Imaging of the Pelvis and Hip Sakti Srivastava, MBBS, MS Associate Professor, Surgery Chief, Division of Clinical Anatomy Stanford University School of Medicine SURG203 / LL / IMAGING / 2015
Bony pelvis
Female Pelvis (Sagittal image) MR images T2 weighted image Sagittal plane Fluid is white Air is black Fat is light gray Soft tissue and bones= middle gray
Female Pelvis (Sagittal image) 1- Pubic symphysis 2- Bladder/ urethra 3- Uterus/ Vagina 4-Rectum 5- Sacrum/coccyx 5 4 3 2 1
Female Pelvis (Horizontal Section) Axial plane 1 -Bladder 2- uterus 3- ovaries 4- rectum 1 2 3 4
Female Pelvis (Horizontal Section) 1- Uterine body 2- Vaginal cuff 3- Ovaries 4- Rectum 5- Hips 1 5 3 2 4
Hysterosalpingogram
Hysterosalpingogram Uterus Fallopian tubes
Male Pelvis- Sagittal Image Bladder Pubic symphsis Prostate Penis Testes
Male pelvis (Coronal section) 1- Bladder 2- Urogenital diaphragm 3- Penis- Corpus cavernosa (2) Corpus spongiosa (1) 4- femoral head 5- psoas muscle 6- iliacus muscle 7- Obturator Internus mm 8 -Obturator Externus mm 5 6 4 1 7 8 2 3
Male pelvis (Horizontal Section) 1- Bladder 2- Seminal vesicles 3- Rectum Bony pelvis 4- Actabulum 5- Femoral heads 6- Coccyx 4 1 5 2 3 6
Bony pelvis
Hip Muscles – Coronal MR 1- Rectus femoris 2- Tensor fasciae latae 3 -Iliopsoas 4 Femoral artery and vein 5- Pubic symphysis 2 4 3 5 1
Hip Muscles – Coronal MR 1- Gluteus med/min 2- Vastus lateralis and intermedius 3- Iliopsoas 4- Obturator externus 5- Adductor mm. 6 Gracilis 3 1 4 6 5 2
Hip Muscles – Coronal MR 1- Iliotibial tract 2- Gluteus med/min 3- Vastus lateralis 4- Obturator Internus 5- Obturator externus 6- Gracilis 7- Adductor brevis/ magnus 2 1 4 5 7 6 3
Hip Muscles – Coronal MR 1 Gluteus max (med/min) 2 Quadratus femoris 3 Gemelli 4 Obturator internus 5 Levator Ani 1 5 3 4 2
Hip Muscles – Horizontal MR 3 1- Gluteus maximus and minimus 2- Rectus femoris 3- Sartorius 4- Iliopsoas 5 -Acetabulum 6- Femoral head 7- Obturator internus 8- Vastus lateralis 2 4 8 5 6 7 1
Hip Muscles – Horizontal MR 1- Gluteus maximus and minimus 2- Rectus femoris 3- Sartorius 4- Iliopsoas 5- Obturator externus 6- Pectineus 7- Obturator internus 8 Vastus lateralis 3 2 6 4 8 5 7 1
Bony pelvis
Bony pelvis Shenton’s line
Bony pelvis Age: 1o years Age: 1 year
Pelvic fractures
Pelvic fractures
Pelvic fractures
Pelvic fractures
Pelvic fractures
Pelvic fractures
CLINICAL CASE Intertrochanteric fracture 68 YEAR OLD,FEMALE H/O SLIP AND FALL, INJURY TO RIGHT HIP Intertrochanteric fracture Common site of fracture in patients with decreased bone stock ( osteoporosis) Major source of morbidity in elderly patients
CLINICAL CASE Pre surgery Surgical fixation
Central fracture dislocation CLINICAL CASE 32 YEAR OLD,MALE H/O MOTOR VEHICLE ACCIDENT INJURY TO RIGHT HIP Central fracture dislocation
CLINICAL CASE Posterior dislocation of hip joint 28 YEAR OLD,MALE H/O MOTOR VEHICLE ACCIDENT INJURY TO PELVIC AND LEFT HIP Posterior dislocation of hip joint Diastasis of pubic symphysis
CLINICAL CASE Congenital dislocation of hip joint 2 YEAR OLD, FEMALE H/O DELAYED AND DIFFICUT WALKING Congenital dislocation of hip joint Developmental dysplasia of the hip