inferior ophthalmic vein
HOLES/NOTCHES/CANALS
• Nasolacrimal canal
• Lacrimal sac fossa to the inferior meatus
• Separates greater wing of sphenoid from lesser wing
of sphenoid
• Transmits third, four th, sixth and V1 and
symphathetic fibers
• Lateral rectus origin separates into superior and
inferior divisions
ORBITS 271
• Superior division transmits lacrimal, frontal and

trochlear nerves
• Inferior division transmits superior and inferior
divisions of CN III, nasociliary branch of CN V,
CN IV, superior ophthalmic vein, and
sympathetic nerve plexus
• Venous system: superior ophthalmic vein
• Supraorbital foramen/notch
• Transmits blood vessels
• Supraorbital nerve
• Anterior/posterior ethmoidal foramen: transmits
ethmoidal blood vessels and nerve
• Zygomatic foramen: transmits zygomaticofrontal
and zygomaticotemporal nerves, zygomatic
artery
• Nasolacrimal duct (NLD): exits into inferior
meatus
• Infraorbital canal: transmits infraorbital nerve
(V2)
• Ethmoidal foramina
• Anterior ethmoidal artery
• Posterior ethmoidal artery
• Allows infections and neoplasms to enter to
orbit from the sinuses
• Optic canal
• 8-10 mm long
• Located within the less wing of sphenoid
• Separated from SOF by OPTIC STRUT
• Transmits ophthalmic nerve, ophthalmic

artery, sympathetic nerves
• Optic foramen is 6.5 mm wide: it may be
enlarged in the presence of optic nerve
glioma; 1 mm of asymmetry between right
and left is abnormal
FIGURE 11.1: Diagram showing bones of orbit

ORBITS 273
FIGURE 11.2: Schematic showing bones of orbit
FIGURE 11.3: Axial CT of orbit

FIGURE 11.4: Axial CT at the level of optic nerve
FIGURE 11.5: Axial sections of orbit
FIGURE 11.6: Axial sections at the level of superior orbital fissure

ORBITS 275
FIGURE 11.7: Coronal sections of intraocular muscles
FIGURE 11.8: Coronal section at the level of inferior orbital fissure
FIGURE 11.9: Coronal sections of orbit showing

intraocular muscles
FIGURE 11.10: Coronal CT showing orbital fissures
FIGURE 11.11: Coronal CT showing optic canal

NORMAL CORONARY ARTERY AND

VENOUS ANATOMY
The aortic valve consists of three semilunar cusps, the right
and the left, from which arise the right and left coronary
arteries, and the posterior or non-coronary cusp.
The left coronary artery usually divides into two
branches, known as the left anterior descending (LAD)
and the circumflex (Cx) coronary arteries. In some
patients, a third branch arises in between the LAD and the
Cx. This is known as the ramus intermediate.
FIGURE 12.1: Schematic and 3D transparency showing origin of

coronary arteries from aorta
LEFT MAIN
The left main coronary artery exits from the left aortic sinus
and travels in the atrioventricular groove in between the
left auricle and the pulmonary trunk. It extends from the
CARDIAC CT ANATOMY 279
coronary ostia to the inner edge of circumflex. It then

quickly divides into the two major branches—the left
anterior descending and the circumflex.
FIGURE 12.2: 3D VR image showing left main coronary artery in violet
FIGURE 12.3: 3D VR showing the left main and its bifurcation

LEFT ANTERIOR DESCENDING ARTERY

The LAD arises from the left main coronary artery and
traverses the anterior interventricular septum towards the
apex of the heart where it anastamoses with the posterior
descending artery (PDA), During its course the LAD gives
rise to perforating septal branches, which supply the
anterior interventricular septum.
Diagonal branches also come of the LAD to supply the
anterolateral free wall of the left ventricle. The diagonal
branches project off the LAD as it courses downward along
the anterior interventricular septum. These branches supply
the anterior aspect of the left ventricle. The number and
position of diagonal branches is highly variable, therefore,
FIGURE 12.4: Schematic diagram showing LAD branches

FIGURE 12.5: 3D VR image showing LAD and

Diagnol branch in purple. Ramus in blue
the branches are numbered from proximal to distal by

convention.
LAD is divided into three segments—proximal is from
the division of left main to the origin of the first diagonal.
MID—from the first diagonal origin to the origin of the
second diagonal or septal branch. Distal—from origin of
second diagonal.
FIGURE 12.6: 3D MIP image showing

the septal and diagonal branches of LAD
SEPTAL PERFORATING BRANCHES

The septal perforating branches curve in towards the
interventricular septum off of the LAD as it courses in the
anterior interventricular sulcus. These branches supply blood
to the tissue of the interventricular septum, including to the
conducting fibers of the AV, right and left bundles.
The circumflex artery arises from the left main coronary
and continues to course along the left atrioventricular (AV),
groove towards the posterior aspect of the heart. As it
traverses the coronary groove it usually gives off one or
more left marginal branches which supply the lateral free
wall of the left ventricle.
FIGURE 12.7: 3D VR image showing septal branch
FIGURE 12.8: Left circumflex artery. Schematic diagram

showing circumflex artery and branches
FIGURE 12.9: 3D VR image showing left circumflex and obtuse

marginal branch in purple
FIGURE 12.10: 3D VR image showing variation in the number and

size of the circumflex and its obtuse marginal branches
FIGURE 12.11: Oblique MPR images showing SA

nodal branch from LCX
Additionally, the circumflex artery gives off branches

to the left atrium, often terminating in an atrioventricular
branch. In approximately 40% of patients, the circumflex
also gives off a sinoatrial (SA) nodal branch.
The first OM branch divides the circumflex in to
proximal and distal half. The distal circumflex after the
origin of the major OM may be a very small vessel.
In a left dominant coronary circulation, the circumflex
artery gives rise to the posterior descending artery . In this
patient population the left main coronary gives rise to the
entire blood supply of the left ventricle, sometimes making
blockage of the right coronary artery in these patients less
clinically significant. Such anatomy occurs in approximately
10% of the population. An additional 15% of patients have
codominance, meaning that the circumflex and right
coronary arteries both maintain branches to the posterior
diaphragmatic surface of the heart.
FIGURE 12.12: 3D VR image showing the left dominance,

note the PDA arising from the left side (arrow)
RIGHT MAIN CORONARY

The right main coronary artery (RCA) exits from the right
aortic sinus and travels in the coronary groove, also known
as the atrioventricular groove or sulcus. In about 60% of
patients, the RCA gives off the Sinoatrial (SA) nodal branch.
In the remaining 40% of the population this area is supplied
by a branch from the circumflex artery.
Additionally, the RCA typically gives off a conus artery,
right ventricular or acute marginal branch and AV nodal
branch as it traverses along the AV groove. In most patients,
the RCA terminates as the posterior descending artery
(PDA) and posteriorlateral branches (PLV), which supplies
the posterior aspect of the right and left ventricles as well
FIGURE 12.13
FIGURE 12.14: 3D VR color rendered image showing RCA in green

as the posterior one-third of the interventricular septum

and conduction system.
The acute marginal (AM) branch of the RCA serves as
the boundary between the proximal and mid portion of
the RCA. The portion of the artery prior to the origin of
the AM is known as the proximal RCA, while the segment
just beyond the AM is the mid RCA. The segment halfway
between the AM and the origin of the PDA is called the
distal RCA.
SINOATRIAL NODAL BRANCH

The sinoatrial (SA) node, located at the junction of the
superior vena cava and the right atrium, serves as the
dominant pacemaker of the heart. In approximately 60%
of patients, this region is perfused by an SA nodal branch
derived from the proximal RCA. In the remainder of
patients this branch comes off of the circumflex artery or
from a combination of the RCA and circumflex.
FIGURE 12.15: 3D VR and axial MIP image

showing the SA nodal branch
CONUS AND ACUTE MARGINAL BRANCHES

The conus or infundibulum, of the right ventricle is usually
supplied by a proximal branch of the right main coronary
artery. The conus is the smooth outflow portion of the
right ventricle.
RCA gives off one or more marginal branches as it
traverses the coronary groove. Called right marginal or
acute marginal branches, these descend along the right
border of the heart towards the apex. They supply the
right ventricle and portions of the apex of the heart.
FIGURE 12.16: 3D VR image showing separate

origin of the conus branch and marginal branches
FIGURE 12.17: 3D VR image showing RCA branches
AV NODAL BRANCH
In 80% of patients, the right coronary artery supplies the
atrioventricular (AV) node via an AV nodal artery. This
FIGURE 12.18: Oblique MPR images showing the AV

nodal branch arising at the level of crux (arrow)
branch arises near the origin of the posterior descending

artery (PDA) at an area known as the crux of the heart,
where the two ventricles and two atria meet.
POSTERIOR DESCENDING ARTERY (PDA)

Approximately 85% of patients have a right dominant
coronary circulation, that is posterior descending artery
(PDA), arises from the right coronary (RCA). The distal
RCA divides into the PDA and the posterior left ventricular
branches. The PDA branches off from the RCA at the crux
of the heart, the area on the posterior wall of the heart
where the two ventricles and two atria meet. The PDA
runs inferiorly in the posterior inventricular groove to supply
the right and left ventricles and the posterior portion of the
interventricular septum. If the LAD artery, which usually
supplies the apex of the heart, is small, the PDA can extend
FIGURE 12.19: 3D VR and MIP image showing the bifurcation of RCA

at the crux into PDA and PLV
FIGURE 12.20: 3D VR image showing the codominant system with

right PDA and left PLV
around the apex to supply one-third of the anterior

interventricular septum.
In 8% of the population the left coronary artery is
dominant, meaning that the PDA comes off the circumflex
branch as does the AV nodal artery. In these patients the
RCA is small and supplies only the right atrium and lateral
portions of the right ventricle.
Seven to eight percent of the population has a balanced
or co dominant circulation. In these patients, the RCA gives
rise to the PDA as in the right dominant heart, but it is the
circumflex that gives rise to other branches that supply the
posterior aspect of the left ventricle.
AXIAL IMAGES SHOWING CORONARY ARTERIES
FIGURE 12.21: Axial image showing the aortic valve
FIGURE 12.22: Axial image showing the origin of left main and LAD
FIGURE 12.23: Axial image showing origin of circumflex
FIGURE 12.24: Axial image showing origin of RCA

FIGURE 12.25: Axial image showing origin of

marginal branch from RCA
FIGURE 12.26: Axial MIP showing the PDA and PLV

FIGURE 12.27: Axial section at the mid ventricular level

showing the distribution of all the coronary vessels
VENOUS SYSTEM
Coronary sinus (CS) is the wide vein which courses in the
posterior part of the coronary sulcus from the left side to
the right side accompanying the circumflex artery. It opens
into the right atrium. It receives the great cardiac vein at its
left, and the middle and small cardiac veins at its end on
the right side.
FIGURE 12.28: Axial images showing the coronary sinus (arrow)

TRIBUTARIES
• The great cardiac vein (GCV) is located in the
anterior interventricular sulcus, alongside the anterior
interventricular (descending) artery. It courses upwards
from the apex and drains into the coronary sinus.
• The middle cardiac vein (MCV) also begins at the
apex but it courses upwards in the posterior interventri-
cular sulcus, alongside the posterior interventricular
(descending) artery.
• The small cardiac vein (SCV) accompanies the right
marginal artery of the right coronary artery. It courses
in the coronary sulcus and opens into the coronary
sinus near its termination.
FIGURE 12.29: Schematic showing the cardiac veins

PV—pulmonary veins; PT—pulmonary trunk
• The oblique vein of the left atrium is a remnant

of the left SVC. Very fine vein that is hard to visualize
macroscopically.
The following few cardiac veins that do not open into
the coronary sinus:
• The anterior cardiac veins are usually three or four
small veins that arise on the anterior surface of the right
ventricle and pass across the coronary sulcus to open
by minute, separate openings into the right atrium on
its anterior wall.
FIGURE 12.30: The middle and small cardiac veins drain the area of
the heart supplied by the right coronary artery
Index
A Aortic bifurcation 135

Apex of
Abdomen 124 cuneus 8
Abdominal wall muscles 126 fibula 180
Acetabular patella 180
fossa 179 Arteries 100
roof 140 Ascending colon 143
Achilles tendon 186 Ascites 139
Acromioclavicular joint 227 Auricle 43
Acromion 227 AV nodal branch 290
Acute marginal branches 289 Axial
Adductor HRCT of temporal bone 49
longus muscle 125 sections at level of body 262
magnus muscle 125 sections of
Adrenal glands 124 canal 251
AE folds 80 orbit 274
Air column 84
Alar fascia 90
Ambient cistern 32 B
Ankle joint 176, 177 Basal ganglia 2, 33
Anterior Base of
abdominal wall muscle plane metatarsal 178
126 patella 180
cardiac veins 298 penis 125
circulation 22 Body of
cranial fossa 244 fornix 12
inferior iliac spine 179 stomach 142
superior iliac spine 179 Bones 268
surface of fibula 185 Bones of orbit 272
triangle 74 Brain 2, 3, 6, 10
Antrum of stomach 141 Brainstem 6, 8, 13
Aorta 124 Bronchi 97
C Codominant system 300

Calcaneal tendon 186 Coracoid process 227
Calcaneus 177, 178 Corona 34
Calcarine sulcus 12 Coronary arteries 293
Canals 270 Coronoid
Capitulum 223 fossa 216
Carina 98 process of ulna 223, 224
Carotid Corpora quadrigemina 2
space 93 Corpus callosum 12
triangle 74 Costal parietal pleura 96
Caudate lobe 127 Cranial
Cecum appendix 124 nerves 2, 71, 248
Celiac root 6
axis level 131 Cribriform plate 63, 67
trunk 124 Cricoid cartilage 79
Central Cuboid 177, 178
fissure 35 Cuneiforms 177, 178
sulcus 11 Cuneus 12
Centrum 36
Cerebellum 2, 13
Cerebral D
aqueduct 2
Deep
hemispheres 2
cervical fascia 86, 87
Cervical
femoral artery 124
nerves 72
layers of cervical fascia 88
parietal pleura 96
Descending colon 124
Choroid plexus 16
Diencephalon 2
Cingulate
gyrus 11 Digital scanogram brain 28
sulcus 11 Dilated CBD and pancreatic duct
Circle of Willis 21, 22, 31 133
Clavicle 227 Distal
Cochlea 48 end of radius 226
Common phalanx 178
femoral artery and vein 124 tibiofibular joint 176
iliac Dorsal spine 258
arteries 124 Duodenum 124
veins 124 Dural venous sinuses 25
INDEX 301
E Flexor
digitorum longus 185
Ear 42 hallucis longus 185
Elbow joint 223, 224 Foramen 249
Epithalamus 2 magnum 2
Epitympanum 46 Forearm 225, 226
Erector spinae muscle 124 Forebrain 2
Ethmoid Fourth ventricle 2
bones 60 Fovea 179
sinuses 60, 67 Frontal
Extensor bones 60
digitorum lobe 3, 10
brevis 185 radiograph of skull 26
longus 185 sinuses 60
hallucis Fundus 141
brevis 185
longus 185
Extent of neck 89 G
spaces in sagittal 89 Gallbladder 124
External Gastrocnemius 186
auditory canal 43, 52, 55 Glenoid fossa 227
ear 43 Gluteus
iliac vessels 124 maximus muscle 124
oblique muscle 124 medius muscle 125
obturator muscle 125 minimus muscle 125
Gracilis muscle 125
F Great cardiac vein 297
Fabella 180 Greater
Facetal joint 261 trochanter 125, 179
False cord 80 tubercle of humerus 227
Fascial nerve canal 52
Femoral head 125 H
Femur 180 Head of
Fibula 176, 177, 178, 180 femur 179
Fibularis humerus 227
brevis 185 metatarsal 178
longus 185 radius 223-226
tertius 185 ulna 225, 226
Hepatic vein confluence 127 K

Hindbrain 2
Hip joint 179 Knee joint 180
Holes 270 Koerner’s septum 49
Horizontal fissure 99 L
Humerus 214
Hyoid bone 82 LAD and branches 300
Hypoglossal nerve 71 Lateral
Hypothalamus 12 border of scapula 227
Hypotympanum 46 condyle of
femur 180
I tibia 185
Iliac wing 124 epicondyle 223
malleolus 176
Iliacus muscle 124
portion of interosseous
Ilium 179
membrane 185
Inferior
radiograph of skull 27
lobe 99
sulcus 5
mesenteric artery 124
supracondylar ridge 223
pubic ramus 125, 138
ventricles 2, 34
ramus of pubis 179
wall 269
vena cava 124
Left
Inner ear 46, 50
anterior descending artery
Intercondylar eminence 180
280
Internal atrium 101
oblique muscle 124 kidney 124
obturator muscle 125 renal
Interphalangeal joints 178 artery 124
Intertrochanteric crest 179 vein 124
Intraocular muscles 275 Lesser
Investing layer of DCF 85 trochanter 179
Ischial tubercle of humerus 227
spine 125 Level of
tuberosity 125 foramen
Ischiorectal fossa 125 ovale 65
Ischium 138, 179 rotundum 250
IVC origin 135 frontal sinus 62
INDEX 303
GB 128 supracondylar ridge 223
head and neck nodes 77 wall 268
jugular foramen 56 Mediastinal parietal pleura 96
maxillary sinus 63, 66 Medulla 29
nasolacrimal duct 62 oblongata 2
neck nodes 76 Mesencephalon 2
orbital apex 64 Mesotympanum 46
renal hilum 132 Metatarsal bone 185
sphenoid sinus 65, 66 Metatarsophalangeal joints 178
styloid process 56 Metathalamus 2
stylomastoid foramen 57 Metencephalon 2
tongue base 82 Midbrain 2, 6, 9
trachea 78 Middle
uvula 83 cardiac vein 297
Limbic lobe 11 cranial fossa 244
Lingual gyrus 8, 11 ear 43
Liver 124 cavity 50
Lobar veins 101 structures 44
Lumbar half of anterior surface of fibula
spine 262 185
vertebrae 262 lobe 99
Lunate 225, 226 phalanx 178
Lungs 96, 98, 100 Muscles 70, 185
Lymphatic drainage 75
Muscular triangle 74
Myelencephalon 2
M
Major vascular structures 72
N
Malleolar fossa 176
Mamillary body 8 Nasolacrimal duct 271
Masticator space 94 Naxopharynx 84
Maxillary Neck of
bone 60 femur 179
sinuses 60 radius 223-226
Medial Neck veins 21
condyle of femur 180 Nerves 71
epicondyle 223 Normal coronary artery 278
malleolus 176 Notches 270
O Pharyngeal mucosa space 92

Pineal gland 12
Oblique
Piriformis muscle 125
fissure 99
Plantaris 186
vein of left atrium 298
Planum sphenoidale 64
Obturator foramen 179
Pleura 96
Occipital
Pons 2, 6, 9, 29
lobe 4, 11
Porta 128
triangle 75
Portal vein 124
Olecranon 223, 224, 226
Posterior
fossa 223
abdominal wall muscles 124
Olfactory
cranial fossa 245
bulb 9
tract 9 descending artery 280, 291
Optic triangle 75
canal 252, 276 tubercle of talus 177
chiasm 10, 12, 32 Prevertebral layer of DCF 86
Orbit 273 Primary bronchus 97
Orbital Promontory of tibia 177
fissures 276 Prosencephalon 2
sulci and gyri 38 Prostate gland 125
Oropharynx 83 Protympanum 46
Ossicles 45 Proximal
Osteology of arm and elbow region phalax 178
214 radioulnar joint 223, 225
Prussak’s space 50
Psoas muscle 124
P Pterygopalatine 251
Pancreas 124, 130 Pubic symphysis 140, 179
Paranasal sinuses 61 Pulmonary
Parapharyngeal space 93 artery 100
Parathyroid glands 73 ligament 97
Parietal lobe 4, 10 trunk 100
Patella 180 Pyriform sinus 81
Pectineus muscle 125
Pelvic brim 179
Q
Pelvis 124
Peritoneal space 153 Quadratus lumborum muscle 124
INDEX 305
R Sigmoid colon 125, 136, 144

Sinoatrial nodal branch 288
Radius 217, 225, 226 Skeleton 70
RCA and branches 299 Skull base
Rectosegmoid junction 137 articulation 253
Rectum 125 foramina 246
Rectus Small
abdominus muscle 124 bowel 124
femoris muscle 125 cardiac vein 297
Retropharyngeal space 92 intestine 124
Rhombencephalon 2 Spaces 46
Right Sphenoid
adrenal gland 124 bone 60
kidney 124 sinuses 60
main coronary 286 Spinal accessory nerve 71
renal Spleen 124
artery 124 Splenic
vein 124 artery 124
subphrenic space 149 vein 124
Round window 53 Stomach 124
Straight gyrus 11
S Structure of auditory apparatus
Sacrum 125, 263 42
Sartorius muscle 125 Styloid process of
Scaphoid 225, 226 radius 225
Secondary bronchus 97 ulna 225, 226
Segmental bronchus 98 Stylomastoid foramina 51
Sella 30 Submandibular
Semicircular canals 48, 54 space 94
Semimembranosus muscles 125 triangle 75
Semitendinosus muscles 125 Submental triangle 75
Seminal vesicle 125 Subthalamus 2
Septal perforating branches 282 Superficial
Serous membrane lining pleural cervical fascia 85
cavity 96 femoral artery 124
Sesamoids 178 Superior
Shaft of metatarsal 178 lobe 99
Shoulder joint 227 meatus 61
mesenteric Transverse colon 124

artery 124 Transversus abdominus muscle
vein 124 124
ramus of pubis 179 Triangles of neck 74
recess of lesser 149 Tributaries 297
Superolateral surface of calcaneus Trochlea 223, 224, 226
185 Trochlear
Supraclavicular triangle 75 notch 224
Supracondylar ridge 224 surface of talus 177
Suprasellar cistern 30 Tuberosity of
Supraventricular level 35 base of 5th metatarsal 185
Surgical neck of humerus 227 radius 223-226
Sustentaculum tali 177 Tympanic
Symphysis pubis 125 cavity 53
membrane 44, 45
T U
Talus 176-178 Ulna 216, 225, 226
Tarsal tunnel 177 Uncus 5
Tarsometatarsal joints 178 Upper thigh 124
Telencephalon 2 Ureter 124
Temporal Urinary bladder 125, 137
bone 51
lobe 4
V
Tensor fascia latae 125
Tentorial hiatus 31 Various sulci and gyri 36
Tertiary bronchus 97 Vastus
Thalami and basal ganglia 39 intermedius muscle 125
Third part of duodenum 133 lateralis muscle 125
Third ventricle 2, 33 medialis muscle 125
Thyroid 78 Veins 101
cartilage 79 Venous system 296
gland 73 Ventricular system of brain 15
Tibia 176-178, 180 Vertebra 124
Tibial tuberosity 180 Vestibule 48
Tibialis Visceral
anterior 186 column 73
posterior 186 pleura 97

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Step by Step®

Accompanying Photo CD ROM is playable only in Computer and not in DVD

D Karthikeyan DMRD DNB

JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD

Step by Step Cross-sectional Anatomy

First Edition: 2005

Multislice computed tomography has changed the way of

Computed tomography has changed the way of looking

2. Temporal Bone ............................................ 41

3. Paranasal Sinuses ........................................ 59

6. Abdomen ................................................... 123

7. Lower Limb ............................................... 175

8. Upper Limb ............................................... 213

9. Skull Base ................................................. 243

10. Spine ......................................................... 257

11. Orbits ........................................................ 267

12. Cardiac CT Anatomy ................................. 277

Index .................................................................... 299

Structure Description Significance

Forebrain Prosencephalon Comprised of: telencephalon or

Midbrain Mesencephalon Connects forebrain and

Hindbrain Rhombencephalon Comprised of: metencephalon or

Telencephalon Rostral part of Comprised of: cerebral

Diencephalon Caudal portion of Comprised of: thalamus,

Myelencephalon Caudal part of Comprised of: medulla

FEATURES OF THE BRAIN—LATERAL VIEW

Structure Description Significance

Cerebral Telencephalon Comprised of: cortex

Longitudinal Midline, sagittal Contains the falx

Frontal pole The most anterior Frontal pole is part of the

Temporal pole The most anterior

Occipital pole The most posterior Occipital pole is part of the

Central sulcus Separates frontal Separates the precentral

Frontal lobe Rostral to central Contains prefrontal

Temporal lobe Separated from the frontal Primarily concerned with

Occipital lobe Posterior to an imaginary Contains the primary

Precentral Most caudal gyrus of the Contains the primary

Postcentral Most rostral gyrus of the Contains the primary

Superior Gyrus between the lateral Contains the primary

Middle Gyrus between the superior

Uncus Portion of the cerebral Contains olfactory cortex

Longitudinal Midline, sagittal cleft Also known as: longitudinal

Precentral The sulcus anterior to the In conjunction with the

Postcentral The sulcus posterior to the In conjunction with the

Parieto-occipital Sulcus between the parietal Landmark used to define

Brainstem Comprised of: midbrain, Origin of most of the

Midbrain Mesencephalon Connects forebrain and

Pons Anterior portion of The site of origin of cranial

Medulla Also known as: It is continuous with the

FEATURES OF THE BRAIN—INFERIOR VIEW

Structure Description Significance

Cerebral Telencephalon Comprised of: cortex

Longitudinal Midline, sagittal cleft Longitudinal sulcus

Frontal The most anterior part Frontal pole is part of the

Temporal The most anterior part

Occipital The most posterior part Occipital pole is part of the

Frontal Rostral to central sulcus Contains prefrontal

Temporal Separated from the Primarily concerned with

Straight Gyrus located on the Gyrus rectus