0:01

Hello, everyone.

0:01

It's Dr. Sidney Levy here.

0:02

4 00:00:04,430 --> 00:00:06,830 Today, I'd like to discuss level four

0:06

of the lymph node levels of the neck.

0:09

This is the lower internal

0:11

jugular or deep cervical chain.

0:15

I would like to demonstrate the boundaries and the

0:17

landmarks that you need to be aware of in order to

0:20

distinguish it from its surrounding levels, which are

0:24

level three, superiorly, level seven, inferiorly, level

0:33

five, posterolaterally, and level six, anteriorly

0:39

and medially.

0:41

So, using this pre-contrast T1 weighted imaging,

0:44

I swould like to demonstrate some landmarks for you.

0:48

Firstly, you need to be aware of the

0:50

superior and inferior boundaries.

0:53

The superior boundary is the inferior

0:55

border of the cricoid cartilage.

0:57

The cricoid cartilage is this structure

1:01

here, so the inferior boundary is there.

1:05

The inferior boundary of level 4

1:07

is the clavicle and adjacent,

1:11

manubrium, or suprasternal notch.

1:14

So I have the manubrium on this slice here,

1:18

so anything above that, we are in level 4.

1:21

Level 7 is there, and level 3 is here.

1:30

On the axial projection, we need to be familiar with

1:34

the posterior margin of sternocleidomastoid. But at this point, we also need to be

1:39

aware of the scalenus anterior muscles on each side.

1:45

The boundary between level 5 laterally and posteriorly

1:51

and level 4 is an oblique line drawn through the

1:56

posterior border of sternocleidomastoid and the

2:00

posterolateral border of scalenus anterior, like so.

2:06

Anything

2:08

posterolateral to that is within level 5B.

2:14

Anything medial and anterior to that

2:17

is within level 4 at this level.

2:21

The only other thing to remember is that sometimes

2:24

there are lymph nodes which are in the anterior

2:27

compartment, in the vicinity of the thyroid gland.

2:31

These are within level 6, and you just need to

2:34

remember that the boundary between levels 3 and 4

2:37

laterally and level 6 medially and anteriorly is

2:43

the medial border of the common carotid artery.

2:47

So I'll just show you that.

2:49

So that gives us level 4.

2:55

In our next vignette, we will discuss level 5.

3:00

Thank you.

Cervical Lymph Nodes Level 4

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0:01

Hello, everyone.

0:01

It's Dr. Sidney Levy here.

0:02

4 00:00:04,430 --> 00:00:06,830 Today, I'd like to discuss level four

0:06

of the lymph node levels of the neck.

0:09

This is the lower internal

0:11

jugular or deep cervical chain.

0:15

I would like to demonstrate the boundaries and the

0:17

landmarks that you need to be aware of in order to

0:20

distinguish it from its surrounding levels, which are

0:24

level three, superiorly, level seven, inferiorly, level

0:33

five, posterolaterally, and level six, anteriorly

0:39

and medially.

0:41

So, using this pre-contrast T1 weighted imaging,

0:44

I swould like to demonstrate some landmarks for you.

0:48

Firstly, you need to be aware of the

0:50

superior and inferior boundaries.

0:53

The superior boundary is the inferior

0:55

border of the cricoid cartilage.

0:57

The cricoid cartilage is this structure

1:01

here, so the inferior boundary is there.

1:05

The inferior boundary of level 4

1:07

is the clavicle and adjacent,

1:11

manubrium, or suprasternal notch.

1:14

So I have the manubrium on this slice here,

1:18

so anything above that, we are in level 4.

1:21

Level 7 is there, and level 3 is here.

1:30

On the axial projection, we need to be familiar with

1:34

the posterior margin of sternocleidomastoid. But at this point, we also need to be

1:39

aware of the scalenus anterior muscles on each side.

1:45

The boundary between level 5 laterally and posteriorly

1:51

and level 4 is an oblique line drawn through the

1:56

posterior border of sternocleidomastoid and the

2:00

posterolateral border of scalenus anterior, like so.

2:06

Anything

2:08

posterolateral to that is within level 5B.

2:14

Anything medial and anterior to that

2:17

is within level 4 at this level.

2:21

The only other thing to remember is that sometimes

2:24

there are lymph nodes which are in the anterior

2:27

compartment, in the vicinity of the thyroid gland.

2:31

These are within level 6, and you just need to

2:34

remember that the boundary between levels 3 and 4

2:37

laterally and level 6 medially and anteriorly is

2:43

the medial border of the common carotid artery.

2:47

So I'll just show you that.

2:49

So that gives us level 4.

2:55

In our next vignette, we will discuss level 5.

3:00

Thank you.

Report

Description

Faculty

Sidney Levy, PhD, MBBS

Radiologist and Nuclear Medicine Specialist

I-MED

Lesson

Oral Cavity Anatomy

Lesson

Oral Cavity Staging of Squamous Cell Malignancy

Lesson

Lymph Node Levels of the Neck

Lesson

Oropharynx

Lesson

Hypopharynx

Lesson

Larynx

Lesson

Sinonasal

Lesson

Perineural Tumor Spread

Cervical Lymph Nodes Level 4