Imaging of spaces of neck and mediastinum by endoscopic ultrasound

Abstract

Endoscopic ultrasound (EUS) of the mediastinum was pioneered by gastroenterologists, and it was taken up by pulmonologists when the smaller-diameter endobronchial ultrasound (EBUS) scope was designed after a few years. The pulmonologists’ approach remained largely confined to entry from the trachea, but they soon realized that the esophagus was an alternative route of entry by the EBUS scope. The new generations of interventionists are facing the challenge of learning two techniques (EUS and EBUS) from two routes (esophagus and trachea). The International Association for the Study of Lung Cancer (IASLC) proposed a classification of mediastinal lymph nodes at different stations that lie within the boundaries of specific spaces. These interventionists need clear definitions of landmarks and clear techniques to identify the spaces. There are enough descriptions of spaces of the neck and the mediastinum in the literature, yet the topic mentioned above has never been discussed separately. The anatomical structures, landmarks, and boundaries of spaces will be important to interventionists in the near future during performances of endosonography. This article combines the baseline anatomy of the spaces with the actual imaging during EUS.

Investigation of the Electric Handpiece-related Pneumomediastinum and Cervicofacial Subcutaneous Emphysema in Third Molar Surgery

“…The infrahyoid region includes the visceral, anterior cervical, and posterior cervical spaces. Both the suprahyoid and infrahyoid regions comprise the carotid, retropharyngeal, perivertebral, and danger spaces 22,23) . The neck consists of two layers of fascia, the superficial and deep layers.…”

Practical approach to linear EUS examination of the mediastinum

“…The IASLC classification defines a total LN stations numbered from 1 to 14. Station 1 is within the root of the neck, Stations 2–9 are within the mediastinum, and Stations 10–14 are within the hila and along the bronchi in the lung parenchyma[ 2 3 ] LNs that lie adjacent to the esophagus or centrally located vessels can be visualized by EUS. LNs seen by EUS include:…”

The Anatomical Relationships of the Tongue with the Body System

“…The deep cervical fascia extends from the hyoid bone to the upper mediastinum, continuing along its path toward the visceral, anterior cervical, posterior cervical, carotid, retropharyngeal, and perivertebral spaces [12]. For fascial continuity, the tongue is connected to the strap muscles and the sternocleidomastoid muscle and to the musculature acting on the thoracic outlet [12-13]. The tongue can change its shape and produce different actions working as a hydrostat; all the muscular components, in direct or indirect contact with the tongue, respond with proper contractile tonus to allow the tongue to work properly, thanks to the complex organization of the central and peripheral nervous system [14-15].…”

“…The tongue position changes with emotions and state of mind, thus becoming an instrument for psychological observation; usually, an anterior tongue placement occurs with a feeling of fear [13]. The multidisciplinary collaboration between the different professional profiles is fundamental to obtaining an appropriate therapeutic effect.…”