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Netter’s Concise
Radiologic
Anatomy
Edward C. Weber, DO
Joel A. Vilensky, PhD
Stephen W. Carmichael, PhD
Contributing Illustrator
Carlos A.G. Machado, MD
Preface
vii
viii Preface
Dr. Edward C. Weber was born and educated in Philadelphia. He has a BA from
Temple University and a DO from the Philadelphia College of Osteopathic Medicine.
Dr. Weber spent 4 years at the Albert Einstein Medical Center in Philadelphia in a
1-year surgical internship and a 3-year residency in diagnostic radiology. In 1980,
the Journal of the American Medical Association published an article he wrote
describing a new percutaneous interventional biliary procedure. After achieving
certification by the American Board of Radiology, he began private practice in 1980
and in 1981 became a founding member of a radiology group based in Fort Wayne,
Indiana. After 15 years of hospital radiology practice, Dr. Weber joined The Imaging
Center, a private outpatient facility. At the Fort Wayne campus of the Indiana Uni-
versity School of Medicine, Dr. Weber presents radiology lectures within the Medical
Gross Anatomy course and is course director for Introduction to Clinical Medicine.
He and his wife, Ellen, have a son who graduated from Brown University and is
pursuing graduate studies at City University of New York, and a daughter who gradu-
ated from Wellesley College and is a graduate student at Carnegie Mellon University.
Ellen and he celebrated his 50th birthday at the summit of Mt. Kilimanjaro, and they
spend as much time as possible at their home in Big Sky, Montana, where he is
Consultant Radiologist for The Medical Clinic of Big Sky.
Dr. Joel A. Vilensky is originally from Bayside, New York, but has been teaching
Medical Gross Anatomy at the Fort Wayne campus of Indiana University School of
Medicine for almost 30 years. He graduated from Michigan State University in 1972
and received an MA from the University of Chicago in 1972 and a PhD from the
University of Wisconsin in 1979. He has authored nearly 100 research papers on
many topics, most recently on the 1920s worldwide epidemic of encephalitis lethar-
gica, and in 2005 had a book published by Indiana University Press: Dew of Death:
The Story of Lewisite, America’s World War I Weapon of Mass Destruction. Dr.
Vilensky is a coeditor of Clinical Anatomy for which he edits the Compendium of
Anatomical Variants. Dr. Vilensky and his wife Deborah have two daughters, one
a music teacher in Brooklyn, New York, and the other a law student at Indiana
University School of Law in Bloomington. Dr. Vilensky is a contented “workaholic”
but also enjoys watching television with his wife, traveling, and exercising.
xi
xii About the Authors
College, which honored him with a DSc degree in 1989. He earned the PhD degree
in anatomy at Tulane University in 1971. He is author or coauthor of over 140 publi-
cations in peer-reviewed journals and 7 books, the majority relating to the adrenal
medulla. He is a consulting editor of the fourth and fifth editions of the Atlas of
Human Anatomy and Editor-in-Chief of Clinical Anatomy. Dr. Carmichael is married
to Dr. Susan Stoddard and has a son who works for a newspaper in Boulder, Colo-
rado. Dr. Carmichael is a certified scuba diver at the professional level, and he is
challenged by underwater photography.
Acknowledgments
We are very grateful to many individuals for assisting us in developing this Atlas. We
would like to thank Elsevier for accepting our book proposal and Anne Lenehan,
Elyse O’Grady, and Marybeth Thiel for championing it and assisting us with every
stage of the book’s development. Among these three individuals, we had almost
daily interactions with Ms. Thiel and were constantly impressed, amazed, and grate-
ful for her diligence and efforts to make this Atlas as good as it could be. Much of
the credit for the final appearance of this book belongs to her. We are similarly grate-
ful to Ms. Rhoda Bontrager, Graphic World’s production editor for this project, who
tirelessly assisted us with the final proofs associated with this book.
We would also like to thank the 2007 first- and second-year medical students at
Indiana University School of Medicine–Fort Wayne for their suggestions to improve
this book.
We extend our appreciation to Robert Conner, MD, who established The Imaging
Center in Fort Wayne, Indiana, where so much of the work for this book was com-
pleted, and who was very supportive of this effort. The Imaging Center is staffed by
nuclear medicine, mammography, general radiology, ultrasonography, CT, and MR
technologists who not only conduct diagnostic procedures with superb technical
skill but also (equally important) do so with great care for the personal needs of our
patients. Those technologists who conducted procedures that resulted in the largest
number of images for this book were Kristen Firestone, RT; Mike Raymond, RT;
Spencer Tipton, RT; and Bruce Roach, RT.
As a final note, we would like to thank the patients whose images appear in this
book and Drs. Frank Netter and Carlos Machado for their artistic insights into human
anatomy.
ix
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All rights reserved. No part of this publication may be reproduced or transmitted in any
form or by any means, electronic or mechanical, including photocopying, recording, or any
information storage and retrieval system, without permission in writing from the publisher.
Permissions for Netter Art figures may be sought directly from Elsevier’s Health Science
Licensing Department in Philadelphia, PA, USA: phone 1-800-523-1649, ext. 3276, or (215)
239-3276; or email H.Licensing@elsevier.com.
Notice
Neither the Publisher nor the Authors assume any responsibility for any loss or injury
and/or damage to persons or property arising out of or related to any use of the material
contained in this book. It is the responsibility of the treating practitioner, relying on
independent expertise and knowledge of the patient, to determine the best treatment
and method of application for the patient.
The Publisher
Printed in China
Frank H. Netter was born in 1906 in New York City. He studied art at the Art Stu-
dent’s League and the National Academy of Design before entering medical school
at New York University, where he received his MD degree in 1931. During his student
years, Dr. Netter’s notebook sketches attracted the attention of the medical faculty
and other physicians, allowing him to augment his income by illustrating articles and
textbooks. He continued illustrating as a sideline after establishing a surgical prac-
tice in 1933, but he ultimately opted to give up his practice in favor of a full-time
commitment to art. After service in the United States Army during World War II, Dr.
Netter began his long collaboration with the CIBA Pharmaceutical Company (now
Novartis Pharmaceuticals). This 45-year partnership resulted in the production of
the extraordinary collection of medical art so familiar to physicians and other medical
professionals worldwide.
Icon Learning Systems acquired the Netter Collection in July 2000 and continued
to update Dr. Netter’s original paintings and to add newly commissioned paintings
by artists trained in the style of Dr. Netter. In 2005, Elsevier Inc. purchased the Netter
Collection and all publications from Icon Learning Systems. There are now over 50
publications featuring the art of Dr. Netter available through Elsevier Inc.
Dr. Netter’s works are among the finest examples of the use of illustration in the
teaching of medical concepts. The 13-book Netter Collection of Medical Illustrations,
which includes the greater part of the more than 20,000 paintings created by Dr.
Netter, became and remains one of the most famous medical works ever published.
The Netter Atlas of Human Anatomy, first published in 1989, presents the anatomic
paintings from the Netter Collection. Now translated into 16 languages, it is the
anatomy atlas of choice among medical and health professions students the world
over.
The Netter illustrations are appreciated not only for their aesthetic qualities, but
more importantly, for their intellectual content. As Dr. Netter wrote in 1949, “ . . . clari-
fication of a subject is the aim and goal of illustration. No matter how beautifully
painted, how delicately and subtly rendered a subject may be, it is of little value as
a medical illustration if it does not serve to make clear some medical point.” Dr.
Netter’s planning, conception, point of view, and approach are what inform his paint-
ings and what make them so intellectually valuable.
Frank H. Netter, MD, physician and artist, died in 1991.
xiii
Netter's Concise Radiologic Anatomy, 1st Edition
4. Axis (C2)
6. Cervical Spondylosis
9. Craniovertebral Ligaments
35. Larynx
63. Sacrum
82. Diaphragm
112. Appendix
139. Pelvis
153. Ureters
Then the Prophet came out of his trance, and addressed himself to
the first Percy.
“Your name is Percy Vere,” he said. “The locket you wear contains
the portraits of your father and your mother. Your companion is your
cousin, Percy Cute; and you are here in the wilderness seeking your
father.”
CHAPTER X.
ONEOTAH.
The warriors, who had drawn nearer when Smoholler dismissed his
spirit, uttered an approving grunt. It may be that the Prophet 47
had purposely availed himself of this opportunity of displaying
his divining power before them.
“Every word of it,” added Cute. “This beats spirit-rapping all hollow;
your spirit comes without a rap, and his information don’t cost a
rap.”
“And having told me so much, I am led to believe you can also tell
me where I can find my father?” cried Percy Vere, eagerly.
“Why have you spared our lives?” asked Percy. “The Indian seldom
extends mercy to a captive, I have heard.”
“You have heard and read many things about the Indian,” he replied;
“but they are spoken and written by the pale-faces, and there is little
truth in them. I have spared your life that you may bear a message
to the surveyor’s camp for me. But first you shall partake of food
with me. You must feel the need of some refreshment.”
“Something to eat would not come amiss,” said Percy Vere. “We
intended to have been back with game to our camp before this.”
“Your camp will not get any game on this side of the river,” he
rejoined. “A dozen of my warriors guard the mouth of the ravine,
and it will be sure destruction to the pale-face who attempts to pass
through it. You would have fallen into the ambush, had you not
turned to the right and ascended the cliff.”
“How did you know the direction we had taken?” asked Percy, 48
curiously.
“In what?”
“That’s so, by king! I never thought of it before; but you are right,
there isn’t.”
“Yes, master,” he replied, in tones that were singularly clear and bell-
like, and then he hastened to obey.
He led the way to a square bowlder that reared its form from the
turf beside a little streamlet that went purling by on its way to the
river, its clear, crystal water looking cool and refreshing. The Prophet
cast himself down beside the rock, and the boys followed his
example. As they glanced through the arches of the forest they saw
several fires blazing in different directions, and groups of Indians
clustered around them. General preparations for a meal were in
progress.
The boys were impressed by the romance of the scene, and Cute
conveyed his idea of it by exclaiming, rather unpoetically:
“Say, Percy, ain’t this high? You said you would like to see Smoholler,
the Prophet, and here we are, invited to take an al fresco dinner
with him.”
The Prophet raised himself upon his elbow, and regarded Percy Vere
earnestly.
The Prophet’s breast heaved and his eyes dilated with a fervid
enthusiasm, as he pronounced these words.
“And why not? The descendants of the Aztecs and Toltecs still roam
these plains and mountains. Why should not I revive the glories of
Montezuma’s empire?”
“Montezuma’s power fell before the white man’s advance, and I fear
the white settlers crowd too closely upon your projected empire,”
replied Percy Vere. “But it is a great idea, and that you may prosper
is my sincere wish. I would like to see the red-man raised to a better
position than that he now occupies. You are the best judge of his
capabilities. The white hunters are too prone to regard him in the
light of a savage beast—and not without some cause, either.”
“Cause? The first offense came from the white man!” cried the
Prophet, fiercely.
“It may be so; but, in our particular instance, if you had let us alone,
we should not have troubled you.”
CHAPTER XI.
A SILVAN REPAST.
“Ah! then you had some hand in the apparitions that appeared upon
the cliff last night?”
Smoholler did the honors of this silvan table with a courtesy that
won strangely upon the boys, and Oneotah stood beside him, ready
to do his bidding at the slightest sign.
“What did the surveyors and the soldiers think of the apparitions?”
asked Smoholler, after the boys had eaten for a while.
“Knocked ’em higher’n a kite!” added Cute. “It was a neat piece of
hocus-pocus, however you did it. Say, couldn’t you give us another
squint at that angelic female of yours?”
“Candidly, I do not.”
“How, then, could she appear upon the face of that inaccessible
cliff?”
“Far from feeling offense, I like your candor,” responded the Prophet,
graciously. “My power impresses the white mind as well as the red—
as you shall have proof anon. You heard the voice of my Monedo, or
Spirit, in the air—you heard his voice, but his body remained invisible
to your eye. How can you account for that?”
“You may have the gift of ventriloquism. My father had such a gift,
for I have often heard my mother describe it. He could throw 52
his voice into inanimate or animate objects to the great
perplexity of the hearer.”
“Yes,” chimed in Cute, “and I have heard lots of funny stories about
him. One day an old woman came to the house to make some
inquiries, and trod, by accident, upon the cat’s tail; and he made the
cat say: ‘You old fool! don’t you know any better than that?’ It nearly
frightened the old woman into a fit, and she left the house in a big
hurry, I tell you; and she believed to her dying day that the cat really
spoke to her.”
“Yes.”
“It is impossible to say what you look like with those hideous daubs
of paint upon your face; but you talk like one—and, besides, you are
too smart for an Indian.”
“Oh! more than life!” exclaimed Oneotah. “If it was only death that
threatened me—”
The Prophet held up his finger warningly, and Oneotah paused and
bowed his head submissively.
“Enough! your bondage will not last until death,” returned Smoholler,
with a significancy which the boys could feel but could not
understand. “Be faithful but a short time longer, and you shall be
restored to your true condition—and the spirits shall no longer
torment you.”
“He was reared by the Nez Perces, but is not of their blood, although
he thinks he is,” replied Smoholler. “There is a secret concerning his
birth, which my skill has divined, and which no other appears to
have suspected. He was made captive by a band of Yakimas under a
chief named Howlish Wampo, who had surprised and defeated the
party to which he was attached. I came up with Howlish Wampo at a
critical moment in the boy’s fate, and took him away from the chief.
Wampo bears me a grudge for it to this day. He would like to gain
possession of the boy again, but dare not do so while I protect him.
If Oneotah were to rejoin the Nez Perces he would no longer be safe
from the pursuit of Howlish Wampo.”
“I am content,” he answered.
“Yes.”
“No; he has dangerous enemies. None here know him but myself.
The shield of my power falls over him, and his influence in my camp
is second only to my own. Now, our meal being ended, you shall
return to your friends. You have seen a portion of my force, and
know my determination. Tell the surveyors and the lieutenant that I
will not permit them to advance through the ravine. They must
recross the river, or be annihilated. For yourself, if you choose to
return, there is a mystic cavern in yonder cliff, and together we will
summon the spirits that await my bidding, and seek to learn your
father’s fate. Will you do so?”
The Antelope boy took two little pouches, made of skin, and richly
trimmed with beads, from a kind of large pocket that he wore
suspended from a belt around his waist. These were attached to
strings made of different-colored strips of doe-skin twisted together.
Smoholler gave one to each of the boys.
“Wear these,” he said. “They are marked with my totem, and I have
charmed them. They are amulets of great power, and they will
preserve you from harm. No Indian who knows Smoholler’s 55
sign will raise his hand against the wearer of his amulet.”
“I thank you for the gift,” returned Percy Vere, “and shall always
treasure it as the memento of a wonderful man.”
“There is a trail along the cliff,” said Smoholler. “Oneotah will guide
you a part of the way. Remember, return this evening, and I will
show you a proof of my magical power that will astonish you.”
The boys promised to do so, shook hands cordially with the Prophet,
notwithstanding his hideous war-paint, and followed Oneotah, who
bounded lightly on before.
The way was a rough one, and they had some difficulty in keeping
up with Oneotah, who sprung over the bowlders and fallen trees in
the path with the nimbleness of a goat.
“Phew! how are we going to get over that?” cried Cute; surveying
the impediment in dismay.
Oneotah pointed to a tall spruce tree that grew beside the crag.
“Climb this,” he said, “and from its branches you can reach the top
of the rock.”
“Beyond it lies your camp. The descent upon the other side is easy.
You can climb?”
Oneotah extended his hand cordially, but he winced a little under the
vigorous grasp that Percy Cute bestowed upon him, for the fat hands
of the boy had quite a degree of strength in them. Cute laughed as
Oneotah quickly released his fingers from the roguish squeeze,
uttering a suppressed “O—h!”
“Yes. When you reach the top of this rock you will see your camp.”
“Good-by.”
Percy extended his hand, but Oneotah hesitated to accept it. Percy
laughed.
With these words, he bounded swiftly away, and was soon lost to
sight among the trees.
“’Tain’t correct.”
“Indeed! Can you suggest an improvement?”
“I know I am. Did you not notice how she squealed when I squeezed
her hand—and didn’t you think her hand was as soft as a girl’s?”
“Oneotah?”
“Yes; she does just as he says, and believes in him, too, but that’s
only natural, because I can just guess what she is.”
“What?”
“His daughter. She’s a chip of the old block, and helps him in his
hocus-pocus conjurocus, I’ll bet.”
“You bet! I’m Cute by name, and ’cute by nature. Tell you what,
Percy—if we could have taken off that antelope’s head, do you know
what we would have found beneath it?”
Percy smiled.
“Yes, and something else—we should have found the face of the
Angel that appeared on the cliff, last night.”
“Do you think so?” he cried, and his voice was strongly 58
charged with incredulity.
“I’ll just bet my bottom dollar on it! She’s the Prophet’s White Spirit,
sure as a gun.”
“I have only one objection to urge to that,” replied Percy Vere. “The
face of the Angel was white—you observed that?”
“Y-e-s,” he admitted.
“You may think so, but I don’t. I tell you, this Prophet is a sly old
’coon, and up to all sorts of dodges. And then, how do we know that
Oneotah is an Indian girl?” he continued, suddenly inspired with a
new idea. “She may be a white girl—stolen away from her home
when she was a wee bit of a shaver—I have heard of such things,
haven’t you?”
“How?”
“When we give the Prophet our next call, I’ll contrive to throw some
flip-flaps for his amusement; and I’ll flip flap over Oneotah and
knock her head off!”
“You just keep your eye on me, and see if I don’t. Now, let’s shin up
this tree and get back to camp. We shall have plenty of news for
them.”
“Yes; they will be very much surprised to see us, as I think they
have given us up for lost. Glyndon has reproached himself 59
with our death, I’m sure, and he will be rejoiced to see us.
Come on.”
“You first.”
When Gummery Glyndon jumped into the river to escape from his
pursuers, he still clutched his trusty rifle by its barrel, and he held
fast to it, as the swift current swept him rapidly down-stream.
The Indians did not follow him into the river, but paused upon its
bank, and began to hastily reload their guns. The loss they had
sustained in their attack upon the hunter and the boys had rendered
them furious for vengeance. But the current swept Glyndon out of
sight, for the bank was thickly wooded, before they could bring their
guns to bear upon him.
He shook his gray head sorrowfully over this reflection. Then he saw
the trunk of a tree floating in the stream ahead of him. He struck out
for it, gained it, and ensconced under its further side, floated with it
down the stream. As he went with the current, he made good
headway, and soon reached the camp of the surveyors.
All were of his opinion that little mercy would be shown to the boys
by their captors, and they deeply lamented their untimely fate.
“Do you know what tribe these Indians belong to?” asked Gardiner.
“That’s more than I can say, for I don’t know him. So I might have
seen him without knowing it. There was a chief at the head of ’em,
and he acted differently from Injun chiefs in general, for he charged
right down upon us, without stopping to count the cost, and that
was what flaxed us—for they just drew our fire, and were upon us
without giving us a chance to reload; and there was too many of ’em
for a hand-to-hand fight. I managed to get out of it, but I had to
leave the boys. There was no help for it.”
“That ain’t the worst of it,” rejoined Glyndon. “They ain’t a-going to
allow us to stop here long. So just look out for a brush. I hope you
have been fixing things here, leftenant,” he continued, turning to
Gardiner.
“Come and see,” replied the lieutenant, who wished to have the old
hunter’s opinion on the measures he had taken for the protection of
the camp.
That there was an approach to the camp over the precipitous cliff to
the right was a circumstance that Lieutenant Gardiner was yet to
learn; not that it made his position more insecure, as his breastwork
was some distance from the cliff.
Within the grove, and the breastwork, were the animals and the
implements of the party, and Ike Yardell, seeing the probability of
remaining there several days, had called upon Corney Donohoe and
Jake Spatz to assist him in building a fireplace of stones; a
substantial affair that would assist his culinary efforts.
“Smoholler can never drive us out of this,” he said. “He don’t care
much for the lives of his men, that’s certain, but he can’t take this
place in a single charge, and it will cost him pretty dear to try it.”
“Have you any idea of the force under his command?” asked
Lieutenant Gardiner.
“Nigh onto fifty, I should judge by the looks of his trail.”
“Yes; but I have an idea that he has a lot more coming. He can set
all the other tribes round here against us; and if he should muster
three or four hundred warriors in front of us, it would make things
look squally for us.”
“It would, indeed. They might flank us on the other bank of the
river, and so hem us in, and starve us into submission. But I have an
idea that this obstruction will only be temporary, and that we shall
be permitted to proceed.”
“Not a bit of it,” replied Glyndon, decidedly. “We have got to whip
these Injuns and drive ’em away—that’s the only way that we shall
ever ever get rid of ’em. And we must have some help to do it.”
“Play the old game here, and set Injuns to fighting Injuns. Send for
a war-party of the Nez Perces.”
“They’ll fight against the Yakimas, Umatillas, and Cayuses, who are
likely to side with him, and if they ’tend to them, we can take care of
the Smohollers.”
“Very good—two heads are better than one. Let’s have a council of
war on the subject. Holloa! What’s up now?”
“Like a book!—and he’s just the man we want, for he’s a war-chief of
the Nez Perces.”
“Good! He is welcome.”
The young chief crossed the river, and rode up to the assembled
group that awaited his coming. He dismounted with an easy grace,
and in a manner that denoted his belief that he was among friends.
Nor are they the only tribe of the Indians of that section who have
lost their original name in the fanciful ones bestowed upon them by
the voyageurs, who were the first explorers of the great North-west.
The Pen D’Oreilles (Ear-rings), Cœur D’Alenes (Needle-hearts), still
exist.
His age could not have been over twenty-five. Take his 64
appearance altogether, he was one of the finest specimens of
the red-men to be found at the present day. He had mixed with the
white men, and learned some portion of their civilization without
becoming contaminated by their vices.
“Good!” cried Glyndon. “We can wipe the Smohollers out in no time
now.”
“Well, he just is. His head-quarters are in yonder cliff, and he has
regularly besieged us here.”
“He don’t like the idea of the railroad going through this territory.
These are the surveyors, Multuomah, Mister Blaikie and Mister
Robbins, and this is Lieutenant Gardiner, from Fort Walla Walla.”
The young chieftain shook hands cordially with all three, as they
were introduced to him.
“No.”
“Then your men believe in the mystical power of this red Prophet?”
asked Lieutenant Gardiner.
“Ah! I see; you would like to doubt him, but can not exactly divest
your mind of a certain belief in his supernatural powers. That is not
to be wondered at, for he has shown us some astonishing sights
since we have been here. I think it’s all trickery, but I can’t tell how
it is done.”
“Yes; black and white. Why should he choose those colors, when he
is red?”
The four white men, who were listening to him, exchanged glances.
Gardiner and Robbins were of his opinion; but Glyndon took a more
favorable view of the matter.
“We must make it of use to us,” he cried. “We are strong enough,
with Multuomah’s band, to just gobble this Prophet, and I’m going to
do it. The boys may be alive yet, and we must rescue them.”
“But if the chief and his braves dare not fight against 66
Smoholler?” urged Lieutenant Gardiner.
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