Reappraisal of the classical abdominal anatomical landmarks using in vivo computerized tomography imaging

  • Ruchi Goyal
  • Anjali AggarwalEmail author
  • Tulika Gupta
  • Ajay Gulati
  • Shallu Jaggi
  • S. Ali Mirjalili
  • Daisy Sahni
Original Article



With expanding scope of interventions it becomes mandatory to have correct and evidence-based knowledge of surface anatomy of internal abdominal structures. Information available in text books is derived from work done on cadaveric studies. Current study was designed to provide data of key abdominal surface anatomical landmarks and their variations in living subjects using CT imaging of adult population.

Materials and methods

Cross-sectional study was conducted using 100 abdominopelvic CT scans of patients of Indian origin.


Vertebral levels of origin of celiac trunk varied from T11 to L1/2 intervertebral disc, superior mesenteric artery from T12 to L2, inferior mesenteric artery from L2 to L4 and aortic bifurcation from L3 to L5. Origin of both renal arteries varied between T12 and L2 and the formation of inferior vena cava varied from L3 to L5. Vertebral levels of upper pole of both kidneys ranged from T11 to upper L3. Spleen was related to 9th to 11th ribs in 36% and 10th to 12th ribs in 34% scans. Most common vertebral levels of subcostal plane, planum supracristale and planum intertuberculare noticed were lower L2, L4 and lower L5, respectively.


Data derived from imaging investigations of living subjects and variations from the conventional descriptions observed in the current study might be helpful for clinicians.


CT imaging Abdominal landmarks Radiological anatomy 



The authors thank the individuals whose data have been used in the study for the advancement in anatomical knowledge.

Author contributions

RG data collection, manuscript writing. AA designed the study, manuscript writing and editing. TG manuscript writing and editing. AG data collection and standardisation of software used in the study. SJ statistical analysis. SAM designed the study. DS read and approved the final manuscript.


This study has not received any funding.

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials and methods used in this study or the findings specified in this report.

Ethical standards

This study was approved by the Institutional ethical committee (No: NK/3654/Study/561).


  1. 1.
    Anson BJ, McVay CB (1936) The topographical positions and the mutual relations of the visceral branches of the abdominal aorta. A study of 100 consecutive cadavers. Anat Rec 67:7–15CrossRefGoogle Scholar
  2. 2.
    Aubert J, Koumare K (1975) Variations of origin of the renal artery: a review covering 403 aortographies. Eur Urol 1:182–188Google Scholar
  3. 3.
    Badshah M, Soames R, Khan MJ, Ibrahim M, Khan A (2017) Revisiting thoracic surface anatomy in an adult population: a computed tomography evaluation of vertebral level. Clin Anat 30:227–236CrossRefGoogle Scholar
  4. 4.
    Beregi JP, Mauroy B, Willoteaux S, Mounier-Vehier C, Remy-Jardin M, Francke JP (1999) Anatomic variation in the origin of the main renal arteries: spiral CTA evaluation. Eur Radiol 9:1330–1334CrossRefGoogle Scholar
  5. 5.
    Brinegar KN, Sheth RA, Khademhosseini A, Bautista J, Oklu R (2015) Iliac vein compression syndrome: clinical, imaging and pathologic findings. World J Radiol 7:375–381CrossRefGoogle Scholar
  6. 6.
    Chakraverty R, Pynsent P, Isaacs K (2007) Which spinal levels are identified by palpation of the iliac crests and the posterior superior iliac spines? J Anat 210:232–236CrossRefGoogle Scholar
  7. 7.
    Cheong B, Muthupillai R, Rubin MF, Flamm SD (2007) Normal values for renal length and volume as measured by magnetic resonance imaging. Clin J Am Soc Nephrol 2:38–45CrossRefGoogle Scholar
  8. 8.
    Chithriki M, Jaibaji M, Steele RD (2002) The anatomical relationship of the aortic bifurcation to the lumbar vertebrae: a MRI study. Surg RadiolAnat 24:308–312Google Scholar
  9. 9.
    Choudhury D, Levi M (2011) Kidney aging—Inevitable or preventable? Nat Rev Nephrol 7:706–717CrossRefGoogle Scholar
  10. 10.
    Ellis H, Mahadevan V (2010) Clinical anatomy: a revision and applied anatomy for clinical students. Blackwell Publishing, OxfordGoogle Scholar
  11. 11.
    Emamian SA, Nielsen MB, Pedersen JF, Ytte L (1993) Sonographic evaluation of renal appearance in 655 adult volunteers. Correlation with age and obesity. Acta Radiol 34:482–485CrossRefGoogle Scholar
  12. 12.
    Fischer NJ, Morreau J, Sugunesegran R, Taghavi K, Mirjalili SA (2017) A reappraisal of pediatric thoracic surface anatomy. Clin Anat 30:788–794CrossRefGoogle Scholar
  13. 13.
    George R (1935) Topography of the unpaired visceral branches of the abdominal aorta. J Anat 69:196–205Google Scholar
  14. 14.
    Glodny B, Unterholzner V, Taferner V, Hofmann KJ, Rehder P, Strasak A, Petersen A (2009) Normal kidney size and its influencing factors—a 64-slice MDCT study of 1.040 asymptomatic patients. BMC Urol 23:9–19Google Scholar
  15. 15.
    Hale SJ, Mirjalili SA, Stringer MD (2010) Inconsistencies in surface anatomy: the need for an evidence-based reappraisal. Clin Anat 23:922–930CrossRefGoogle Scholar
  16. 16.
    Heijmen RH, Bollen TL, Duyndam DA, Overtoom TT, Van Den Berg JC, Moll FL (2001) Endovascular venous stenting in May–Thurner syndrome. J Cardiovasc Surg (Torino) 42:83–87Google Scholar
  17. 17.
    Ilica AT, Kocaoglu M, Bilici A, Ors F, Bukte Y (2007) Median arcuate ligament syndrome: multidetector computed tomography findings. J Comput Assist Tomogr 31:728–731Google Scholar
  18. 18.
    Karim OM, Boothroyd AE, Wyllie JH (1990) McBurney’s point—fact or fiction? Ann R Coll Surg Engl 72:304–308Google Scholar
  19. 19.
    Keough N, Mirjalili SA, Suleman FE, Lockhat ZI, van Schoor A (2016) The thoracic surface anatomy of adult black South Africans: a reappraisal from CT scans. Clin Anat 29(8):1018–1024CrossRefGoogle Scholar
  20. 20.
    Kornreich L, Hadar H, Sulkes J, Gornish M, Ackerman J, Gadoth N (1998) Effect of normal ageing on the sites of aortic bifurcation and inferior vena cava confluence: a CT study. Surg Radiol Anat 20:63–68CrossRefGoogle Scholar
  21. 21.
    Koch C, Taghavi K, Hamill J, Mirjalili SA (2016) Redefining the projectional and clinical anatomy of the duodenojejunal flexure in children. Clin Anat 29:175–182CrossRefGoogle Scholar
  22. 22.
    Kreel L, Mindel S (1969) The radiographic position of the spleen. Br J Radiol 42:830–834CrossRefGoogle Scholar
  23. 23.
    Lee CH, Seo BK, Choi CY, Shin HJ, Park JH, Jeon HJ, Kim KA, Park CM, Kim BH (2004) Using MRI to evaluate anatomic significance of aortic bifurcation, right renal artery, and conus medullaris when locating lumbar vertebral segments. AJR Am J Roentgenol 182:1295–1300CrossRefGoogle Scholar
  24. 24.
    Lumley JSP (2008) Surface anatomy: the anatomical basis of clinical examination. Churchill Livingstone, Edinburgh, p 134Google Scholar
  25. 25.
    McDermott S, Oliveira G, Ergül E, Brazeau N, Wicky S, Oklu R (2013) May–Thurner syndrome: can it be diagnosed by a single MR venography study? Diagn Interv Radiol 19:44–48Google Scholar
  26. 26.
    Mirjalili SA, McFadden SL, Buckenham T, Wilson B, Stringer MD (2012) Anatomical planes: are we teaching accurate surface anatomy? Clin Anat 25:819–826CrossRefGoogle Scholar
  27. 27.
    Mirjalili SA, Hale SJ, Buckenham T, Wilson B, Stringer MD (2012) A reappraisal of adult thoracic surface anatomy. Clin Anat 25:827–834CrossRefGoogle Scholar
  28. 28.
    Mirjalili SA, McFadden SL, Buckenham T, Stringer MD (2012) A reappraisal of adult abdominal surface anatomy. Clin Anat 25:844–850CrossRefGoogle Scholar
  29. 29.
    Mirjalili SA, McFadden SL, Buckenham T, Stringer MD (2012) Vertebral levels of key landmarks in the neck. Clin Anat 25:851–857CrossRefGoogle Scholar
  30. 30.
    Moore KL, Dalley AF, Agur AMR (2010) Clinically oriented anatomy. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  31. 31.
    Moussallem CD, Hamad IA, El-Yahchouchi CA, Moussallem MD, Arnalsteen DM, Mertl P, Havet E (2012) Relationship of the lumbar lordosis angle to the abdominal aortic bifurcation and inferior vena cava confluence levels. Clin Anat 25:866–871CrossRefGoogle Scholar
  32. 32.
    O’Neill WC (2014) Renal relevant radiology: use of ultrasound in kidney disease and nephrology procedures. Clin J Am Soc Nephrol 9:373–381CrossRefGoogle Scholar
  33. 33.
    Özbülbül NI (2011) CT angiography of the celiac trunk: anatomy, variants and pathologic findings. Diagn Interv Radiol 17:150–157Google Scholar
  34. 34.
    Özkan U, Oguzkurt L, Tercan F, Kizilkiliç O, Koç Z, Koca N (2006) Renal artery origins and variations: angiographic evaluation of 855 consecutive patients. Diagn Interv Radiol 12:183–186Google Scholar
  35. 35.
    Pak N, Patel SG, Hashemi Taheri AP, Hashemi F, Eftekhari Vaghefi R, Naybandi Atashi S, Mirjalili SA (2016) A reappraisal of adult thoracic and abdominal surface anatomy in Iranians in vivo using computed tomography. Clin Anat 29:191–196CrossRefGoogle Scholar
  36. 36.
    Reiff JE, Werner-Wasik M, Valicenti RK, Huq MS (1999) Changes in the size and location of kidneys from the supine to standing positions and the implications for block placement during total body irradiation. Int J Radiat Oncol Biol Phys 45:447–449CrossRefGoogle Scholar
  37. 37.
    Render CA (1996) The reproducibility of the iliac crest as a marker of lumbar spine level. Anaesthesia 51:1070–1071CrossRefGoogle Scholar
  38. 38.
    Rosse C, Gaddum-Rosse P (1997) Hollinshead’s textbook of anatomy, 5th edn. Lippincott-Raven, PhiladelphiaGoogle Scholar
  39. 39.
    Schwartz LH, Richaud J, Buffat L, Touboul E, Schlienger M (1994) Kidney mobility during respiration. Radiother Oncol 32:84–86CrossRefGoogle Scholar
  40. 40.
    Scott-Conner CE, Hall TJ (1992) Variant arterial anatomy in laparoscopic cholecystectomy. Am J Surg 163:590–592CrossRefGoogle Scholar
  41. 41.
    Shen XH, Su BY, Liu JJ, Zhang GM, Xue HD, Jin ZY, Mirjalili SA, Ma C (2016) A reappraisal of adult thoracic and abdominal surface anatomy via CT scan in Chinese population. Clin Anat 29:165–174CrossRefGoogle Scholar
  42. 42.
    Sinnatamby CS (2011) Last’s anatomy: regional and applied. Churchill Livingstone, Elsevier, EdinburghGoogle Scholar
  43. 43.
    Standring S (2008) Gray’s anatomy: the anatomical basis of clinical practice. Churchill Livingstone, EdinburghGoogle Scholar
  44. 44.
    Standring S (2015) Gray’s anatomy: the anatomical basis of clinical practice. Churchill Livingstone, EdinburghGoogle Scholar
  45. 45.
    Subramaniam H, Taghavi K, Mirjalili SA (2016) A reappraisal of pediatric abdominal surface anatomy utilizing in vivo cross-sectional imaging. Clin Anat 29:197–203CrossRefGoogle Scholar
  46. 46.
    Tsai HC, Yoshida T, Chuang TY, Yang SF, Chang CC, Yao HY, Tai YT, Lin JA, Chen KY (2017) Transversus abdominis plane block: an updated review of anatomy and techniques. Biomed Res Int 2017:8284363Google Scholar
  47. 47.
    Tsushima Y, Endo K (2000) Spleen enlargement in patients with nonalcoholic fatty liver: correlation between degree of fatty infiltration in liver and size of spleen. Dig Dis Sci 45:196–200CrossRefGoogle Scholar
  48. 48.
    Uzun C, Atman ED, Ustuner E, Mirjalili SA, Oztuna D, Esmer TS (2016) Surface anatomy and anatomical planes in the adult Turkish population. Clin Anat 29:183–190CrossRefGoogle Scholar
  49. 49.
    Verghese A, Horwitz RI (2009) In praise of the physical examination. BMJ 339:1385–1386CrossRefGoogle Scholar
  50. 50.
    Walsh JC, Quinlan JF, Butt K, Towers M, Devitt AT (2006) Variation in position of the l4/5 disc inter-space from the anatomical landmark: review of 450 radiographs and clinical applications. Eur J Orthop Surg Traumatol 16:203–206CrossRefGoogle Scholar
  51. 51.
    White RD, Weir-McCall JR, Sullivan CM, Mustafa SA, Yeap PM, Budak MJ, Sudarshan TA, Zealley IA (2015) The celiac axis revisited: anatomic variants, pathologic features, and implications for modern endovascular management. Radiographics 35:879–898CrossRefGoogle Scholar
  52. 52.
    Yildiz AE, Ariyurek MO, Karcaaltincaba M (2013) Splenic anomalies of shape, size, and location: pictorial essay. Sci World J 2013:321810Google Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • Ruchi Goyal
    • 1
  • Anjali Aggarwal
    • 1
    Email author
  • Tulika Gupta
    • 1
  • Ajay Gulati
    • 2
  • Shallu Jaggi
    • 2
  • S. Ali Mirjalili
    • 3
  • Daisy Sahni
    • 1
  1. 1.Department of AnatomyPGIMERChandigarhIndia
  2. 2.Department of Radiodiagnosis and ImagingPGIMERChandigarhIndia
  3. 3.Anatomy and Medical Imaging Department, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand

Personalised recommendations