Cardiac Notch Impressions from the Heart and Spleen

The endoscopic appearance of the fundus and cardia is influenced by the adjacent diaphragm, spleen, and and heart. Understanding this appearance requires an adjustment in thinking due to the U-shaped deflection of the endoscope for inspecting the fundus and cardia (Fig. 2.63).

The diaphragm creates the deep fold of the cardiac notch. The impressions from the spleen and heart can be identified in the dome of the fundus (Figs. 2.60-2.63). The spleen may bulge deeply into the fundus, but in some cases it may only flatten the fundus dome and produce a dark discoloration of the gastric mucosa. Distinct cardiac pulsations can usually be seen opposite the splenic impression.

Fig. 2.60 Normal configuration of the gastric fundus b

Fig. 2.60 Normal configuration of the gastric fundus

Fig. 2.61 a, b Impression from the heart.

Shape changes are seen in the dome of the fundus during cardiac pulsations. The cardiac impression is clearly visible at the center

Fig. 2.61 a, b Impression from the heart.

Shape changes are seen in the dome of the fundus during cardiac pulsations. The cardiac impression is clearly visible at the center

Fig. 2.62 Relations of the stomach, heart, and spleen. The heart is in contact with the stomach superiorly and anteriorly; the spleen superiorly, posteriorly, and laterally

Fig. 2.63 Cross section at the level of the fundus. Caudocranial view. The retroflexed endoscope is shown. The impressions from the heart and spleen are visible, along with a small pool of fluid sp = spleen h = heart fi s iĆ®'.i k

m CT

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