title: The thoracic surface anatomy of adult black South Africans: A reappraisal from CT scans.
abstract: Surface landmarks or planes taught in anatomy curricula derive from standard anatomical textbooks. Although many surface landmarks are valid, clear age, sex, and population differences exist. We reappraise the thoracic surface anatomy of black South Africans. We analyzed 76 (female = 42; male = 34) thoracoabdominal CT-scans. Patients were placed in a supine position with arms abducted. We analyzed the surface anatomy of the sternal angle, tracheal, and pulmonary trunk bifurcation, azygos vein termination, central veins, heart apex, diaphragm, xiphisternal joint, and subcostal plane using standardized definitions. Surface anatomy landmarks were mostly within the normal variation limits described in previous studies. Variation was observed where the esophagus (T9) and inferior vena cava (IVC) (T8/T9/T10) passed through the diaphragm. The bifurcations of the trachea and pulmonary trunk were inferior to the sternal angle. The subcostal plane level was positioned at L1/L2. The origin of inferior mesenteric artery was mostly inferior to the subcostal plane. Sex differences were noted for the plane of the xiphisternal joint (P = 0.0082), with males (36%) intersecting at T10 and females (36%) intersecting at T9. We provide further evidence for population variations in surface anatomy. The clinical relevance of surface anatomical landmarks depends on descriptions of normal variation. Accurate descriptions of population, sex, age, and body type differences are essential. Clin. Anat. 29:1018-1024, 2016. © 2016 Wiley Periodicals, Inc.
authors: Department of Anatomy, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa. natalie.keough@up.ac.za.
authors: N
authors: N
authors: Keough
authors: Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.
authors: S A
authors: SA
authors: Mirjalili
authors: Department of Radiology, Faculty of Health Sciences School of Medicine, University of Pretoria, Pretoria, South Africa.
authors: F E
authors: FE
authors: Suleman
authors: Department of Radiology, Faculty of Health Sciences School of Medicine, University of Pretoria, Pretoria, South Africa.
authors: Z I
authors: ZI
authors: Lockhat
authors: Department of Anatomy, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa.
authors: A
authors: A
authors: van Schoor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012016:Reference Values; D013019:South Africa; D013909:Thorax / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: apex of heart; central veins; diaphragm; sternal angle; subcostal plane; xiphisternal joint