Diagnostic Ultrasound - Abdomen and Pelvis
Peritoneal Spaces and Structures PERITONEAL DIVISIONS AND COMPARTMENTS Anatomy: Abdomen Hepatogastric ligament Hepatoduodenal ligament Epiploic foramen (of Winslow) Greater omentum Left triangular l. Coronary ligament of liver Root of transverse mesocolon Gastrophrenic l. Phrenicocolic ligament Root of transverse mesocolon Left paracolic gutter Right paracolic gutter Site of descending colon Site of ascending colon Root of small bowel mesentery Root of sigmoid mesocolon (Top) In this graphic, the liver has been retracted upward. The lesser omentum is comprised of the hepatoduodenal and hepatogastric ligaments. It forms part of the anterior wall of the lesser sac, and contains the common bile duct, hepatic and gastric vessels, and the portal vein. The aorta and celiac artery can be seen through the lesser omentum, as they lie just posterior to the lesser sac. (Bottom) Frontal view of the abdomen, with all of the intraperitoneal organs removed, shows that the root of the transverse mesocolon divides the peritoneal cavity into supramesocolic and inframesocolic spaces that communicate only along the paracolic gutters. The coronary and triangular ligaments suspend the liver from the diaphragm. The superior mesenteric vessels traverse the small bowel mesentery, whose root crosses obliquely from the upper left to the lower right posterior abdominal wall. 91
Peritoneal Spaces and Structures Anatomy: Abdomen RIGHT SUPRAMESOCOLIC SPACE Fluid in right subphrenic space Atelectatic right lung Cirrhotic liver Right hemidiaphragm Right pleural effusion Fluid in anterior subhepatic space Cirrhotic liver (right lobe) Fluid in Morison pouch Gallbladder Right kidney Fluid in right anterior subhepatic space Visceral peritoneum Right lobe of liver (cirrhotic with nodular contour) Fluid in Morison pouch Parietal peritoneum Right kidney (Top) Intercostal oblique grayscale ultrasound (in a patient with cirrhosis) shows the dome of the right lobe of the liver and moderate fluid in the right subphrenic region extending anterior to the liver. The fluid is separated from the right-sided pleural effusion by the right diaphragmatic leaf. (Middle) Subcostal oblique transverse ultrasound of the right upper quadrant shows fluid in the right anterior subhepatic space and in the hepatorenal space. The ascites are secondary to hepatic cirrhosis and the gallbladder is physiologically distended. (Bottom) Longitudinal transabdominal grayscale ultrasound shows fluid in the right posterior subhepatic space, also known as the Morison pouch, and hepatorenal fossa. This space is continuous with the right anterior subhepatic space and right paracolic gutter. 92
- Page 62 and 63: Pancreas PANCREAS, TRANSVERSE VIEW
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- Page 80 and 81: Kidneys LEFT KIDNEY, CT CORRELATION
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- Page 134 and 135: Ureters and Bladder URINARY BLADDER
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Peritoneal Spaces <strong>and</strong> Structures<br />
PERITONEAL DIVISIONS AND COMPARTMENTS<br />
Anatomy: <strong>Abdomen</strong><br />
Hepatogastric ligament<br />
Hepatoduodenal ligament<br />
Epiploic foramen (of Winslow)<br />
Greater omentum<br />
Left triangular l.<br />
Coronary ligament of liver<br />
Root of transverse mesocolon<br />
Gastrophrenic l.<br />
Phrenicocolic ligament<br />
Root of transverse mesocolon<br />
Left paracolic gutter<br />
Right paracolic gutter<br />
Site of descending colon<br />
Site of ascending colon<br />
Root of small bowel<br />
mesentery<br />
Root of sigmoid mesocolon<br />
(Top) In this graphic, the liver has been retracted upward. The lesser omentum is comprised of the hepatoduodenal <strong>and</strong> hepatogastric<br />
ligaments. It forms part of the anterior wall of the lesser sac, <strong>and</strong> contains the common bile duct, hepatic <strong>and</strong> gastric vessels, <strong>and</strong> the<br />
portal vein. The aorta <strong>and</strong> celiac artery can be seen through the lesser omentum, as they lie just posterior to the lesser sac. (Bottom)<br />
Frontal view of the abdomen, with all of the intraperitoneal organs removed, shows that the root of the transverse mesocolon divides<br />
the peritoneal cavity into supramesocolic <strong>and</strong> inframesocolic spaces that communicate only along the paracolic gutters. The coronary<br />
<strong>and</strong> triangular ligaments suspend the liver from the diaphragm. The superior mesenteric vessels traverse the small bowel mesentery,<br />
whose root crosses obliquely from the upper left to the lower right posterior abdominal wall.<br />
91
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