Atlas of Human Anatomy in Cross Section: Appendix: Topography of the Thorax and Abdomen
Ronald A. Bergman, Ph.D., Adel K. Afifi, M.D., Jean J. Jew, M.D., and Paul
C. Reimann, B.S.
Peer Review Status: Externally Peer Reviewed
Right Lobe, Highest Point
The highest point of the upper or superior surface of the liver varies from the lower third of the seventh thoracic vertebra to the middle of the eleventh thoracic vertebra. Eycleshymer and Schoemaker also stated the average to be at the level of the lower third of the ninth thoracic vertebra.
The highest point of the right lobe of the liver in relation to the anterior chest wall was found to be at the level of the fourth intercostal space in the parasternal line, and at the level of the upper margin of the fifth rib in the mamillary line. The lateral margin of the liver reached to the mamillary line on the left side. The round ligament was 2.5 cm to the right of the median line. Luschka and Corning report the upper surface of the right lobe at the costochondral Junction of the fourth rib. Spalteholtz described and illustrated the upper surface as opposite the fourth intercostal space. Merkel and Morris place the upper surface at about the level of the upper border of the fifth rib or the fourth intercostal space in the mamillary line, and both Toldt and Treves indicate it to be at the fifth costochondral junction.
Right Lobe, Lowest Point
The lowest point of the liver on the right side in Eycleshymer and Schoemaker's specimens varied from the lower third of the second lumbar vertebra to the fourth lumbar disk. The average position is at a level between the lower third of the third lumbar vertebra and the third lumbar disk. Treves reports that it lies at the level of the second lumbar spine.
In Eycleshymer and Schoemaker's specimen, the liver was considerably lower than the average, being less than 1.5 cm above the iliac crest. Langer and Toldt, Joessel, and Corning state that the lowest point on the right side corresponds, in life, to the costal margin. Merkel, Treves, Morris, and Cunningham reported that in the upright position it projects a little below the costal margin, whereas in the recumbent position it ascends about 2 to 3 cm.
Anterior Margin, Midline
The anterior margin of the liver in the Midline was reported by Eycleshymer and Schoemaker to vary in position from the tenth thoracic vertebra to the second lumbar disk. The average position is at the level of the lower third of the first lumbar vertebra. In their specimen, the anterior margin of the liver in the Midline lies opposite the middle third of the space between the xiphosternal junction and the umbilicus.
The lower margin, reported by Joessel, lies opposite a line joining the tips of the ninth left and the tenth right costal cartilages. Langer and Toldt define the lower border by a line joining the middle of the seventh costal cartilage on the left and the tip of the eighth on the right. Quain, Treves, and Piersol report that the lower margin corresponds to a line passing from the tip of the eighth left to that of the ninth right costal cartilages. Merkel says it crosses the right costal margin at the tip of the ninth rib. Schultze indicated, "In the right mamillary line the inferior border leaves the costal margin, passes obliquely upward and to the left, crosses the median line midway between the navel and the xiphoid process, and reaches the left costal margin in the parasternal line." Corning places its anterior margin, in the median line, midway between the base of the xiphoid and the umbilicus.
Charpy describes the lower border of the liver in the Midline as usually lying opposite the upper third of the space between the xiphoid and the umbilicus. The lower border of the liver, according to Cunningham, passes from the eighth left to the tip of the tenth right costal cartilages.
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