A reappraisal of pediatric abdominal surface anatomy utilizing in vivo cross-sectional imaging

Despite being integral to medical and surgical practice, pediatric anatomy has remained relatively neglected except for a few landmark works. Neonatal and pediatric anatomy differs structurally and functionally from adult anatomy in many ways. The aim of the current study was to reappraise common abdominal surface landmarks of important structures in infants and children. After cases with related pathologies had been excluded, computer tomography scans of 90 children were divided into three age groups and systematically analyzed. The vertebral levels of the unpaired branches of the abdominal aorta (AA) were recorded. The vertebral level and relationship to the midline of the bifurcation of the AA and the formation of the inferior vena cava were measured. The renal long axes, costal relationships, renal artery vertebral levels, and hilar vertebral levels were measured. The splenic long axis and relationship to the mid-axillary line were also measured. The renal length was disproportionately large in the youngest age group and increased less with age (7.12 cm, 7.85 cm, 8.86 cm). The renal artery was consistently found around L1; the left kidney was related to the 11th and 12th ribs posteriorly, the right kidney only to the 12th rib. The AA bifurcated to the right of the midline in 10% of children. The unpaired visceral branches of the aorta were commonly found at T12 (celiac artery), L1 (superior mesenteric artery), and L3 (inferior mesenteric artery). The current study provides age-standardized surface landmarks and measurements for major abdominal vascular structures and solid organs in normal children. The clinical applications of these data are multiple and diverse.