Radio Anatomy of Endocrine Glands Ppt1-14

8/14/2019 Radio Anatomy of Endocrine Glands Ppt1-14

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Radioanatomy of theRadioanatomy of theEndocrine GlandsEndocrine Glands


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What are endocrine glands?

Glands that produce hormones andsecrete them directly in the bloodstream

They do not have ducts

Pituitary

Thyroid

Parathyroid Adrenals

Pancreas


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Pituitary GlandPituitary Gland


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Master gland of the endocrine systemMaster gland of the endocrine system

Lies in the hypophyseal fossa (sellaLies in the hypophyseal fossa (sella

turcica)turcica)

Fossa is roofed by diaphragma sellaeFossa is roofed by diaphragma sellae

Stalk of the hypophysis cerebri piercesStalk of the hypophysis cerebri pierces

the diaphragma sellae and is attachedthe diaphragma sellae and is attached

above to the floor of the third ventricleabove to the floor of the third ventricle


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Gland is oval in shapeGland is oval in shape

Measures 8 mm (AP diameter) andMeasures 8 mm (AP diameter) and

12 mm (transversely)12 mm (transversely)

Weighs 500 mgWeighs 500 mg


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RelationsRelations

SuperiorlySuperiorly Diaphragma sellaeDiaphragma sellae

Optic chiasmaOptic chiasma

Tuber cineriumTuber cinerium

Infundibular recess of 3Infundibular recess of 3rdrd ventricleventricle InferiorlyInferiorly

Hypophyseal fossa and irregular venousHypophyseal fossa and irregular venouschannels between the two layers of durachannels between the two layers of dura

covering itcovering it Sphenoidal air sinusesSphenoidal air sinuses

On each sideOn each side

Cavernous sinus with its contentsCavernous sinus with its contents


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SubdivisionsSubdivisions

AdenohypophysisAdenohypophysis

Anterior lobeAnterior lobe

Intermediate lobeIntermediate lobe

Tuberal lobeTuberal lobe

NeurohypophysisNeurohypophysis

Posterior lobePosterior lobe

Infundibular stemInfundibular stem

Median eminence of the tuber cineriumMedian eminence of the tuber cinerium


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Blood SupplyBlood Supply

ArterialArterial

Branches of internal carotid arteryBranches of internal carotid artery

VeinsVeins Short veins emerge on the surface ofShort veins emerge on the surface ofthe gland and drain into thethe gland and drain into the

neighbouring venous sinusesneighbouring venous sinuses


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Radio-Imaging of PituitaryRadio-Imaging of Pituitary

GlandGland

Not visualized on Plain X-Ray of theNot visualized on Plain X-Ray of the

skull, except for the sella turcica andskull, except for the sella turcica and

clinoid processes housing theclinoid processes housing the

pituitary glandpituitary gland

Visualized onVisualized on

CT Scan of brainCT Scan of brain

MRI of brainMRI of brain

PET Scan of brainPET Scan of brain


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Radiograph of SkullRadiograph of Skull

Lateral view showsLateral view shows

the sella turcicathe sella turcica

Pituitary glandPituitary gland

resides on top of theresides on top of thesella turcicasella turcica

The anterior andThe anterior and

posterior clinoidposterior clinoid

processes define theprocesses define theanterior and posterioranterior and posterior

boundariesboundaries


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Radiograph of SkullRadiograph of Skull

Townes ViewTownes View

shows dorsumshows dorsum

sellae on top ofsellae on top of

which lies thewhich lies thepituitary glandpituitary gland


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A. Frontal LobeA. Frontal LobeB. Frontal Bone (SuperiorB. Frontal Bone (Superior

Surface of Orbital Part)Surface of Orbital Part)

C. Dorsum SellaeC. Dorsum Sellae

D. Basilar ArteryD. Basilar ArteryE. Temporal LobeE. Temporal Lobe

F. Mastoid Air CellsF. Mastoid Air Cells

G. Cerebellar HemisphereG. Cerebellar Hemisphere CT Scan of

Head


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http://upload.wikimedia.org/wikipedia/commons/d/d7/Gray715.png


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MRI of Brain


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MRIofBrain


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MRI of Brain


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MRI of Brain
http://www.med.harvard.edu/AANLIB/cases/caseM/mr1_t/019.gif


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http://www.med.harvard.edu/AANLIB/cases/caseM/mr1_t/023.gif


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PituitaryGland


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http://upload.wikimedia.org/wikipedia/commons/6/6a/Pituitary_gland.png


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Pituitary Gland


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http://upload.wikimedia.org/wikipedia/commons/d/d7/Gray715.png


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NormalOpticChiasm


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PituitaryAdenoma


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Opticnerves

PituitaryAdenom

a


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Thyroid GlandThyroid Gland


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Endocrine Gland

regulates basalmetabolic rate

stimulatessomatic and psychicgrowth

plays importantrole in calciummetabolism


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Ultrasound of Thyroid Gland
http://www.delrioheart.com/images/thyroid.jpg


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Two lobes joined by theTwo lobes joined by theisthmusisthmus

Lies against the C5,C6, C7Lies against the C5,C6, C7and T1 vertebrae claspingand T1 vertebrae claspingthe upper part of tracheathe upper part of trachea

Each lobe extends fromEach lobe extends fromthe middle of the thyroidthe middle of the thyroidcartilage to the 4cartilage to the 4thth or 5or 5thth tracheal ringtracheal ring

Isthmus extends from 2Isthmus extends from 2ndnd

to 3to 3rdrd tracheal ringstracheal rings


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Lobes measure about 5 cm x 2.5 cmLobes measure about 5 cm x 2.5 cm

x 2.5 cmx 2.5 cm

Isthmus measures about 1.2 cm xIsthmus measures about 1.2 cm x

1.2 cm1.2 cm

Larger in females than in malesLarger in females than in males

Increases in size during menstruationIncreases in size during menstruation

and pregnancyand pregnancy


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CapsulesCapsules

True peripheral condensation ofTrue peripheral condensation ofconnective tissue of the glandconnective tissue of the gland

False derived from pretrachealFalse derived from pretracheal

layers of deep cervical fascialayers of deep cervical fascia False capsule forms the suspensoryFalse capsule forms the suspensory

ligament of Berry which connects theligament of Berry which connects the

lobe to the cricoid cartilagelobe to the cricoid cartilage A dense capillary plexus is presentA dense capillary plexus is present

deep to the true capsuledeep to the true capsule


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RelationsRelations

Lobes are conical in shape and haveLobes are conical in shape and have

ApexApex

BaseBase

Three surfaces lateral, medial andThree surfaces lateral, medial and

posterolateralposterolateral

Two borders anterior and posteriorTwo borders anterior and posterior


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RelationsRelations

Lateral surfacesLateral surfaces

ConvexConvex

Covered by sternothyhyoid,Covered by sternothyhyoid,

sternohyoid, superior belly of omohyoidsternohyoid, superior belly of omohyoidand anterior border of sternomastoidand anterior border of sternomastoid

musclesmuscles


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RelationsRelations

Medial surfaceMedial surface

Two tubes trachea and esophagusTwo tubes trachea and esophagus

Two muscles inferior constrictor andTwo muscles inferior constrictor and

cricothyroidcricothyroid

Two nerves extrenal laryngeal andTwo nerves extrenal laryngeal and

recurrent laryngealrecurrent laryngeal


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RelationsRelations

Posterolateral surfacePosterolateral surface

Carotid sheathCarotid sheath

Overlaps common carotid arteryOverlaps common carotid artery


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RelationsRelations

Anterior borderAnterior border

ThinThin

Anterior branch of superior thyroid arteryAnterior branch of superior thyroid artery

Posterior borderPosterior border ThickThick

Inferior thyroid arteryInferior thyroid artery

Anastomosis between superior and inferiorAnastomosis between superior and inferior

thyroid arterythyroid artery

Parathyroid glandParathyroid gland

Thoracic duct (left side)Thoracic duct (left side)


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RelationsRelations

ApexApex

Directed upwardsDirected upwards

BaseBase

At the level of 4At the level of 4 thth or 5or 5thth tracheal ringtracheal ring


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RelationsRelations

IsthmusIsthmus

Connects the lower parts of the lobesConnects the lower parts of the lobes

Two surfaces Two surfaces Anterior and posterior surfacesAnterior and posterior surfaces

Two bordersTwo borders Superior and inferior bordersSuperior and inferior borders


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Anterior surface covered byAnterior surface covered by

Sternothyroid and sternohyoid musclesSternothyroid and sternohyoid muscles

(R&L)(R&L) Anterior jugular veinsAnterior jugular veins

Fascia and skinFascia and skin

Posterior surface related toPosterior surface related to 22ndnd and 3and 3rdrd tracheal ringstracheal rings

Isthmus


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IsthmusIsthmus

Upper borderUpper border

Anastomosis between Right and LeftAnastomosis between Right and Left

Superior Thyroid ArteriesSuperior Thyroid Arteries Lower borderLower border

Inferior thyroid veins leave the gland atInferior thyroid veins leave the gland at

this borderthis border


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ArterialArterial

Superior thyroid artery branch ofSuperior thyroid artery branch of

external carotid arteryexternal carotid artery

Inferior thyroid artery branch ofInferior thyroid artery branch ofthyrocervical trunkthyrocervical trunk

VeinousVeinous

Superior thyroid veinSuperior thyroid vein Inferior thyroid veinInferior thyroid vein

R di I i f Th idR di I i f Th id


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Radio-Imaging of ThyroidRadio-Imaging of Thyroid

GlandGland Not visualized on Plain X-Ray unlessNot visualized on Plain X-Ray unless

calcifiedcalcified

Visualized onVisualized on

UltrasoundUltrasound

CT scanCT scan

MRIMRI

Nuclear Medicine studyNuclear Medicine study


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Coned apical radiograph of the upperthorax shows curvilinear calcificationin a thyroid adenoma, at the root of

the neck, on the right side


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CarotidArtery

Trachea

Thyroid Gland

IsthmusStenohyoid andsternothyroid

muscles

Transverse Section of the Right Lobe of Thyroid

Gland
http://www.radiologyinfo.org/en/photocat/photos_pc.cfm?image=gen-us-thyroid.jpg&pg=us-thyroid


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Sagittal Sectionof the ThyroidGland

Transversesection of ThyroidGland
http://www.ultrasound-images.com/images/suprasternal-lipoma-1e.jpghttp://www.ultrasound-images.com/images/suprasternal-lipoma-1c.jpg


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Isthmus

Right LobeLeft Lobe

Trachea

Transver

seSectionof the

Thyroid

Gland
http://www.ultrasound-images.com/images/thyroid-carcinoma-2b.JPGhttp://www.ultrasound-images.com/images/thyroid-carcinoma-2b.JPG


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http://www.ultrasound-images.com/images/hashimotos-thyroiditis-full-1a.jpg


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CT Scan of Thyroid GlandCT Scan of Thyroid Gland


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Thyroid Scanning NuclearMedicine


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Parathyroid GlandParathyroid Gland


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Two pairsTwo pairs

SuperiorSuperior

InferiorInferior

Lie on the posterior border of the thyroidLie on the posterior border of the thyroidgland within the thyroid capsulegland within the thyroid capsule

Oval or lentiform in shapeOval or lentiform in shape

Measure about 6 x 4 x 2 mmMeasure about 6 x 4 x 2 mm Weighs 50 mgWeighs 50 mg


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Anastomotic artery between superiorAnastomotic artery between superior

and inferior thyroid artery is a goodand inferior thyroid artery is a good

marker because they lie close to itmarker because they lie close to it

Superior parathyroid glands are moreSuperior parathyroid glands are moreconsistent in location near theconsistent in location near the

middle of the posterior border of themiddle of the posterior border of the

thyroid lobethyroid lobe


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ArterialArterial

Inferior thyroid arteryInferior thyroid artery

Anastomosis between superior andAnastomosis between superior and

inferior thyroid arteriesinferior thyroid arteries

VeinousVeinous

Thyroid veinsThyroid veins


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Radio-ImagingRadio-Imaging

Not visualized on normal studiesNot visualized on normal studies

Seen mostly when there is adenomaSeen mostly when there is adenoma

Sometimes may be ectopic inSometimes may be ectopic in

locationlocation


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Transverse and longitudinal viewsof the left parathyroid gland


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Immediatescan Delayed scans

Nonspecific accumulation ofradioactivity in the region of the

parathyroids


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A 1.3 x 1.0 cm. nodule, relativelyhyperintense is seen posterior to the left lobeof the thyroid gland and lateral to theesophagus.


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Injection of radioactiveInjection of radioactive

material shows rapidmaterial shows rapid

uptake by the thyroiduptake by the thyroid

glandgland

Delayed imageshows a retention of

the radioactivematerial at theinferior pole of theleft thyroid arath roid


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Adrenal GlandsAdrenal Glands


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A pair of glandsA pair of glands

Lie in the epigastium at the upperLie in the epigastium at the upper

pole of the kidneyspole of the kidneys

In front of the crus of diaphragmIn front of the crus of diaphragm

Opposite the vertebral end of the 11Opposite the vertebral end of the 11ththintercostal space and 12intercostal space and 12thth ribrib


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Right adrenal gland is triangular orRight adrenal gland is triangular or

pyramidal in shapepyramidal in shape

Left adrenal gland is semilunarLeft adrenal gland is semilunar

Measures about 50 mm in height, 30 mmMeasures about 50 mm in height, 30 mmin breadth and 10 mm in thicknessin breadth and 10 mm in thickness

1/31/3rdrd the size of kidneys in children andthe size of kidneys in children and

1/301/30thth

the size in adultsthe size in adults Weighs 5 gWeighs 5 g


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Right Adrenal GlandRight Adrenal Gland

An apexAn apex

A baseA base

Two surfaces anterior and posteriorTwo surfaces anterior and posteriorThree borders anterior, medial andThree borders anterior, medial and

laterallateral


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RelationsRelations

Anterior surface devoid of peritoneumAnterior surface devoid of peritoneumexcept a small part belowexcept a small part below Inferior vena cava mediallyInferior vena cava medially Liver laterally andLiver laterally and Occasionally duodenum inferiorlyOccasionally duodenum inferiorly

Posterior surfacePosterior surface Crus of diaphragmCrus of diaphragm

Anterior borderAnterior border Hilum where veins emerge below the apexHilum where veins emerge below the apex

Medial borderMedial border Right celiac ganglionRight celiac ganglion Right inferior phrenic arteryRight inferior phrenic artery


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Left Adrenal GlandLeft Adrenal Gland

Two ends Two ends Upper narrow endUpper narrow end

Lower rounded endLower rounded end

Two bordersTwo borders Medial convexMedial convex

Lateral concaveLateral concave

Two surfacesTwo surfaces AnteriorAnterior PosteriorPosterior


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RelationsRelations

Anterior surface Anterior surface cardiac end of stomachcardiac end of stomach

Splenic arterySplenic artery

PancreasPancreas

Posterior surfacePosterior surface Kidney laterallyKidney laterally

Left crus of diaphragm mediallyLeft crus of diaphragm medially

Medial borderMedial border Left celiac ganglionLeft celiac ganglion Left inferior phrenic arteryLeft inferior phrenic artery

Left gastric arteryLeft gastric artery


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ArterialArterial

Superior adrenal artery branch ofSuperior adrenal artery branch of

inferior phrenic arteryinferior phrenic artery

Middle adrenal artery branch ofMiddle adrenal artery branch ofabdominal aortaabdominal aorta

Inferior adrenal artery branch of renalInferior adrenal artery branch of renal

arteryartery


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VeinousVeinous

Each gland drained by one veinEach gland drained by one vein

Right adrenal vein drains into inferiorRight adrenal vein drains into inferior

vena cavavena cava Left adrenal vein drains into left renalLeft adrenal vein drains into left renal

veinvein


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Radio-ImagingRadio-Imaging

Not seen on plain X-Ray unlessNot seen on plain X-Ray unless

calcifications are presentcalcifications are present

Visualized byVisualized by

CT ScanCT Scan

MRIMRI

Ultrasonography seen better inUltrasonography seen better in

children than in adultschildren than in adults


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Imaging of Adrenal GlandsImaging of Adrenal Glands

Located in the perirenal space near the upper pole ofeach kidney

They may be shaped like the letters H, L, Y, T, or V

They are less than 4 cm in length and less than 1.0 cm

in thickness


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CT ScanCT Scan

They may be shaped like the letters H, L, Y, T, or V


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Crus of diaphragm

IVC

Pancreas

Spleen

andSplenic

Vessels


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Ultrasound of adrenalUltrasound of adrenalmassmass

Oblique sagittal imageOblique sagittal image

of the abdomenof the abdomen

demonstrates andemonstrates an

isoechoic mass of theisoechoic mass of the

left adrenal gland thatleft adrenal gland that

is anterolateral to theis anterolateral to the

aorta and medial toaorta and medial to

the left kidneythe left kidney
http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=%5Cwebsites%5Cemedicine%5Cradio%5Cimages%5CLarge%5C27592759rad005522-13.jpg&template=izoom2


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Right

AdrenalAdenoma


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PancreasPancreas

PP


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PancreasPancreas

Exocrine glandExocrine gland Secretes digestive enzymesSecretes digestive enzymes

Endocrine glandEndocrine gland

Secretes hormones like insulinSecretes hormones like insulin


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The pancreas is 12-15 cm long and isThe pancreas is 12-15 cm long and islocated in the epigastriumlocated in the epigastrium

Parts of the pancreas:Parts of the pancreas: HeadHead Uncinate processUncinate process NeckNeck

BodyBodyTailTail

The head and body lie outside theThe head and body lie outside theperitoneumperitoneum

The head of the pancreas is surrounded byThe head of the pancreas is surrounded bythe duodenum as it makes a C-loopthe duodenum as it makes a C-looparound the pancreasaround the pancreas


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The common bile duct traversesThe common bile duct traversesthrough the head of the pancreas andthrough the head of the pancreas and

joins with the pancreatic duct at thejoins with the pancreatic duct at theampulla of Vater to empty bile into theampulla of Vater to empty bile into the

second or descending part of thesecond or descending part of theduodenumduodenum Both the pancreatic ducts of SantoriniBoth the pancreatic ducts of Santorini

and Wirsung drain the exocrineand Wirsung drain the exocrine

pancreaspancreas

Relationship to SurroundingRelationship to SurroundingSt tSt t


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StructuresStructures

HeadHead PosteriorPosterior

Superior Mesenteric VeinSuperior Mesenteric Vein Splenic veinSplenic vein

Inferior Vena CavaInferior Vena CavaTerminal portion of renal veinTerminal portion of renal vein Right crus of diaphragmRight crus of diaphragm

AnteriorAnterior

Transverse colonTransverse colon LateralLateral

Bile ductBile duct

Relationship to SurroundingRelationship to Surrounding


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Relationship to Surroundingp g


NeckNeckAnteriorAnterior

PylorusPylorus

Omental bursaOmental bursaPosteriorPosterior

SMVSMVBeginning of portal veinBeginning of portal vein



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Relationship to Surroundingp g


BodyBody AnteriorAnterior

Stomach separated by omental bursaStomach separated by omental bursa PosteriorPosterior

Aorta and SMAAorta and SMA Left crus of diaphragmLeft crus of diaphragm Left kidney and adrenal glandLeft kidney and adrenal gland Left renal vein and splenic veinLeft renal vein and splenic vein

InferiorInferiorTransverse mesocolon and splenicTransverse mesocolon and splenic

flexureflexure Duodeno-jejunal junctionDuodeno-jejunal junction



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p gp g

StructuresStructuresTailTail

The tail of the pancreas lies in theThe tail of the pancreas lies in thesplenorenal ligament and enters thesplenorenal ligament and enters thehilum of the spleen with splenichilum of the spleen with splenic

vesselsvessels


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Radio Anatomy of Endocrine Glands Ppt1-14

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