Vertebral Levels

Question 1

What does the mnemonic RAT PLANT stand for?

Answer 1

Vertebral level T4 (Thoracic plane aka plane of Ludwig) contents:

Rib 2
Aortic arch
Tracheal bifurcation (carina)

Pulmonary trunk
Ligamentum arteriosum
Azygous vein drains into superior vena cava (SVC)
Nerves
-> Loop of recurrent laryngeal nerves
-> Parasympathetic: contributes to the cardiopulmonary plexuses
-> Sympathetic: branches of the cardiopulmonary splanchnic nerves
Thoracic duct moves from right-to-left

Question 2

What does CLAP TRAP stand for?

Answer 2

Vertebral level T4 (Thoracic plane aka plane of Ludwig) contents.

Cardiac plexus
Ligamentum arteriosum
Aortic arch (inner concavity)
Pulmonary trunk

Tracheal bifurcation (carina)
Right-to-left movement of the thoracic duct posterior to the oesophagus
Azygous vein drains into superior vena cava (SVC)
Pre-vertebral fascia and pre-tracheal fascia end

Question 3

What’s at the C3 level?

Answer 3

Body of hyoid bone

Question 4

What’s at the C4 level?

Answer 4

Bifurcation of common carotid artery

Superior border of thyroid cartilage

Question 5

What’s at the C5 level?

Answer 5

Upper border of the thyroid gland

Question 6

What’s at the C6 level?

Answer 6

Cricoid Cartilage
Trachea begins (end of larynx)
Oesophagus begins (end of pharynx)
Inferior thyroid artery crosses posterior to thyroid sheath
Middle cervical sympathetic ganglion behind inferior thyroid artery
Inferior laryngeal nerve enters the larynx
Vertebral artery enter the transverse foramen of C6

Question 7

What’s at the C7 level?

Answer 7

Thoracic duct reaches its greatest height
Isthmus of thyroid gland
Vertebra prominens
Stellate ganglion

Question 8

What’s at the T1 level?

Answer 8

Lower border of thyroid gland

Highest point of lung apex

Question 9

What’s at the T2 level?

Answer 9

Sternoclavicular joint
Superior angle of scapula
Suprasternal notch / Jugular notch

Question 10

What’s at the T3 level?

Answer 10

Medial end / Base of spine of scapula

End of oblique fissure of lung posteriorly

Question 11

What’s at the T4 level?

Answer 11

Thoracic Plane / Plane of Ludwig
Sternal Angle of Louis
Division between superior and inferior mediastinum

RAT PLANT
CLAP TRAP

Question 12

What’s at the T5 level?

Answer 12

Upper border of the heart

Question 13

What’s at the T7 level?

Answer 13

Inferior angle of scapula

Question 14

What’s at the T8 level?

Answer 14

Inferior Vena Cava (IVC) hiatus of diaphragm

Terminal branches of right phrenic nerve

Question 15

What’s at the T9 level?

Answer 15

Xiphisternal junction

Lower border of heart

Question 16

What’s at the T10 level?

Answer 16

Oesophageal hiatus of the diaphragm
Right and left vagus nerves
Oesophageal branches of left gastric artery/vein
Xiphoid process

Question 17

What’s at the T12 level?

Answer 17

Aortic hiatus of the diaphragm: Aorta, Azygous Vein, Thoracic Duct
Upper border of the kidneys

Question 18

What’s at the L1 level?

Answer 18

Transpyloric plane / Addison’s plane
Midpoint between jugular notch and pubic symphysis
Tip of 9th costal cartilage

Pylorus of stomach
D1 part of the duodenum
Duodeno-jejunal flexure
Root of the transverse mesocolon
Hepatic flexure of the colon
Splenic flexure of the colon
Fundus of the gallbladder
Neck of the pancreas
Hila of the kidneys (supine)
-> left: above
-> right : below
Position of renal pelvis
Renal arteries originate
-> left: above
-> right : below
Celiac artery originates just above
Hilum of the spleen
Termination of the spinal cord and superior portion  of the conus medullaris
Origin of superior mesenteric artery (SMA)
Splenic vein traverses behind pancreas and joins superior mesenteric vein (SMV) to form the portal vein
Cisterna chyli
Liver

Question 19

What’s at the L2 level?

Answer 19

Renal veins
Thoracic duct begins
Azygos and hemiazygos veins begin
Ligament of Treitz (upper border)

Question 20

What’s at the L3 level?

Answer 20

Subcostal plane
Through tenth costal cartilage

Inferior Mesenteric Artery branches of the abdominal aorta
Lowest point of the costal margin
Lowest border of the kidneys
Umbilicus
Spinal cord ends in infants

Umbilicus plane / Transumbilical plane

One of the most common sites for causes of chronic lower back pain

Question 21

What’s at the L4 level?

Answer 21

Supracristal plane
Through the highest point of the iliac crest

Bifurcation of the abdominal aorta into left and right common iliac arteries
Inferior Vena Cava (IVC) begins

Question 22

What’s at the L5 level?

Answer 22

Transtubercular plane
Passes through the iliac tubercles, small elevations found in the iliac crest of the iliac bone

Inferior vena cava formed (convergence of right and left common iliac veins)
Continuation of caecum as ascending colon

Question 23

What’s at the S1 level?

Answer 23

Sacral promontory

Question 24

What’s at the S2 level?

Answer 24

Posterior superior iliac spine
Sacral dimples
Dural sac terminates
Middle of sacroiliac joint

Question 25

What’s at the S3 level?

Answer 25

Posterior inferior iliac spine

End of sigmoid colon -> rectum starts

Question 26

What’s at the S4 level?

Answer 26

Sacral hiatus

Vertebral column ends

Question 27

What’s at the C2 level?

Answer 27

Superior cervical ganglion

Question 28

What’s at the C1 level?

Answer 28

Spinal root of accessory nerve crosses transverse process of atlas