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Topic

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Cardia of stomach

The cardia is the most proximal region of the stomach, located immediately distal to the gastroesophageal junction. It is the area where the esophagus empties into the stomach and surrounds the internal cardiac orifice. Unlike other gastric regions, the cardia is relatively small and lacks distinct anatomical borders but is defined functionally as the transition zone between esophageal squamous epithelium and gastric columnar mucosa (the Z-line). Its primary role is to act as a passage for ingested food and to contribute to prevention of gastroesophageal reflux.

Synonyms

  • Gastric cardia

  • Cardiac orifice of stomach

  • Proximal stomach region

Function

  • Serves as the entry point of food and liquids into the stomach

  • Provides part of the anti-reflux mechanism in conjunction with the lower esophageal sphincter and diaphragmatic crura

  • Secretes mucus to protect esophageal mucosa from gastric acid exposure

  • Acts as a functional transition zone between esophagus and stomach

Arterial Supply

  • Supplied mainly by the left gastric artery (branch of the celiac trunk)

  • Additional contributions from esophageal branches of the thoracic aorta

  • Minor supply from the short gastric arteries in some individuals

Venous Drainage

  • Drains via the left gastric vein, which empties into the portal vein

  • Also communicates with the esophageal venous plexus, forming part of the portosystemic anastomoses (site of esophageal varices in portal hypertension)

Nerve Supply

  • Parasympathetic innervation: via the vagus nerves (CN X) through the esophageal plexus

  • Sympathetic innervation: via the celiac plexus and greater splanchnic nerves

  • These regulate motility, mucous secretion, and tone of the gastroesophageal junction

MRI Appearance

T1-weighted images:

  • Lumen contains air (signal void, black) or fluid (low signal)

  • Gastric wall shows intermediate signal intensity

  • Perigastric fat is bright hyperintense, providing natural contrast

T2-weighted images:

  • Gastric wall shows intermediate to slightly hyperintense signal

  • Fluid-filled lumen is bright hyperintense, air remains signal void

  • Inflammation or edema of the cardia appears as hyperintense wall thickening

STIR (Short Tau Inversion Recovery):

  • Fat suppression improves visualization of wall edema, inflammation, or infiltration

  • Normal cardia wall is low signal; pathology appears bright hyperintense

T1 Post-Contrast (Gadolinium-enhanced):

  • Normal gastric wall shows homogeneous mucosal enhancement

  • Pathological changes (tumor, inflammation, ulceration) demonstrate heterogeneous or asymmetric enhancement

CT Appearance

Non-contrast CT:

  • Appears as a soft tissue density region at the gastroesophageal junction

  • Lumen contains air (black) or fluid (soft tissue density)

  • Wall thickening may be detected in pathology

Contrast-enhanced CT (CECT):

  • Normal cardia wall enhances homogeneously

  • Carcinomas, ulcers, and inflammation appear as asymmetric or irregular thickening with enhancement

  • Best modality for evaluating tumors, varices, and extrinsic compression

MRI images

Cardia of stomach anatomy MRI axial image -img-00000-00000

MRI images

Cardia of stomach anatomy MRI coronal image -img-00000-00000

CT image

Cardia of stomach anatomy CT axial image -img-00000-00000