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Aberrant right subclavian artery. Axial (a) CT image demonstrating aberrant right subclavian artery (arrow) coursing posterior to the esophagus (asterisk) and trachea (triangle). b 3D model demonstrating the distal take-off the aberrant right subclavian artery (arrow) from the aortic arch
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The thoracic inlet is located at the crossroads between imaging of the neck and chest. It represents an important anatomic landmark, serving as the central conducting pathway for many vital structures extending from the neck into the chest and vice versa. Many important body systems are located within this region, including the enteric, respiratory...
Context in source publication
Context 1
... to the trachea in the Raider triangle. An esophagram in the lateral view will show an oblique posterior impression on the esophagus. Both CT and MR can be easily used to demonstrate a right subclavian artery branch arising distal to the left subclavian artery origin from the aortic arch and coursing posterior to the trachea and esophagus (Fig. 5). ...
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Citations
... A cervical incision is performed, extending downwards to the upper mediastinum. The neurovascular structures are identified in the neck and followed inferiorly into the upper thorax [62]. The RLN is identified in the tracheoesophageal groove [63,64]. ...
Introperative nerve monitoring (IONM) of the recurrent laryngeal nerve (RLN) is a well-established technique to aid in thyroid/parathyroid surgery. However, there is little evidence to support its use in non-thyroid or non-parathyroid surgery. The aim of this paper was to review the current evidence regarding the use of IONM in non-thyroid/non-parathyroid surgery in the head and neck and thorax. A literature search was performed from their inception up to January 2024, including the term “recurrent laryngeal nerve monitoring”. IONM in non-thyroid/non-parathyroid surgery has mainly been previously described in oesophageal surgery and in tracheal resections. However, there is little published evidence on the role of IONM with other resections in the vicinity of the RLN. Current evidence is low-level for the use of RLN IONM in non-thyroid/non-parathyroid surgery. However, clinicians should consider its use in surgery for pathologies where the RLN is exposed and could be injured.
... Defined as the junction between the neck and the chest, the thoracic inlet is considered an "edge" of a series of images in the computed tomography (CT) of the cervical spine that can be easily overlooked [1]. The thoracic inlet contains several vital structures including lung apices, pleural spaces and superior mediastinum [1][2][3]. ...
... Defined as the junction between the neck and the chest, the thoracic inlet is considered an "edge" of a series of images in the computed tomography (CT) of the cervical spine that can be easily overlooked [1]. The thoracic inlet contains several vital structures including lung apices, pleural spaces and superior mediastinum [1][2][3]. These structures may be injured in an acutely traumatized patient, resulting in significant pathologies such as pneumothorax, pneumomediastinum, mediastinal hematoma, pulmonary contusion and fractures [4]. ...
... Cervical spine CT is the recommended imaging in blunt-trauma patients suspected of having cervical spine injuries according to the ATLS protocol [8,9]. This examination typically covers the skull base to T1 or T2 vertebrae, and is therefore inclusive of many structures within the thoracic inlet, such as bones, pleurae and lung apices [1,10,11]. A few previous investigations have reported a high prevalence of incidental CT findings on trauma cervical spine CT [4,12,13]. ...
Background:
The thoracic inlet of blunt trauma patients may have pathologies that can be diagnosed on cervical spine computed tomography (CT) but that are not evident on concurrent portable chest radiography (pCXR). This retrospective investigation aimed to identify the prevalence of thoracic inlet pathologies on cervical spine CT and their importance by measuring the diagnostic performance of pCXR and the predictive factors of such abnormalities.
Methods:
This investigation was performed at a level-1 trauma center and included CT and concurrent pCXR of 385 consecutive adult patients (280 men, mean age of 47.6 years) who presented with suspected cervical spine injury. CT and pCXR findings were independently re-reviewed, and CT was considered the reference standard.
Results:
Traumatic, significant nontraumatic and nonsignificant pathologies were present at 23.4%, 23.6% and 58.2%, respectively. The most common traumatic diagnoses were pneumothorax (12.7%) and pulmonary contusion (10.4%). The most common significant nontraumatic findings were pulmonary nodules (8.1%), micronodules (6.8%) and septal thickening (4.2%). The prevalence of active tuberculosis was 3.4%. The sensitivity and positive predictive value of pCXR was 56.67% and 49.51% in diagnosing traumatic and 8.89% and 50% in significant nontraumatic pathologies. No demographic or pre-admission clinical factors could predict these abnormalities.
Conclusions:
Several significant pathologies of the thoracic inlet were visualized on trauma cervical spine CT. Since a concurrent pCXR was not sensitive and no demographic or clinical factors could predict these abnormalities, a liberal use of chest CT is suggested, particularly among those experiencing high-energy trauma with significant injuries of the thoracic inlet. If chest CT is not available, a meticulous evaluation of the thoracic inlet in the cervical spine CT of blunt trauma patients is important.
... This article presents an image rich systematic discussion of the neoplastic pathology that can occur in this region focusing on a systembased approach using different imaging modalities, including plain film, computed tomography (CT), magnetic resonance (MR), and ultrasound (US) imaging. The anatomy of the thoracic inlet, review of imaging modalities, and the non-neoplastic pathology of the thoracic inlet have been covered in our companion article [1]. ...
The thoracic inlet is located at the crossroads between imaging of the neck and the chest. Its location is an important anatomic landmark, serving as the central conducting pathway for many vital structures extending from the neck into the chest and vice versa. Many critical body systems, including the respiratory, lymphatic, neurologic, enteric, musculoskeletal, endocrine, and vascular systems, are located within this region. Neoplasms, both benign and malignant, can arise in any of the body systems located in this area. Due to the small size of this anatomic location, pathology is easily overlooked and imagers should be aware of the imaging appearance of these neoplasms, as well as which imaging modality is the most appropriate for neoplasm evaluation. This article will present an image rich, system-based discussion of the neoplastic pathology that can occur in this region. The anatomy of the thoracic inlet and the non-neoplastic pathology of the thoracic inlet have been covered in our companion article.
