(BQ) Part 1 book “Atlas on X-ray and angiographic anatomy” has contents: Skull, spine, radiological procedures, ossifiatin centers, X- ray chest, abdominal radiograph, upper limb, lower limb.
Atlas on X-ray and Angiographic Anatomy Atlas on X-ray and Angiographic Anatomy Hariqbal Singh MD DMRD Professor and Head Department of Radiology Shrimati Kashibai Navale Medical College Pune, Maharashtra, India Parvez Sheik MBBS DMRE Consultant Radiology Shrimati Kashibai Navale Medical College Pune, Maharashtra, India ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • London • Philadelphia • Panama ® Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: jaypee@jaypeebrothers.com Overseas Offices J.P Medical Ltd 83, Victoria Street, London SW1H 0HW (UK) Phone: +44-2031708910 Fax: +02-03-0086180 Email: info@jpmedpub.com Jaypee-Highlights Medical Publishers Inc City of Knowledge, Bld 237, Clayton Panama City, Panama Phone: +507-301-0496 Fax: +507-301-0499 Email: cservice@jphmedical.com Jaypee Brothers Medical Publishers (P) Ltd 17/1-B, Babar Road, Block-B Shaymali, Mohammadpur Dhaka-1207, Bangladesh Mobile: +08801912003485 Email: jaypeedhaka@gmail.com Jaypee Brothers Medical Publishers Ltd The Bourse 111, South Independence Mall East Suite 835, Philadelphia, PA 19106, USA Phone: + 267-519-9789 Email: joe.rusko@jaypeebrothers.com Jaypee Brothers Medical Publishers (P) Ltd Shorakhute Kathmandu, Nepal Phone: +00977-9841528578 Email: jaypee.nepal@gmail.com Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2013, Jaypee Brothers Medical Publishers All rights reserved No part of this book may be reproduced in any form or by any means without the prior permission of the publisher Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com This book has been published in good faith that the contents provided by the authors contained herein are original, and is intended for educational purposes only While every effort is made to ensure accuracy of information, the publisher and the authors specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work If not specifically stated, all figures and tables are courtesy of the authors Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device Atlas on X-ray and Angiographic Anatomy First Edition: 2013 ISBN 978-93-5090-432-9 Printed at Dedicated to Our dear consorts Arvind Hariqbal and Naasiya Musthafa Saying Anatomy is a nursery offers framework to enter the infirmary, clasp it firmly it will help analyze the pathology rightly with foundation in place all is well the value of radiology cannot be measured it can only be treasured –Hariqbal Singh Preface Human anatomy has not transformed over the years but the advance in imaging has changed the perception of structural details Thorough understanding of the normal anatomy is an essential prerequisite to precise diagnosis of pathology Atlas on X-ray and Angiographic Anatomy is loaded with meticulously labeled illustrations This book is steal a look into the anatomy in an easy and understandable manner This atlas is meant for undergraduates, residents in orthopedics and radiology, orthopedic surgeons, radiologists, general practitioners and other specialists It is meant for medical colleges, institutional and departmental libraries and for stand-alone X-ray and orthopedic establishments They will find the book useful Hariqbal Singh Parvez Sheik Acknowledgments We thank Professor MN Navale, Founder President, Sinhgad Technical Educational Society and Dr Arvind V Bhore, Dean, Shrimati Kashibai Navale Medical College, Pune, Maharashtra, India, for their kind acquiescence in this endeavor Our special thanks to the consultants Dr Sasane Amol, Roshan Lodha, Santosh Konde, Shishir Zargad, Yasmeen Khan, Shivrudra Shette, Anand Kamat, Varsha Rangankar, Prashant Naik, Abhijit Pawar, Aditi Dongre, Rajlaxmi Sharma, Manisha Hadgaonkar, Subodh Laul, Sumeet Patrikar, Ronaklaxmi, Shrikant Nagare and Vikash Ojha, who have helped in congregation of this imagery and for their indisputable help in assembly of this educational entity Our special appreciation to the technicians Mritunjoy Srivastava, Premswarup, Sudhir Mane, Sonawane Adinath, Deepak Shinde, Vinod Shinde, Yogesh Kulkarni, Pravin Adlinge, Parameshwar and Amit Nalawade, for their untiring help in retrieving the data Our gratitude to Sachin Babar, Anna Bansode, Sunanda Jangalagi and Shankar Gopale, for their clerical help We are grateful to God and mankind who have allowed us to have this wonderful experience Last but not least, we would like to thank M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, who took keen interest in publishing the book 52 Atlas on X-ray and Angiographic Anatomy Fig 6.4: X-ray hip joint—Posterior oblique view Fig 6.5: X-ray hip joint with pelvis—Lateral view Lower Limb two condyles that articulate with the upper end of tibia The head of femur has the fovea on its medial surface where the ligament of head attaches to it The neck of femur has an angle of around 125° with the shaft of femur and slightly tilted forwards The greater trochanter projects upwards and backwards from the junction of the neck and shaft of femur, it is slightly pyramidal in shape with its apex pointed outwards The lesser trochanter arises from the lowermost part of the neck of femur on the posterior aspect of femur Between the greater trochanter and lesser trochanter anteriorly lies the intertrochanteric line, posteriorly lies the intertrochanteric crest The shaft of femur is long and gives attachment A 53 to muscles At the lower end of femur are two condyles, lateral condyle and medial condyle Between these condyles lies the intercondylar fossa The muscle groups of the thigh provide support to the hip and knee joints and help in movement The main muscle groups are—The anterior, medial, gluteal region, posterior thigh muscles and iliotibial tract on lateral aspect The muscles of the anterior thigh are the iliopsoas and quadriceps femoris The iliopsoas muscle group consists of the psoas major, iliacus, tensor fascia lata and sartorius The main action of this group of muscles at the hip is flexion and medial rotation B C D E Figs 6.6A to E: (A) CT scan topogram of thigh with both hip joints; (B to D) CT scan multiplanar reconstructed (MPR) images of femur with hip joint; (B) Anterior view; (C) Lateral view; (D) Posterior view; (E) MRI-T1WI coronal section of femur with hip joint 54 Atlas on X-ray and Angiographic Anatomy Fig 6.7: X-ray thigh (femur)—AP view Fig 6.8: X-ray thigh (femur)—Lateral view Lower Limb 55 Fig 6.9: X-ray thigh (femur)—Postero-oblique view The quadriceps femoris muscles comprise of the rectus femoris, vastus lateralis, vastus medialis and vastus intermedius muscles The quadriceps group of tendons fuse together and attach to the base of the patella The patella in turn through the patellar tendon is attached to the tibial tuberosity The main action of quadriceps group of muscles is extension at knee joint The muscles of the medial aspect of thigh are the pectinius, adductor longus, adductor brevis, adductor magnus, gracialis and obturator externus muscles The action at the hip is adduction and flexion movements The muscles of the gluteal region are gluteus maximus, gluteus medius, gluteus minimus, pyri formis, obturator internus, gemelli (superior and inferior), and quadratus femoris These muscles assist in extension, abduction, medial and lateral rotation at the thigh The muscles of the posterior thigh are hamstring muscles—Semitendinosus, semimembranosus and biceps femoris muscles Their main action is extension, flexion and medial rotation of the leg KNEE JOINT On plain X-rays, the knee joint is appreciated in AP and lateral views (Figs 6.10 to 6.12) Additional views like the patellar (skyline) view may be necessary to visualize the patellofemoral joint spaces (Fig 6.13) The knee joint is a modified pivotal hinge joint It is the largest synovial joint Atlas on X-ray and Angiographic Anatomy 56 in the body The synovial fluid is around 0.5 ml normally to prevent friction in joint spaces The knee joint consists of two condylar joints between the femur and the tibia and a saddle joint between the patella and the femur, the capsule of knee joint is attached to the articular margins of these bones The intercondylar eminence of the tibia prevents sideway slipping of femur on tibia The ligaments and muscles make knee a very stable joint The medial and lateral articular surfaces of the femur and tibia are asymmetrical The distal surface of the medial condyle of the femur is narrower and more curved than the lateral condyle The articular surface of lateral tibia is almost circular whereas the medial surface is oval in shape The articular surface of patella has a larger lateral and a smaller medial surface The knee joint is stabilized by the surrounding muscles and their tendons Anteriorly, it is the quadriceps tendon This broad tendon attaches to and surrounds the patella and continues as the patellar ligament, which is attached to the tuberosity of the tibia Posteriorly are the popliteus, plantaris and medial and lateral heads A B C D Figs 6.10A to D: CT scan (A and B) multiplanar reconstructed images of knee joint: (A) Anterior view; (B) Lateral view, MRIT1WI images; (C) Coronal section; (D) Sagittal section Lower Limb Fig 6.11: X-ray knee joint—AP view Fig 6.12: X-ray knee joint—Lateral view 57 58 Atlas on X-ray and Angiographic Anatomy Fig 6.13: X-ray knee joint skyline, view for patella of gastrocnemius Laterally are the tendons of the biceps femoris and popliteus Medially are the sartorius, gracialis, semitendinosus and semimembranosus muscles The ligaments of knee joint include the cruciate ligaments, arcuate popliteal ligament, the oblique popliteal ligament, fibular collateral ligament and the tibial collateral ligament The patellar ligament is a central band of the tendon of quadriceps femoris muscles; it is about cm long Proximally, it attaches to the anterior and posterior surfaces of patella including the apex Distally it attaches to the smooth area of tibial tuberosity The menisci are called semilunar cartilages These are cresenteric disks of fibrocartilage that act as shock absorbers The menisci are avascular structures comprising mainly of collagenous fibrous tissue attached to the tibial plateau There are two menisci, the lateral and the medial meniscus Movements at the knee joint are the flexion (normal range 150o), extension (normal range 30o), medial and lateral rotation (normal 5–10o) Blood supply to knee joint is by anastomosis of the genicular branches of the popliteal artery The middle genicular branches supply the cruciate ligaments Bursae of knee joint reduce the friction between tendon and bones The suprapatellar bursa lies between the femur and the quadriceps femoris The prepatellar bursa lies between the skin and the patella The infrapatellar bursa lies between the skin and the tibial tuberosity The deep infrapatellar bursa lies between the patellar ligament and the upper part of the tibia The semimembranosus bursa lies between the medial collateral ligament and the tendon of the semimembranous LEG On plain X-rays, the tibia and fibula are appreciated on both AP and lateral views Either the ankle joint or the knee joint is included to provide the radiologist a landmark to assess and report the abnormality on plain X-rays Lower Limb The tibia is a long bone on the medial aspect of leg; it has a larger upper end at the knee joint and a rather smaller lower end at the ankle joint At the knee joint the upper end of tibia has a superior articular surface (plateau-like surface), and divided by the intercondylar eminence into two unequal surfaces (medial and lateral surfaces) The medial surface is larger than the lateral surface, they articulate with the medial and lateral condyles of femur The shaft of tibia is more triangular in shape and provides attachment to the muscle of knee joint and leg The lower end of tibia has a prominence called the medial malleolus on its medial side at the ankle joint The tibia articulates with the talus at the ankle joint (talocrural joint) The fibula is a slender long bone on the lateral aspect of leg The head of fibula has a facet to articulate with the upper end of tibia The shaft has surfaces for muscle attachments The common peroneal nerve run close to the neck of fibula and in case of fracture to the neck of fibula the nerve A B C 59 can get injured The lower end of fibula at ankle has a prominence on its lateral aspect called as the lateral malleolus (Figs 6.14 to 6.16) Soft tissues of the leg are mostly made of muscles These muscles are grouped into compartments for description purposes The anterior group of muscles comprises of tibialis anterior, extensor hallucis longus, extensor digitorum longus and peroneus tertius muscles Their main action is dorsiflexion at ankle, inversion of foot, eversion of foot, extend the great toe and the four lateral digits The lateral group of muscles comprises of peroneus longus muscle, peroneus brevis muscles Their main action is eversion of the foot and plantar flexion of the ankle The posterior group of muscles are classified into two subgroups—Superficial group and deep group of muscles The superficial group comprises of gastrocnemius, soleus and plantaris muscles Its main action is to assist in plantar flexion of ankle and flexion at knee joint The deep group D E Figs 6.14A to E: CT scan multiplanar reconstructed images of lower leg with ankle: (A) Anterior view; (B) Medial view; (C) Lateral view; (D) Posterior view; (E) MRI-T1WI coronal section of lower leg 60 Atlas on X-ray and Angiographic Anatomy Fig 6.15: X-ray leg (tibiofibula)—AP view of muscles comprises of popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior muscles Its main action is flexion at knee joint, flexion at great toe, plantar flexion at ankle, flexion of lateral four digits and inversion of the foot ANKLE JOINT On plain X-rays, the ankle joint (talocrural joint) is appreciated on AP and oblique views The articular surfaces of the lower ends of tibia and fibula, the upper ends of talus and calcaneus constitute the ankle joint (Figs 6.17 to 6.21) The body weight is transmitted through the tibia to the talus which distributes anteriorly and posteriorly within the foot The muscles and ligaments around the ankle joint provide stability and movements possible at the ankle joint The ankle joint has two groups of ligaments— The lateral collateral ligaments and the medial collateral ligaments These ligaments are strong fibrous bands and they are extremely important in the stability of the ankle joint The lateral collateral ligament prevents excessive inversion and comprises of anterior talofibular ligament, calcaneofibular ligament and posterior talofibular ligament The medial collateral ligament or the deltoid ligament is thicker than the lateral ligament and spreads in a fan shape manner to cover the distal end of the tibia and the inner surfaces of the talus, navicular, and calcaneus Lower Limb 61 Fig 6.16: X-ray leg (tibiofibula)—Lateral view A B C Figs 6.17A to C: CT scan multiplanar reconstructed images of ankle joint: (A) Anterior view; (B) Posterior view; (C) MRI-T1WI coronal section of ankle joint 62 Atlas on X-ray and Angiographic Anatomy Fig 6.18: X-ray ankle joint—AP view Fig 6.19: X-ray ankle joint—Lateral view Lower Limb A B D E 63 C F Figs 6.20A to F: CT scan multiplanar reconstructed images of foot with ankle: (A) Medial view; (B) Anterior view; (C) Posterior view; (D) Lateral view; (E) View from below; (F) MRI-T1WI sagittal section of foot with ankle Fig 6.21: X-ray ankle and foot—Lateral view 64 Atlas on X-ray and Angiographic Anatomy Fig 6.22: X-ray foot showing the location of arches of foot Fig 6.23: X-ray foot—AP view Lower Limb The medial collateral ligament or deltoid ligament includes the tibionavicular ligament, calcaneotibial ligament, anterior talotibial ligament and the posterior talotibial ligament They prevent abduction and limit plantar flexion and dorsiflexion of the ankle joint Tarsal joints at ankle: comprises of the talocal caneonavicular joint, talocalcaneal joint and the calcaneocuboid joint The main action at these joints is inversion and eversion at ankle joint The talocalcaneonavicular joint is a synovial joint of the ball and socket type The ball is formed by the head of talus; the socket is formed by the navicular, calcaneus and spring ligament The posterior surface of navicular is concave and articulates with the head of talus which is convex-shaped The inferior convexity of head 65 of talus articulates with the calcaneus at the sustentaculum tali Between the articular surfaces of talus with the navicular and calcaneus, the head of talus articulates with the spring ligament The talocalcaneonavicular joint is enclosed in a single capsule The talocalcaneal joint lies behind the talocal caneonavicular joint The calcaneocuboid joint is a synovial joint between the anterior surface of calcaneus and the back of the cuboid The talonavicular part of talocalcaneonavicular joint and the calcaneocuboid joint form the midtarsal joint Radiological interventions like aspiration of the ankle joint is possible - from lateral side of ankle joint, directing the needle in front of the lateral malleolus and lateral to the tendon of Fig 6.24: X-ray foot—Oblique view 66 Atlas on X-ray and Angiographic Anatomy peroneus tertius muscle to enter the joint capsule It is also possible to direct the needle from the medial side of ankle, in front of the medial malleolus and medial to tibialis anterior muscle to enter the joint capsule FOOT On plain radiographs, the foot is appreciated on AP, oblique and lateral views The tarsal bones are Navicular, cuboid, cuneiform bones (medial, intermediate and lateral) The metatarsal bones articulate with the tarsal bones proximally and distally they articulate with the phalanges The interphalangeal joints are similar to the joints of hand with capsules and collateral ligaments The first tarsometatarsal joint has its own capsule and synovial membrane, some movements in vertical plane possible along with the medial longitudinal arch of foot The second tarsometatarsal joint is immobile, in addition its slender metatarsal shaft makes it prone for injury, it is a commonly involved site in “March fractures” Supporting mechanisms of the foot are the arches of the foot namely, medial longitudinal arch, lateral longitudinal arch and the transverse arch The arches are formed by the bony undersurfaces of the bones of foot with the ligaments and muscles Due to the upright posture and bodyweight transmitted to the foot, these arches help to act as shock absorbing mechanism and propulsion to some extent The medial longitudinal arch is formed by the undersurfaces of the calcaneus, talus, navicular, three cuneiform bones and their three metatarsal bones (Figs 6.20 to 6.24) The lateral longitudinal arch is formed by undersurfaces of calcaneus, cuboid, and the two lateral metatarsal bones The transverse arch is formed by the undersurfaces of bases of five metatarsal bones, cuboid and cuneiform bones ... Delhi 11 0 002, India Phone: + 91- 11- 43574357 Fax: + 91- 11- 43574 314 Email: jaypee@jaypeebrothers.com Overseas Offices J.P Medical Ltd 83, Victoria Street, London SW1H 0HW (UK) Phone: +44-20 317 08 910 ... Figs 1. 2A and B: X-ray skull—AP view Atlas on X-ray and Angiographic Anatomy A B Figs 1. 3A and B: X-ray skull—Lateral view Skull Fig 1. 4: X-ray skull—Mastoid view (Schuller’s view) Fig 1. 5: X-ray. .. skull—Reverse Water’s view Fig 1. 9: X-ray skull—Towne’s view (30o fronto-occipital view) Atlas on X-ray and Angiographic Anatomy Fig 1. 10: X-ray skull—Submentovertical view Fig 1. 11: X-ray skull showing