1380 



CLINICAL AND TOPOGRAPHICAL ANATOMY 



organs lie much higher and nearer to the vertebrae than is usually supposed to be 

 the ^case, the upper two-thirds of the right and all the left kidney being behind 

 the ribs. Relatively to the vertebrae, the kidneys lie along the sides of the last 

 thoracic and the first three lumbar. 



To mark them in from the front the following points should be noted: The upper extremity 

 of the right should reach as high up as the seventh costal cartilage, the left up to the sixth, on 

 either side close to the costo-chondral and inter-chondral junctions. This level will corre- 

 spond to one half way between the sterno-xiphoid and transpyloric lines. The lower end, 



Fig. 1110. — Renal Fascia, as seen in Cross-section. 



Aorta and vena cava 



Anterior layer of renal fascia 



Peritoneum 

 Posterior layer of renal fascia 



about 11 cm. (4^ in.) below this point, would be opposite to the subcostal line; that of the right 

 kidney is usually lower, and may encroach upon the umbilical line. For practical purposes 

 the hilus is opposite a point on the anterior abdominal wall, a finger's breadth medial to the tip 

 of the ninth costal cartilage (Stiles), or the junction of the transpyloric and lateral vertical 

 lines. The importance of the relation of the last rib has been mentioned at p. 1245. The 

 lateral vertical line has one-third of the kidney to its lateral side, and two-thirds to its medial 

 side. The shortest distance between the two kidneys, obliquely placed so as to be closer above, 

 'at the upper part of their medial borders' (Thane and Godlee), measures about 6.2 cm. (2^ in.). 

 On the posterior surface of the body the kidney's boundaries are indicated by the following: 

 — (1) A line parallel with, and 2.5 cm. (1 in.) from, the mid-line, between the lower edge of the tip 



Fig. 1111. — Renal Fascia, as seen in Sagittal Section. 



. Lung 

 Diaphragm 



Posterior layer of renal fascia 



Ilium 



Suprarenal gland 



Kidney 



ii »^^^ il "if"^?i — Anterior layer of renal fascia 



of the spinous process of the eleventh thoracic and the lower edge of the spinous process of the 

 third lumbar vertebra; (2) and (3) lines drawn from the top and l)ottom of this line laterally, 

 at right angles to it, for 7 cm. (2 J in.); (4) a line parallel to the first, and connecting the ex- 

 tremities of (2) and (3). Within this parallelogram the kidney lies (Morris). 



The chief relations of the kidneys are: — posteriorly — quadratus lumborum, 

 psoas, diaphragm, last thoracic, ilio-hypogastric, and ilio-inguinal nerves. The 

 twelfth rib lies behind both, the right, as a rule, not reaching above the upper 

 border. The left often reaches the eleventh rib. The pleural rellcction usually 

 crosses the twelfth ril) obli(iuoly rcacliing below its neck. Anteriorly — The 

 liver, right colic flexure and second part of the duodenum (figs. 950 and 1009), on 



