Cross-sectional Imaging Anatomy and Pathologic Conditions Affecting Thoracic Nerves

Cummings, Kristopher W.; Sridhar, Sreevathsan; Parsons, Matthew S.; Javidan-Nejad, Cylen; Bhalla, Sanjeev

doi:10.1148/rg.2017160071

Cited by 13 publications

(6 citation statements)

References 41 publications

(40 reference statements)

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“…The vagus nerve traverses the esophageal hiatus. The retrocrural space contains the sympathetic nerve trunks that run in the paravertebral region along the spine (34).…”

Section: Neural and Perineural Pathologic Conditionsmentioning

confidence: 99%

Routes of Transdiaphragmatic Migration from the Abdomen to the Chest

et al. 2020

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The diaphragm serves as an anatomic border between the abdominal and thoracic cavities. Pathologic conditions traversing the diaphragm are often incompletely described and may be overlooked, resulting in diagnostic delays. Several routes allow abdominal contents or pathologic processes to spread into the thorax, including along normal transphrenic structures, through congenital defects in the diaphragm, through inherent areas of weakness between muscle groups, or by pathways created by tissue destruction, trauma, or iatrogenic injuries. A thorough knowledge of the anatomy of the diaphragm can inform an accurate differential diagnosis. Often, intraperitoneal pathologic conditions crossing the diaphragm may be overlooked if axial imaging is the only approach to this complex region because of the horizontal orientation of much of the diaphragm. Multiplanar capabilities of volumetric CT and MRI provide insight into the pathways where pathologic conditions may traverse this border. Knowledge of these characteristic routes and use of multiplanar imaging are critical for depiction of specific transdiaphragmatic pathologic conditions. © RSNA, 2020 • radiographics.rsna.org

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“…The vagus nerve traverses the esophageal hiatus. The retrocrural space contains the sympathetic nerve trunks that run in the paravertebral region along the spine (34).…”

Section: Neural and Perineural Pathologic Conditionsmentioning

confidence: 99%

Routes of Transdiaphragmatic Migration from the Abdomen to the Chest

et al. 2020

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“…Cummings et al and Scholtemeijer et al support this belief, noting that, in esophagectomies, the left RLN is most at risk during cervical esophageal dissection. 7,16 Other authors also suggest a higher right or left RLN injury during esophagectomy. 17,18 Further lymph node dissection, a general requirement for esophageal cancer resection, may place the RLN in danger of injury during robotic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…There is significant interest in understanding the anatomy of RLNs given potential surgical complications, namely vocal cord mobility. 4,[6][7][8][9][10] Unfortunately, there is a lack of intraoperative understanding of right and left RLN comparative positioning. 4 After measuring the RLN distance from the third tracheal ring, Liu et al concluded that although differences were found between males and females, live patients and cadavers, there was no statistically significant difference in the distances of the right and left RLNs.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive Comparison of Right and Left Recurrent Laryngeal Nerves in the Tracheoesophageal Groove

Herr

Cottrell

Kahl

et al. 2020

Innovations�(Phila)

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Objective A left-sided cervical approach to esophageal mobilization is considered safer given the perceived oblique path and more lateral orientation of the right recurrent laryngeal nerve (RLN) in the tracheoesophageal groove. Given the risk of recurrent laryngeal nerve, the current study investigated if there are differences in right and left RLN location in the tracheoesophageal groove. Methods Right and left RLNs were carefully exposed in human cadavers. Comparison of location was determined at tracheal rings 2, 4, and 6 using 3 parameters: depth of the RLN from the anterior margin of the tracheal ring, lateral distance of the RLN from the posterior margin of the tracheal ring, and distance of the RLN to the anterior midline trachea following the curvature of the trachea. Statistical analysis was used to determine differences between the right and left sides. Results Compared with the right RLN, the left RLN was slightly over 1 mm deeper at the second tracheal ring. Despite this trend, there was no significant difference in RLN location between individual sides or as an aggregate for any of the 3 parameters at tracheal rings 2, 4, or 6. Conclusions Careful characterization of RLN location precludes avoiding hoarseness, aphonia, and vocal cord paralysis. Counter to common surgical perception and educational beliefs, this study demonstrated that right and left RLN anatomical courses do not significantly differ along the trachea. Therefore, ensnarement on either side during a blind mobilization of the cervical esophagus is equally likely to occur.

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“…Thereafter, it crosses lateral on the left side of the aortic arch. Bilaterally, the phrenic nerves pass anterior to the hilum of the lung above the pericardium; at the level of the corresponding diaphragm, both phrenic nerves then divide into multiple terminal branches (1).…”

Section: Surgical Anatomymentioning

confidence: 99%

Iatrogenic phrenic nerve palsy

Whiteley¹,

Shoeib²,

Rocco³

2021

Shanghai Chest

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Iatrogenic phrenic nerve injury is an issue that all thoracic surgeons will be called to tackle during their career. Injury of the phrenic nerve leads to paralysis of the hemidiaphragm, which can result in a spectrum of symptom severity from asymptomatic to disabling shortness of breath. It can result from any operation requiring dissection close to its anatomical pathway from the neck to the diaphragm, but is also at risk with interventional procedures within its vicinity, such as cardiac ablation techniques. Injury can range from complete, irreversible transection of the nerve to neuropraxia with temporary nerve dysfunction. Due to this the timing of intervention is individual to each patient. Symptoms may range from mild to severe and from typical to aspecific. Confirmation of diagnosis is accomplished with a combination of static (CXR, CT) and dynamic imaging (ultrasound, fluoroscopy). The presence of other co-morbidities such as obesity, heart conditions or obstructive airways disease potentially contributing to the same symptoms, makes relative contribution of each difficult to ascertain and may increase surgical risks. A careful risk/benefit assessment, as well as the optimisation of these underlying conditions prior to treatment is paramount. Treatment options include minimally invasive diaphragmatic plication as well as nerve repair techniques. We hereby give an overview of the relevant anatomy and aetiology of iatrogenic phrenic nerve injury, as well as of the diagnostic work-up and different therapeutic options, with a focus on diaphragmatic plication, nerve repair and treatment timing.

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Cross-sectional Imaging Anatomy and Pathologic Conditions Affecting Thoracic Nerves

Cited by 13 publications

References 41 publications

Routes of Transdiaphragmatic Migration from the Abdomen to the Chest

Routes of Transdiaphragmatic Migration from the Abdomen to the Chest

Comprehensive Comparison of Right and Left Recurrent Laryngeal Nerves in the Tracheoesophageal Groove

Iatrogenic phrenic nerve palsy

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