The gastric cardia is well known for its importance in harboring carcinoma and for the common difficulty of its clear roentgen delineation. Variations and benign influences may closely resemble the more dangerous lesion. The collection of cases presented here comprises only that material which is rare in our experience or quite new to us. An attempt has been made not to display obvious or common lesions or effects. Some of this has been shown to consultants of great experience, so that the commonplace would be eliminated and the unusual might be identified by broader knowledge. These discussions have been most valuable, although some of the apparently normal variants deserve yet further recording and confirmation. The normal organ relations are shown in Figure 1: the right lobe of the liver, the left lobe, the small rectangular caudate lobe that at some time we suspected might cause the defect to be shown later, the gastrohepatic omentum attaching to the lesser curve of the stomach, and the spleen. For comparison, 4 carcinomas are shown in Figure 2. These resemble: Figure 2, A, some splenic defects we have seen; B, the 2 cases of normal variants shown in Figure 10; C, the liver cyst shown in Figure 3, B; and D, the spleen shown in Figure 4, A. 1. The Liver (Fig. 3): In Figure 3, A, a case of advanced cirrhosis with marked liver enlargement displacing and constricting the cardia is shown; Figure 3, B demonstrates a large benign cyst of the liver creating an irregular defect by adhesion, duplicating that due to the carcinoma of Figure 2, C so far as we could determine; Figure 3, C shows a far advanced neuroblastoma of the liver in a child, again displacing the cardia and causing fixation. 2. The Spleen: Since the normal spleen rarely creates a pressure defect on the stomach, enlargement is nearly always a prerequisite for displacement and deformity of the cardia. Such changes occur for the most part in cases of blood dyscrasia in our experience. Diagnosis is usually not too difficult, but we have been wrong in two or three instances. Figure 4, A shows a large lymphomatous spleen creating pinching of the cardia. The appearance is much like that of the cancer in Figure 2, D. Figure 4, B is a carcinomatous splenomegaly. 3. The Heart: Our first indication that the enlarged heart was a factor in differentiation came at fluoroscopy. The left ventricle normally rests upon the left side of the diaphragm, and immediately below is the cardiac-fundal portion of the stomach. One of the important aids in estimating the size of the left ventricle without an opaque medium is to observe its pulsation against the air bubble in the stomach while the patient is erect. Figure 5, A demonstrates the moderate impression of a slightly large left ventricle. Such small defects may be more difficult to evaluate than larger ones like those shown in Figures 5, B 1 and 2 and Figure 6. Fluoroscopy is irnportant in studying the slight changes.