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Topic

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Cardia of stomach

The cardia of the stomach is the anatomical region immediately surrounding the gastroesophageal junction, where the abdominal esophagus enters the stomach. It is a small area, typically 2–3 cm wide, located just below the diaphragm at the level of the T11 vertebra, slightly to the left of the midline.

Histologically, the cardia is lined by cardiac glands, which secrete primarily mucus to protect the esophagus from gastric acid. Functionally, it serves as the transition zone between esophageal squamous epithelium and gastric columnar mucosa (the Z-line). The cardia contributes to the anti-reflux barrier, along with the lower esophageal sphincter and diaphragmatic crura.

Clinically, this region is significant in GERD (gastroesophageal reflux disease), Barrett’s esophagus, hiatal hernia, and adenocarcinoma of the cardia.

Synonyms

  • Gastric cardia

  • Cardiac part of stomach

  • Cardiac orifice

Function

  • Serves as the entry region of the stomach, receiving swallowed material from esophagus

  • Produces mucus for protection against gastric acid reflux

  • Works with LES and diaphragm to prevent reflux into esophagus

  • Transition zone important for histological and pathological assessment

Nerve Supply

  • Parasympathetic: Vagus nerve via esophageal plexus → gastric branches

  • Sympathetic: Greater splanchnic nerves via celiac plexus

Arterial Supply

  • Left gastric artery (branch of celiac trunk)

  • Contributions from esophageal branches of left gastric artery

Venous Drainage

  • Left gastric vein → portal vein

  • Communicates with esophageal veins → azygos system (important porto-systemic anastomosis, site of varices in portal hypertension)

MRI Appearance

T1-weighted images:

  • Cardia wall appears intermediate signal intensity

  • Lumen signal depends on ingested contents (fluid → low, fat → high)

T2-weighted images:

  • Wall is low-to-intermediate signal, mucosa may appear slightly higher signal

  • Inflammation or edema appears as hyperintense thickening

STIR:

  • Suppresses fat, accentuating mucosal/submucosal edema, tumor infiltration, or inflammatory changes

T1 Fat-Saturated (Pre-contrast):

  • Cardia wall shows intermediate signal, stands out against suppressed fat planes of diaphragm and lesser omentum

T1 Fat-Saturated Post-Contrast (Gadolinium):

  • Normal gastric wall shows thin, uniform enhancement

  • Pathologies:

    • Cardia carcinoma → irregular, asymmetric, heterogeneous enhancement

    • Esophagitis/gastritis → circumferential smooth thickening and intense enhancement

MRI Non-Contrast 3D Imaging:

  • Provides volumetric assessment of cardia, GE junction, and diaphragmatic hiatus

  • Useful in hiatal hernia mapping and surgical planning

CT Appearance

CT Pre-Contrast:

  • Cardia seen as a soft-tissue structure below the diaphragm

  • Distended lumen may contain air, fluid, or ingested contrast for better delineation

CT Post-Contrast:

  • Wall enhances homogeneously in normal state

  • Pathological findings:

    • Cardia carcinoma: focal or circumferential irregular thickening with heterogeneous enhancement

    • Hiatal hernia: cardia herniates above diaphragm

    • GERD-related inflammation: smooth circumferential thickening

    • Varices: serpiginous enhancing structures around cardia in portal hypertension

CT images

Cardia (stomach) anatomy ct axial image

CT images

Cardia (stomach) anatomy ct coronal image

MRI images

Cardia (stomach) anatomy MRI coronal anatomy image -img-00000-00000