Non-neoplastic pathology at the crossroads between neck imaging and cardiothoracic imaging

Abstract

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, vascular, lymphatic, neurologic, and endocrine systems. A detailed examination of this region is essential when reviewing neck and thoracic imaging. This article will discuss the normal anatomic boundaries of the thoracic inlet and present an image-rich systematic discussion of the non-neoplastic pathology that can occur in this region. The neoplastic pathology of the thoracic inlet will be covered in a companion article.

Neoplastic pathology at the crossroads between neck imaging and cardiothoracic imaging

“…Because most of these lesions are found incidentally, the ACR has published a consensus for management of incidental thyroid nodules, which gives guidelines about which nodules need further follow up and which do not. They established the 3 tiers that depict the need of further evaluation: (1) high-risk imaging characteristics including a suspicious lymph nodes measuring 1.5 cm short axis, local invasion, and/or PET avid nodule; (2) nodule measuring > 1 cm in a patient younger than 35 years; (3) and nodules > 1.5 cm in a patient older than 35 years of age. Patients that meet any of these criteria should have a dedicated thyroid ultrasound for further evaluation [49].…”

“…This article presents an image rich systematic discussion of the neoplastic pathology that can occur in this region focusing on a system-based 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 ]. …”

Thoracic Inlet in Cervical Spine CT of Blunt Trauma Patients: Prevalence of Pathologies and Importance of CT Interpretation

“…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 ].…”