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Coronary Arteries, Heart, and Pericardium

The coronary arteries are vessels that course through the epicardial fat to supply the myocardium with oxygenated blood. There is a great deal of variability in the anatomy of the coronary arteries from person to person, and the size and branching pattern of each coronary artery can vary significantly. Therefore it is important to remember that anatomic variants are quite common, and it is imperative to…

Female Pelvis

Imaging Considerations of the Female Pelvis Imaging of the female pelvis plays a critical role in the diagnosis and evaluation of various gynecologic diseases. Typically ultrasonography (US) is used as first-line evaluation of the female genital organs. The lack of ionizing radiation, relative low cost, and ability to evaluate normal and pathologic findings in a wide range of gynecologic diseases makes US an attractive choice in…

Male Pelvis

Introduction Evaluation of the male pelvis can be performed with several imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US), depending on the clinical indication and anatomic region of interest. US may be the first study of choice for selected indications because of its lack of radiation exposure, benefit of real-time examination, and ability of color Doppler to investigate blood flow. However,…

Retroperitoneum

Introduction The retroperitoneum is the compartmentalized space located external to and predominantly posterior to the posterior parietal peritoneum. About half a century ago, the retroperitoneum was described as a “veritable jungle of strange things” and as a “hinterland of straggling mesenchyme, with vascular and nervous plexuses, weird embryonic rests and shadowy fascial boundaries”. Since then, a better understanding of the anatomy and pathology of the retroperitoneum…

Kidney

Computed tomography (CT) is a rapid, easily performed, and safe diagnostic imaging technique that provides valuable information about a wide spectrum of renal disorders. CT is highly accurate for determining the nature and extent of renal masses and plays a valuable role in assessing patients with renal cystic disease, renal trauma, renal infections, renal blood flow disturbances, and hydronephrosis of unknown cause. Multidetector (MD)CT (multislice CT)…

Adrenal Glands

Introduction In 1564, Bartolomeo Eustachius (1520-1574) was the first anatomist to give a detailed description of the adrenal glands, which he depicted in a series of drawings on copper plates. However, the function of the adrenal glands remained a mystery for the next 3 centuries. In 1855, Thomas Addison (1793-1860) described the clinical syndrome of adrenal insufficiency in his monograph titled, “On the Constitutional and Local…

Contrast Nephropathy and Its Management

Since the introduction of multidetector computed tomography (MDCT) technology, the number of patients undergoing contrast-enhanced CT studies has steadily increased. In addition the patient population subjected to CT is becoming progressively older with more comorbid conditions. The benefits of contrast-enhanced CT are well recognized in the diagnosis of diseases, evaluation of trauma patients, and guidance of interventional and therapeutic procedures. However, adverse reactions to contrast administration…

Rectum

Anatomy The rectum and anal canal form the terminal part of the intestine. The rectum varies in length from 10 to 15 cm and extends from the rectosigmoid junction at the level of the S3 sacral vertebra to the anorectal line. The surgical anorectal junction is at the upper edge of the anorectal muscle ring located about 4 cm from the anal verge. The anatomic anorectal junction called…

Peritoneum

Computed tomography (CT) and magnetic resonance imaging (MRI) have proven useful for the diagnosis of many peritoneal and mesenteric problems. Even in the absence of a primary peritoneal problem, many secondary signs that add valuable insights about other disorders may be observed. This chapter discusses the embryology, normal anatomy, and physiology of the peritoneum and retroperitoneum and a wide spectrum of relevant pathologic disorders. Because of…

Spleen

The spleen is well evaluated with current cross-sectional imaging modalities. The primary imaging technique continues to be computed tomography (CT), although magnetic resonance imaging (MRI) has become important for lesion characterization. Ultrasonography is also used frequently, although there may be limited visualization of the spleen owing to a subcostal location or obscuration by adjacent bowel gas. 18 Fluorodeoxyglucose ( 18 FDG) positron emission tomography (PET) is…

Mesentery

Embryology At the end of the third week of gestation, the primitive gastrointestinal (GI) tract of an embryo consists of a straight tube suspended from the esophagus to the rectum by the dorsal mesentery, which contains the vascular supply. In the dorsal mesentery, the portion connected to the stomach is known as the dorsal mesogastrium. As the embryo lengthens, the caudal portion of the septum transversum…

Pancreas

Whether the pancreas is adorable or not is a debatable issue; however, advanced cross-sectional imaging has permitted generation of excellent and exquisite images of the pancreas, which in turn has contributed immensely to the assessment of pancreatic diseases. Ultrasonography (US) has been used to evaluate abdominal pathologies, and its advantages include wide availability, low cost, and lack of radiation. Despite significant improvements and refinements in ultrasound…

Liver Transplantation

History Transplantation of the liver is the definitive treatment for irreversible acute and chronic liver disease. The first successful liver transplant was performed by Starlz in 1967 on a patient with hepatocellular carcinoma, who survived for more than 1 year. The development of cyclosporine in 1970, followed by other immunosuppressant agents and improved surgical techniques, has significantly improved the survival rates of liver transplant patients, leading…

Liver: Focal Hepatic Mass Lesions

Focal hepatic mass lesions can be divided into: (1) pseudolesions or pseudotumors, (2) nontumorous mass lesions, including cysts and inflammatory masses, (3) benign tumors, and (4) primary and secondary malignant tumors. Ultrasonography plays a primary role in detection of focal hepatic mass lesions; for further characterization, computed tomography (CT) and magnetic resonance imaging (MRI) provide valuable information. This chapter discusses the CT and MRI features of…

Liver : Normal Anatomy, Imaging Techniques, and Diffuse Diseases

Over more than 3 millennia the liver held a central and unsurpassed role among all human organs, manifested in coeval theogony, poetry, and fairy tales. The liver was chosen to be the seat of the soul, intelligence, and passion, equipped with particular divine protection and hoped to be indestructible, reflecting the prodigious recuperative powers of hepatic parenchyma. In Egyptian mythology, Isis's envoy Imsety (18th Dynasty, 1570-1350…

Biliary Tract and Gallbladder

Biliary Tract Normal Anatomy and Variants On high-resolution computed tomography (CT), normal intrahepatic bile ducts (IHDs) appear as linear water-density structures accompanying the portal vein branches. Normal IHDs measure less than 3 mm. They appear to be randomly scattered throughout the liver but are confluent toward the hilum. The IHDs from each lobe unite to form the right and left main hepatic ducts, which are located anterior…

Chest Imaging in the Pediatric Patient

Introduction Plain film radiography is the first-line imaging modality in the evaluation of pediatric chest disorders. However, computed tomography (CT) and magnetic resonance imaging (MRI) are increasingly being used and are more valuable for further characterization of pediatric chest abnormalities. Multidetector CT (MDCT) is the most important imaging modality and is more sensitive than radiographs. CT has several advantages including high spatial resolution, good temporal resolution…

Airway

Normal Anatomy Trachea and Main Bronchi The trachea comprises 16 to 22 C -shaped cartilages that are linked longitudinally by annular ligaments of fibrous and connective tissue. The cartilages are connected posteriorly by the membranous wall of the trachea, which lacks cartilage and is supported by the trachealis muscle, which is composed of transverse smooth muscle fibers that narrow the tracheal lumen on contraction. During forced…

Disease of the Pleura, Chest Wall, and Diaphragm

Normal Anatomy Pleura and Chest Wall The pleura is a thin, two-layered serous membrane that lines the lungs and thoracic cavity. The visceral pleura lines the lungs and invaginates into a double layer to form the major and minor fissures, and the parietal pleura lines the chest wall, mediastinum, and diaphragmatic surface (sparing the hila). The pleural space is a potential space between the parietal and…