Location of the Hypochondriac Region
The hypochondriac region is located in the upper lateral abdomen, directly below the ribs on either side—specifically, the right hypochondriac region lies beneath the right costal margin, and the left hypochondriac region lies beneath the left costal margin.
Anatomical Boundaries
Right Hypochondriac Region
- The right hypochondriac area is positioned in the right upper quadrant, extending from the midclavicular line to the anterior axillary line, beneath the right costal margin 1.
- This region contains the liver, which serves as the primary anatomical landmark and provides a sonographic window for examination 1, 2.
- When examining this area, the probe is typically placed in a subcostal location in the mid-clavicular line, or via an intercostal approach between the mid-clavicular and posterior axillary lines 1.
Left Hypochondriac Region
- The left hypochondriac area is located in the left upper quadrant, also known as the perisplenic region, positioned beneath the left costal margin 1.
- This region contains the spleen, which provides a more limited sonographic window compared to the liver on the right side 1.
- Clinical examination may reveal a palpable spleen below the left sub-costal margin in pathological conditions 3.
- The posterior intercostal approach is utilized extensively in this region, often requiring probe placement on the posterior axillary line or more posteriorly to avoid gas-filled structures 1.
Clinical Relevance
Pain Localization
- Right hypochondriac pain is associated with liver and biliary tract pathology, with positive likelihood ratios ranging from 2.17 to 4.14 4.
- Left hypochondriac tenderness may indicate splenic pathology, such as splenic infarction or splenomegaly 3.
- Gas-forming liver abscesses can present with right hypochondriac and epigastric pain 5.
Examination Technique
- The hypochondriac regions are best examined with patients taking a deep breath and holding it, which facilitates visualization of structures beneath the costal margins 1, 6.
- Physical examination has limited accuracy, with sensitivity of only 60% and specificity of 44% for detecting organomegaly, making imaging confirmation essential 6.