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
Eycleshymer and Schoemaker found that the level of the cardiac orifice varied between the upper and middle thirds of the ninth thoracic vertebra to the middle of the twelfth thoracic vertebra. The average position is at the level of the upper third of the eleventh thoracic vertebra. Rudinger found it at the ninth thoracic vertebra; Langer and Toldt, at the ninth or tenth; Corning, Morris, and Piersol, at the tenth; Spalteholtz and Sobotta, at the tenth or eleventh; Merkel, joessel, and Schultze, at the eleventh; and Cunningham, 2.5 cm to the left of the ninth thoracic spine.
In relation to the anterior thoracic wall, it is located about 2 cm to the left of and slightly below the sternal end of the seventh costal cartilage, opposite the sixth intercostal space. Rudinger places it nearly opposite the sternal ends of the sixth and seventh left costal cartilages. Corning places it behind the seventh left costal cartilage 3 cm from the sternum Cunningham found it on the seventh left costal cartilage 2.5 cm from the sternum.
As reported by Eycleshymer and Schoemaker, the location of the highest portion of the fundus of the stomach ranges from the middle of the eighth thoracic vertebra to the eleventh thoracic disk. The average position is opposite the middle third of the tenth thoracic vertebra. Cunningham gives the vertebral level as the eighth thoracic spine and its relation to the anterior thoracic wall as opposite the fifth costochondral junction. Joessel found the fundus to extend 3 to 5 cm above the cardia. According to Poirier and Charpy, the highest point is at the level of the fifth rib in the mamillary line. Treves and Morris placed the highest level at the sixth chondrosternal junction. Piersol indicated that the fundus rises to the level of the fifth chondrosternal junction. The lower margin of the average moderately distended stomach extends, according to Corning, to a level midway between the xiphosternal Junction and the umbilicus. Jonnesco and Merkel have suggested that it is at the level of a transverse plane passing through the tips of the tenth costal cartilages.
Eycleshymer and Schoemaker reported the range of positional variation of the pylorus to be between the second lumbar disk and the upper third of the third lumbar vertebra, with an average level between the middle and lower thirds of the first lumbar vertebra.
Braune and Spalteholtz reported that the pyloric orifice may be found at a level somewhere between the eleventh thoracic and the first lumbar vertebrae. Rudinger and Corning locate it between the twelfth thoracic disk and the first lumbar vertebra, and Sobotta found it at the level of the twelfth thoracic vertebra. Joessel, Schultze, Rosenfeld (cited but not referenced by Eycleshymer and Schoemaker), and Jonnesco place it opposite the first lumbar vertebra, and Cunningham, opposite the twelfth thoracic spine. Addison found the transpyloric plane in 68% of 40 bodies to be within 1 cm of the level of the first lumbar disk. According to most writers, it lies in the median plane or slightly to the right of the median plane. For example, Spalteholtz reported the transpyloric plane in the median line or slightly to the left when empty and markedly to the right when full. Braune, Cunningham, Merkel, and Piersol indicate it "close to the median line."
In relation to the anterior thoracic wall, the pyloric orifice lies in the median plane at a level midway between the xiphosternal )unction and the umbilicus. According to Poirier and Charpy, it lies at the level of a line uniting the internal (medial) extremities of the ninth costal cartilages.
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