Pelvis & Perineum Anatomy Gerald R. Aben, MD, FACR Associate Professor Radiology College of Osteopathic Medicine In this segment we will be reviewing her a variety of anatomic objectives related to the pelvic and perineal anatomy 9/21/2018 DEPARTMENT OF RADIOLOGY

DEPARTMENT OF RADIOLOGY Obtained as part of a hysterosalpingogram, this examination allows us to demonstrate the relationship of the uterus to the fallopian tubes to the cervical canal and the vagina as it relates to pelvic structures in the normal patient. 9/21/2018 DEPARTMENT OF RADIOLOGY

DEPARTMENT OF RADIOLOGY CT examination the pelvis gives us better delineation of the internal anatomy and anatomic objectives related with the female pelvis. Note the relative location of the uterus and the adjoining ovary. Muscular structures including the rectus muscles, the obturator internus muscles are clearly defined. The relationship of the obturator internus to the ileum and iliac vessels is clearly seen. The dotted line outlines the portion of the pelvis containing the sigmoid colon and rectum in this particular individual. 9/21/2018 DEPARTMENT OF RADIOLOGY

DEPARTMENT OF RADIOLOGY Slightly different anatomic structure in the male patient again demonstrable the rectus muscle,s the bladderand in this case seminal vesicles located in the area just anterior to the rectum posterior to the bladder having almost a butterfly Wing or batwing appearance. Note the relative location of the common femoral artery and vein in this individual. The sacrum seen posteriorly. The superior aspect of the acetabulum noted as a sclerotic zone superimposing both ilioischial regions. 9/21/2018 DEPARTMENT OF RADIOLOGY

DEPARTMENT OF RADIOLOGY At a slightly lower level in this male patient we identify the pubic symphysis and the femoral neck. We also again demonstrate the common femoral artery and vein and the relative relationship of the rectum to the prostate gland. 9/21/2018 DEPARTMENT OF RADIOLOGY

DEPARTMENT OF RADIOLOGY On the coronal sections through the thighs the relative anatomy of the corporal cavernosal incorporate spongiosum of the penis in a male patient can be identified. 9/21/2018 DEPARTMENT OF RADIOLOGY

DEPARTMENT OF RADIOLOGY This axial image through the upper portion of thigh, gives usa better delineation of the corpus cavernosum and the corpus spongiosum in this individual. 9/21/2018 DEPARTMENT OF RADIOLOGY

DEPARTMENT OF RADIOLOGY The arterial anatomy of the pelvic region clearly seen on this study. The aorta, the common iliac arter, the external iliac artery and the internal iliac artery branches are demonstrated. The location the femoral artery noted at the medial aspect of each femoral head. 9/21/2018 DEPARTMENT OF RADIOLOGY

DEPARTMENT OF RADIOLOGY In the past, contrast material could be introduced into the region of the foot for evaluation of lymph nodal structures. This was commonly performed in patients with a question of lymphoma in the days prior to CT and MRI evaluation of structure. In this case the contrast material has accumulated along the lymph nodes in the iliac chains as well as the peri-aortic chain and can be identified as patchy areas of opacification in those distributions. 9/21/2018 DEPARTMENT OF RADIOLOGY

DEPARTMENT OF RADIOLOGY This collage of images represent images obtained in another patient. The lowermost image in the lower leg demonstrates contrast material within lymphatic channels in the lower leg. We see filling of both lymphatic channels and lymph nodes in the pelvic region on the middle image and on the upper image we again identify the contrast material within lymph nodes in the pelvic region. Noted incidentally a renal stent or drain superimposing the left kidney 9/21/2018 DEPARTMENT OF RADIOLOGY

Trans Abdominal Imaging Urinary bladder Cervix On the sagittal view the urinary bladder is noted towards the top of the image as a black or low echogenicity area. Directly behind the urinary bladder is the uterus indicated by white arrows. The cervix is demonstrated indicated by a single long narrow arrow

Trans Abdominal Imaging Uterus body cervix A similar view demonstrates uterine body as well as the cervix.

Trans Abdominal Imaging Endometrium A third image in this series with an arrow indicating the location of the endometrium.

Trans Abdominal Imaging Endometrium Bladder Right Adnexa An axial cross-sectional ultrasound image through the abdominal wall of the lower pelvic region demonstrated the bladder anteriorly with the uterus posteriorly as an oval structure. The relatively lower echogenicity endometrium is indicated by white arrows. An oval low echo area to the right of the uterus likely representing the right adnexa likely the right ovary..

Endovaginal Imaging Uterine fundus An additional sagital image demonstrating the uterus and uterine fundus. Uterine fundus