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1、Click to edit Master title style,,,*,Click to edit Master text styles,,Second level,,Third level,,Fourth level,,Fifth level,,腹部橫斷層解剖,,From vesalius,,,Abdomen Sectional Atlas: 1,The following cross-sectional atlas of a normal male abdomen demonstrates anatomical relationships of the abdominal org

2、ans in the context of the CT scan. The sections span the area between the dome of the right hemidiaphragm at T9 to L5 below the aortic bifurcation.,,Abdomen Sectional Atlas: 2,The air-filled colon outlines a pendent transverse colon between prominent hepatic and splenic flexures. Note the proximity

3、of the heart to the cardia of the stomach and the lesser curve of the stomach crossing the T12-L1 disc.,,Abdomen Sectional Atlas: 3,The sequence of abdomen sections 1 to 14 below, shown as an animation.,,Abdomen Sectional Atlas: 4,The section levels superimposed on an x-ray. Click the appropriate nu

4、mber above to view a particular section.,,1,,2,,3,,4,,5,,6,,7,,8,,9,,10,,11,,12,,13,,14,,,Abdomen Sectional Atlas: section 1,By convention, CT cross sections are viewed from a caudal perspective. Section 1, at the level of T9, cuts across the dome of the right hemidiaphragm, the bases of the lungs,

5、and the long axis of the ventricles of the heart. The termination if the inferior vena cava is seen at its junction with the right atrium (see,Heart Anatomy, Cross-Sections,).,,Abdomen Sectional Atlas: section 2,The second section, through T10, sections the dome of the liver where faint traces of th

6、e hepatic veins can be seen converging toward the hepatic portion of the inferior vena cava (see,Right Upper Quadrant Anatomy,). The aorta is still to the left of the midline in the lower posterior mediastinum and the esophagus lies directly anterior to it. When exploring an abdomen with no nasogast

7、ric tube in place, the aortic pulsation is the guide to the location of the esophagus.,,Abdomen Sectional Atlas: section 3,Level 3, at the top of T11, starts to catch the cardia of the stomach and the adjacent upper pole of the spleen. Note the esophagus anterior to the aorta, indicating this sectio

8、n is above the esophago-gastric junction.,,Abdomen Sectional Atlas: section 4,At the bottom of T11, the portal vein is seen in the hepatic hilum. The esophago-gastric junction is seen. The body of the spleen is partially separated from the body of the stomach by the prominent splenic flexure in this

9、 individual (see,Spleen Anatomy,).,,Abdomen Sectional Atlas: section 5,At the middle of T12, the body of the gallbladder is seen as a radial lucency within the liver. The plane through the gallbladder bed and the inferior vena cava divides the liver into right and left lobes (see,Hepatic Anatomy, Ca

10、udal View,). The crura of the diaphragm are seen uniting anterior to the aorta as the arcuate ligament. The posteromedial border of the spleen is indented by the beginning of perinephric fat within,Gerota's fascia. The hilum and gastric surface of the spleen faces anteromedial.,,Abdomen Sectional At

11、las: section 6,At the upper border of L1, the celiac trunk emerges perpendicular to the aorta, just beneath the arcuate ligament of the crura (see image,abdG3004,). The pancreas is draped across the origin of the celiac and the tail of the pancreas abuts the hilum of the spleen (see image,panG3001,)

12、. The upper pole of the left kidney and adjacent adrenal gland are seen. The top of the right adrenal gland is seen immediately posterior to the inferior vena cava where the adrenal vein drains directly into its posterior wall.,,,Abdomen Sectional Atlas: section 7,At the bottom of L1, the superior m

13、esenteric artery arises from the aorta. Immediately anterior to it, the celiac is dipping down to divide into splenic and hepatic branches. Just anterior to the celiac, the splenic vein is seen as a light streak along the posterior border of the pancreas. The splenic vein drains into the portal vein

14、 posterior to the neck of the pancreas (see,Portal Vein,anatomy). The lower pole of the spleen abuts the middle of the left kidney.,,Abdomen Sectional Atlas: section 8,At the level of L2, the superior mesenteric artery and vein are distinctly seen in the root of the small bowel mesentery. The third

15、portion of the duodenum passes between them and the great vessels (see,panG3001,). The left renal vein crosses the aorta to drain into the inferior vena cava. Note the short right renal vein. Branches of the renal arteries, which arose anterolaterally just below the level of the superior mesenteric,

16、 are seen entering the renal hila.,,Abdomen Sectional Atlas: section 9,At the top of L3, the tip of the right hepatic lobe is seen as well as the left renal pelvis.,,Abdomen Sectional Atlas: section 10,At the lower portion of L3, the inferior mesenteric artery is seen arising from the aorta (see,Low

17、er GI Bleed Case Study,). The left ureter is visualized lying at the anterior border of the left psoas muscle. The draped transverse colon occupies the anterior abdominal space.,,Abdomen Sectional Atlas: section 11,Near the top of L4, the lower poles of the kidneys are seen as well as the numerous v

18、essels in the small bowel mesentery. The lucency around the kidneys is perinephric fat, which tapers above and below the kidneys within Gerota's fascia (see image,bilL3018,).,,Abdomen Sectional Atlas: section 12,At L4, the aortic bifurcation is seen. The narrow descending colon on the left and wide

19、cecum on the right are seen. The appendix is visualized with contrast in the lumen (see,Appendectomy,). The appendix is retrocecal here as it is in the majority of individuals.,,Abdomen Sectional Atlas: section 13,At the top of L5, the common iliac arteries diverge. The base of the appendix is seen

20、at the cecum. Note the umbilicus in relation to the aortic bifurcation.,,,Abdomen Sectional Atlas: section 14,At the lower portion of L5 near the lumbosacral junction, the psoas muscles have become larger and rounded as they begin their anterior course around the brim of the true pelvis (see image,a

21、bdG3004,).,,Abdomen Sectional Reconstructions: 1,Stacking the sections allows conceptual reconstruction and visualization of relationships (see image,abdG3005,).,,Abdomen Sectional Reconstructions: 2,The high posterior position of the spleen beneath the left hemidiaphragm affords protection by the r

22、ib cage (and makes it difficult to reach by laparotomy). Note the relationships to cardia of stomach, left kidney and splenic flexure of colon (see,Spleen Anatomy,).,,Abdomen Sectional Reconstructions: 3,The kidneys lie in the retroperitoneum surrounded by perinephric fat, encapsulated within the an

23、terior and posterior lamina of Gerota's fascia. The fusiform psoas muscles direct the axis of the kidneys anterolaterally toward the lower poles. Note relationships to surrounding structures (see images,abdG3004,and,abdG3005,).,,,Abdomen Sectional Reconstructions: 4,,,The liver fills the right hemid

24、iaphragm and extends to the left between the heart and cardia of the stomach anteriorly (see image,abdG3005,, biliary-hepatic anatomy). Note the relationship to the right kidney, hepatic flexure of colon and duodenum, all of which make impressions on the underside of the liver (see,Hepatic Anatomy, Caudal View,).,,,