title: Computed tomography celiac trunk topography relating to celiac plexus block.
abstract: OBJECTIVE
  The celiac plexus is a dense autonomic network surrounding the celiac trunk. To block this plexus, the celiac trunk is a landmark for needle placement. Needles inserted at a distance from the midline, "walking off" the vertebra, may penetrate surrounding organs. We reviewed 200 computed tomography images to investigate the celiac trunk topography relating to the block.
  
  
  METHODS
  Two hundred computed tomography images across the celiac trunk were displayed. The celiac emergence level and celiac-aortic-vertebral anatomies were examined. On each image, 2 needle trajectories imitating walking-off technique were placed tangential to the vertebral body passing through the crus of the diaphragm on both sides: L-9s and L-4.5s (9 and 4.5 cm from the midline, respectively). The vital organs traversed by these lines were noted and analyzed.
  
  
  RESULTS
  Celiac emergence levels: T11-12, 6.5%; T12, 34%; T12-L1, 31%; L1, 28.5%. Aortic locations: 70% were anterior-left to and 29% were anterior-middle to the vertebra. Celiac runoffs: 63.5% from the aorta anterolaterally on the left, 36% from the midportion. Celiac-aortic-vertebral correlations showed a various distribution in groups; 88% L-9s and 64% L-4.5s on the right side, and 96% L-9s and 88% L-4.5s on the left side traversed different vital organs with various frequencies.
  
  
  CONCLUSIONS
  The celiac trunk anatomy varies. Blocking needles walking off the vertebra from a fixed distance frequently traverse vital organs. Previewing celiac-aortic-vertebral topography with a simulating block on individual patient's computed tomography (CT) image for accordant needle placement subsequently is warranted.
authors: Department of Anesthesiology and Pain Medicine, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, 1650 Grand Concourse, Bronx, NY 10457, USA. iyangmd@yahoo.com
authors: Ian Y
authors: IY
authors: Yang
authors: Saeed
authors: S
authors: Oraee
authors: Carlos
authors: C
authors: Viejo
authors: Harvey
authors: H
authors: Stern
mesh_terms: D000328:Adult; D000368:Aged; D001027:Aortography; D001340:Autonomic Nerve Block / Q000009:adverse effects; D002447:Celiac Plexus / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007267:Injections; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009518:New York; D012189:Retrospective Studies; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media