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CVM 6101 Radiographic Anatomy of the Abdomen

Travis C. Saveraid, DVM, DACVR Medical Imaging Department College of Veterinary Medicine University of Minnesota
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CVM 6101 [Imaging Anatomy]


Goals & Expectations:
Identify specific structures or parts thereof Understand why the views (projections) look as they do Keep in mind that the items listed in the to know lists are from the perspective of practicing radiologists If asked, be able to describe what soft-tissue (muscle, tendon, ligament, vessel, or alimentary/parenchymal) structure(s) attach to, pass through, or lie in contact with a given anatomic landmark or region
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CVM 6101 [Imaging Anatomy]


Approach:
Introductory lectures defining the important structures and how they are viewed radiographically Open session, instructor proctored group laboratory exercises wherein actual radiographs of the anatomic structures are viewed and understood Web-based self-study sets both available on CD and from the web site http://www.academicserver.cvm.umn.edu/radiology//
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CVM 6101 [Imaging Anatomy]


Sources of Information:
Anatomy Textbooks Radiographic Anatomy Textbooks General Veterinary Imaging Textbooks U-MN Medical Imaging web site http://www.academicserver.cvm.umn.edu/radiology/
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1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) 17) 18) 19)

liver spleen left and right kidneys urinary bladder small intestine colon rectum prostate gland left and right diaphragmatic crura diaphragmatic cupola approximate area of the adrenal glands approximate area of the pancreas xiphoid of the sternum approximate area of the uterus approximate area of the left and right ovaries stomach: cardiofundic, body, and pylorus/pyloric antrum regions cecum approximate area of the caudal vena cava, aorta, and iliac (sublumbar) lymph nodes region of the falciform fat

To Know List

Abdominal CT images (single slice)

Sagittal Dorsal

Left parasagittal

Midline sagittal

Right parasagittal (*3 different dogs)

Normal Lateral Views

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Normal VD Views

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Normal Canine Abdomen

Normal (Fat) Feline

Normal (Fat) Feline

Interpretive Background: Abdomen


Peritoneal organs (surrounded by peritoneum and obscured by peritoneal fluid) include liver, spleen, pancreas, alimentary organs, urinary bladder, uterus, ovary, prostate (depending on location) and mesenteric lymph nodes Retroperitoneal organs (only partially surrounded by peritoneum and NOT obscured by peritoneal fluid) include great vessels, kidneys, adrenal glands, ureters (except very distal), urethra and retroperitoneal lymph nodes
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CVM 6101 [Imaging Anatomy]


Diaphragm:
V D/D V and R L/L R views Beware of superimposed structures including vertebrae, ribs, sternebrae, lungs, stomach, nipples, fascial planes, trachea, etc. Remember, the diaphragm is a sling-like muscle that actively contracts (caudally) and passively relaxes (cranially) [numerous influences such as lungs, abdominal fat, etc.]
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CVM 6101 [Imaging Anatomy]


Diaphragm: Specific Morphology
Hiatus for caudal vena cava Hiatus for aorta Hiatus for esophagus (esophagus, vagal n)

For more review, see normal thoracic lecture


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CVM 6101 [Imaging Anatomy]


Diaphragm
Aortic hiatus

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CVM 6101 [Imaging Anatomy]


Diaphragm
CVC hiatus

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CVM 6101 [Imaging Anatomy]


Diaphragm
Esophageal hiatus

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CVM 6101 [Imaging Anatomy]


Stomach:
V D/D V and R L/L R as well as horizontalbeam views Beware of superimposed structures including vertebrae, ribs, sternebrae, lungs, stomach, nipples, fascial planes, liver, etc. Remember, the stomach is like a wine skin with an outlet on both ends (distension changes its shape) The stomach responds to forces from regional organs and masses by changing shape
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CVM 6101 [Imaging Anatomy]


Stomach: Broad Anatomic Regions
Cardia Fundus Body Pylorus

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Normal Abdominal Architecture

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Interpretive Background: Abdomen


Useful interpretive criteria:
Liver size influences the fundic-pyloric axis
Normally parallel to last 2-3 ribs on lateral view Normally perpendicular to spine on VD/DV views

Large liver or right-sided liver mass displaces pylorus caudally and to the left
remember F-P axis effect

Small liver allows pylorus to drift cranially


remember F-P axis effect
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Fundic-pyloric axis
Normal axis between perpendicular to spine and parallel to caudal ribs

CVM 6101 [Imaging Anatomy]


Stomach:
Appearance changes depending on DV (sternal recumbency) vs. VD (spinal recumbency) views (with the X-ray beam is centered on the last rib):
On DV views, the gas is primarily in the cardiac region with less in the pyloric region; fluid is in the body region On VD views, the fluid is primarily in the cardiac region with less in the pyloric region; air is in the body region Appearance may vary depending on the relative amounts of fluid and gas UNIVERSITY OF MINNESOTA
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CVM 6101 [Imaging Anatomy]


Stomach
DV Gas in cardia and pyloric antrum

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CVM 6101 [Imaging Anatomy]


Stomach
VD Gas in body/fundus

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CVM 6101 [Imaging Anatomy]


Stomach:
Appearance changes depending on R vs. L recumbent lateral views (with the X-ray beam is centered on the last rib):
On R lateral views, the gas is primarily in the cardiac region with fluid in the pyloric region (may look like ball) On L lateral views, the gas is primarily in the pyloric region with fluid in the cardiac region Appearance may vary depending on the relative amounts of fluid and gas UNIVERSITY OF MINNESOTA
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CVM 6101 [Imaging Anatomy]


Stomach R lateral recumbency Gas in cardia Fluid in pylorus

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CVM 6101 [Imaging Anatomy]


Stomach
L lateral recumbency Gas in pylorus Fluid in cardia

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CVM 6101 [Imaging Anatomy]


Stomach: Specific Morphology
Gastroesophageal Junction Rugae Pyloric Antrum/pylorus

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CVM 6101 [Imaging Anatomy]


Stomach
Gastroesophageal Junction

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CVM 6101 [Imaging Anatomy]


Stomach Rugae

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CVM 6101 [Imaging Anatomy]


Stomach Pyloric Antrum

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CVM 6101 [Imaging Anatomy]


Small Intestine:
V D/D V and R L/L R and horizontalbeam views Beware of superimposed structures including vertebrae, ribs, stomach, nipples, kidneys, spleen, fascial planes, urinary bladder, etc. Remember, relative amounts of small bowel gas varies by species (dogs, 30 60 %; cats, nearly gasless)
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Interpretive Background: Abdomen


Useful interpretive criteria: Small bowel can be compared to the width and length of the lumbar vertebral bodies: Normal canine or feline small bowel are less than 3 rib widths or less than the height of a lumber vertebral body in diameter Concern should arise if the diameter approaches the width of a lumber vertebral body Surgical intervention is often indicated if the diameter equals or exceeds the length of a lumber vertebral body
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CVM 6101 [Imaging Anatomy]


Small Intestine : Broad Anatomic Regions
Duodenum
Descending Ascending

Jejunum Ileum

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CVM 6101 [Imaging Anatomy]


Small Intestine
Note gas-fluid relationship Note gas-fluid distribution Beware of influences by other regional organs including retroperitoneal fat

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Normal Abdominal Architecture

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CVM 6101 [Imaging Anatomy]


Small Intestine :
Appearance changes depending on DV vs. VD and R vs. L lateral recumbency views (with the X-ray beam is centered on the last rib):
Gas and fluid distribution should be even Gut diameter should be randomly varied, but some degree of uniformity Beware of measuring gut wall on recumbent views
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Intestinal wall thickness?


Gravity Wall Gas

Cross-section axial Wall +Fluid

Cross-section sagittal

Gas

CVM 6101 [Imaging Anatomy]


Small Intestine Lateral recumbency

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CVM 6101 [Imaging Anatomy]


Small Intestine
Dorsal recumbency (VD)

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CVM 6101 [Imaging Anatomy]


Large Intestine:
V D/D V and R L/L R with occasional horizontal-beam views Beware of superimposed structures including vertebrae, ribs, pelvis, lidneys, stomach, nipples, fascial planes, urinary bladder, prostate gland, small intestine, etc. Remember, colonic and cecal gas as well as stool diameter are highly variable
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CVM 6101 [Imaging Anatomy]


Large Intestine : Broad Anatomic Regions
Ascending colon Cecum (big difference between dog and cat) Transverse colon Descending colon

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Normal Abdominal Architecture

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CVM 6101 [Imaging Anatomy]


Large Intestine
Lateral view Post-barium enema

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CVM 6101 [Imaging Anatomy]


Large Intestine
Ventrodorsal view

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CVM 6101 [Imaging Anatomy]


Large Intestine :
Appearance (basically gas and fluid shifts, not stool movement) changes depending on R vs. L or dorsal vs. ventral recumbent views (with the X-ray beam is centered on the last rib): Varied recumbency can foster differentiating normal variation from abnormal

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CVM 6101 [Imaging Anatomy]


Liver:
V D/D V and R L/L R and, when indicated, horizontal-beam views Beware of superimposed structures including vertebrae, ribs, sternebrae, lungs, stomach, nipples, fascial planes, small intestine, and (occasionally) colon, etc.

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CVM 6101 [Imaging Anatomy]


Liver: Broad Anatomic Regions
Left lateral lobe Left medial lobe Quadrate lobe Porta hepatis (hilus) Right medial lobe Right lateral lobe Caudate lobe: Caudate process (R kidney) Papillary process

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Normal Abdominal Architecture

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Liver Sagittal

CVM 6101 [Imaging Anatomy]


Liver
L lateral recumbency R lateral recumbency

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CVM 6101 [Imaging Anatomy]


Liver
Dorsal recumbency

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Liver Mass

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CVM 6101 [Imaging Anatomy]


Gall Bladder
Normally not seen on survey radiographs Opacified with iodinated contrast medium ingested or injected parenterally Opacified with iodinated contrast medium via direct injection Contained (roughly) between the R medial and quadrate liver lobes UNIVERSITY OF MINNESOTA
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CVM 6101 [Imaging Anatomy]


Spleen:
V D/D V and R L/L R views Beware of superimposed structures including vertebrae, ribs, sternebrae, lungs, stomach, small bowel, large bowel, kidneys, pancreas, occasionally urinary bladder, nipples, fascial planes, etc. Remember, the spleen is attached to the stomach by the gastrosplenic ligament, but the spleen can move around freely within limits (beyond which it becomes a splenic torsion)
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CVM 6101 [Imaging Anatomy]


Spleen: Broad Anatomic Regions
Head Body Tail

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Normal Abdominal Architecture

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CVM 6101 [Imaging Anatomy]

Spleen
Lateral view (1o tail)

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CVM 6101 [Imaging Anatomy]

Spleen
VD View (1o body)

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Splenic Mass

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CVM 6101 [Imaging Anatomy]


Pancreas:
V D/D V and R L/L R views Typically pancreas is NOT visible (exception fat cats) Remember, pancreas has a close relationship to the greater omentum, the descending duodenum and the transverse colon/stomach interface

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CVM 6101 [Imaging Anatomy]


Pancreas: Broad Anatomic Regions
Head (bile ducts) Right limb Left limb

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Normal Abdominal Architecture

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CVM 6101 [Imaging Anatomy]


Pancreas regions
R lateral view Pancreatitis (haze caudal to stomach)

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CVM 6101 [Imaging Anatomy]


Pancreas regions
VD view Pancreatitis (haze in RUQ)

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Pancreatic Mass

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CVM 6101 [Imaging Anatomy]


Kidneys & Ureters:
V D/D V and R L/L R views Beware of superimposed structures including vertebrae, ribs, stomach, nipples, spleen, pancreas, small bowel, large bowel, occasionally urinary bladder, fascial planes, etc. Remember, kidneys and the proximal +/- 80% of the ureters are functionally retroperitoneal
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Interpretive Background: Abdomen


Kidneys & Ureters
Kidney size (on VD view) is compared to the length of the 2nd lumbar vertebral body
Normally dog kidneys between 2.5 and 3.5 L-2 lengths Renal pelvic width (seen only with intravenous contrast medium) is no more than 2 3 mm Normally cat kidneys between 2.4 and 3.0 L-2 length Note with advancing age, old cat kidneys (particularly when neutered) approach 2.0 L-2 UNIVERSITY OF MINNESOTA lengths Veterinary Medical Center

CVM 6101 [Imaging Anatomy]


Kidneys & Ureters: Broad Anatomic Regions
Parenchyma:
Cortex Medulla

Hilus (sinus) Pelvis Pelvic recesses

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Dorsal Plane CT and MR images

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Cranial margin of right kidney


Not usually visible (dogs) because of close relationship with the liver in the renal fossa of the caudate process of the caudate liver lobe

CVM 6101 [Imaging Anatomy]


Kidneys & Ureters
R lateral view Preferred because R recumbency fosters kidney cranial-caudal separation

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CVM 6101 [Imaging Anatomy]


Kidneys & Ureters
VD view Preferred because available measurements are standardized from the VD view against the length of L2 vertebral body

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CVM 6101 [Imaging Anatomy]


Kidneys & Ureters
R lateral view Intravenous urogram (iodine) [L stricture]

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CVM 6101 [Imaging Anatomy]


Kidneys & Ureters
VD view Intravenous urogram (iodine) [L stricture]

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Kidney Mass

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CVM 6101 [Imaging Anatomy]


Adrenal Glands
Normally not seen on survey radiographs Very close to aorta and caudal vena cava (e.g. tumor invasion problem) Masses displace ipsilateral kidney L adrenal mass
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Left Adrenal Mass

CVM 6101 [Imaging Anatomy]


Urinary Bladder and Urethra:
V D/D V and R L/L R views Beware of superimposed structures including vertebrae, pelvis, small bowel, large bowel nipples, fascial planes, etc. Remember, bladder is a holding tank for urine delivered from the kidneys via the ureters; size and shape are, therefore, variable
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CVM 6101 [Imaging Anatomy]


Urinary Bladder: Broad Anatomic Regions
Trigone: 2 ureters 1 urethra Apex
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CVM 6101 [Imaging Anatomy]


Urethra: Broad Anatomic Regions
Male:
Prostatic portion (within prostate gland) Membranous portion (from prostate gland to the tuber ischii) Penile portion (from the tuber ischii to the external urethral orifice)

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CVM 6101 [Imaging Anatomy]


Urinary Bladder
R lateral view

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CVM 6101 [Imaging Anatomy]


Urinary Bladder
VD view

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CVM 6101 [Imaging Anatomy]


Urinary Bladder and Urethra in a male dog
Positive contrast (iodine), distension urethrocystogram Lateral view URETHRAL NOTE: prostatic portion larger than either membranous or penile portions
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CVM 6101 [Imaging Anatomy]


Urinary Bladder and Urethral in a male dog
Positive contrast (iodine) urethrocystogram VD view URETHRAL NOTE: prostatic portion larger than either membranous or penile portions
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CVM 6101 [Imaging Anatomy]


Uterus & Ovaries:
V D/D V and R L/L R views Beware of superimposed structures including vertebrae, urinary bladder, bony pelvis, colon and small bowel, stomach, nipples, fascial planes, prepuce/penis, etc. Remember, the ovaries and uterus are both intraperitoneal (mix with bowel, hard to find) Normal ovaries and uterus on rarely seen on survey films
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CVM 6101 [Imaging Anatomy]


Uterus & Ovaries: Broad Anatomic Regions
Uterus:
Horns Body Cervix

Ovaries

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Ovarian Mass

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CVM 6101 [Imaging Anatomy]


Uterus & Ovaries
Enlarged L ovary VD view

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CVM 6101 [Imaging Anatomy]


Uterus (spoon technique)
R lateral view NOTE: from dorsal to ventral colon uterine body urinary bladder

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CVM 6101 [Imaging Anatomy]


Uterus (spoon technique)
R lateral view NOTE: from dorsal to ventral colon uterine body urinary bladder

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CVM 6101 [Imaging Anatomy]


Uterus & Ovaries: Contrast Morphology
Hysterosalpingogram
Cervix Uterine body Uterine horns Oviduct

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CVM 6101 [Imaging Anatomy]


Uterus & Ovaries: Contrast Morphology
Retrograde vaginogram
Vestibule Vagina External urethral orifice Cervix

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CVM 6101 [Imaging Anatomy]


Prostate Gland:
V D and R L/L R views Beware of superimposed structures including vertebrae, pelvis, colon/rectum, urinary bladder, nipples, fascial planes, prepuce, etc. Remember, the prostate gland position varies with age so position may be as much a function of age as it is size
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CVM 6101 [Imaging Anatomy]


Prostate Gland: Broad Anatomic Regions
R lobe L lobe Urethral fossa Note: Not normally visible on neutered dogs.

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CT Prostate Sagittal

CVM 6101 [Imaging Anatomy]


Prostate Gland
Lateral view NOTE: should be a uniform soft tissue opacity

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CVM 6101 [Imaging Anatomy]


Prostate Gland
VD view

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Interpretive Background: Abdomen


Useful interpretive criteria:
Prostate gland size (on lateral view) in the dog is measured against the distance between the sacral promontory and the leading edge of the pubic bone (pubic-promontory distance)
Normally dog prostate gland less than 70 % of the pubicpromontory distance in planes either perpendicular or parallel to the pubic-promontory plane Position of canine prostate gland varies with age and it is not abnormal to find the prostate gland outside the pelvic canal in older dogs apparently without prostatic disease Remember, neutering should effectively render the canine prostate gland indistinguishable after 4-6 months unless there are other complications UNIVERSITY OF MINNESOTA
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Prostatic Measurement

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Interpretive Background: Abdomen


Useful interpretive criteria:
Normally cat prostate glands are not seen and the role of radiography or ultrasonography in feline prostatic disease has yet to be determined

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CVM 6101 [Imaging Anatomy]


Sublumbar Lymph Nodes
[medial iliac & lumbar aortic]

Normally not seen on survey radiographs Retroperitoneal Lateral view

Normal medial iliac lymph node


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Sublumbar Mass

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CVM 6101 [Imaging Anatomy]


Sublumbar Lymph Nodes
[medial iliac & lumbar aortic]

Masses displace descending colon and urinary bladder ventrally Lateral view

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Major Abdominal Vessels
Caudal Vena Cava (CVC) and Aorta (mostly retroperitoneal) Portal Vein (intraperitoneal) Normally not seen on survey radiographs Local/regional masses may invade
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Aorta

CVM 6101 [Imaging Anatomy]


Major Abdominal Vessels
Caudal Vena Cava (mostly retroperitoneal) Normally not seen on survey radiographs Local/regional masses may invade

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CVM 6101 [Imaging Anatomy]


Major Abdominal Vessels
Aorta (mostly retroperitoneal) Normally not seen on survey radiographs Local/regional masses may invade

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CVM 6101 [Imaging Anatomy]


Major Abdominal Vessels
Portal Vein (intraperitoneal) Normally not seen on survey radiographs Subject to anatomic anomalies

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CVM 6101 [Imaging Anatomy]


Remember:
Radiation is through and through Medial Lateral = Lateral Medial *EXCEPT for effects of gravity on gas, fluid, and organ shape Patient anatomy, cooperation, and status may dictate how views are made Oblique views facilitate clarification (less superimposition)
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Specific References: ABDOMEN


Grandage J: Posture, gravity and radiographic interpretation. J Am Vet Radiol Soc 22:80, 1979. Grandage J: Radiology of the dogs diaphragm. J Small Anim Pract 15:1, 1974. Bhargava AK, Rudy JL, Diesem CD: Radiographic anatomy of the pleura in dogs as visualized by contrast pleurography. J Am Vet Radiol Soc 10:61, 1969.
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General References: ABDOMEN


Thrall DE (ed): Textbook of Veterinary Diagnostic Radiology. WB Saunders, Philadelphia, 2002. Burk RL, Feeney DA: Small Animal Radiology and Ultrasonography. Saunders/Elsevier, Philadelphia, 2003

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