Cervical Lymph Nodes Level 4
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Hello, everyone.
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It's Dr. Sidney Levy here.
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4 00:00:04,430 --> 00:00:06,830 Today, I'd like to discuss level four
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of the lymph node levels of the neck.
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This is the lower internal
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jugular or deep cervical chain.
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I would like to demonstrate the boundaries and the
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landmarks that you need to be aware of in order to
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distinguish it from its surrounding levels, which are
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level three, superiorly, level seven, inferiorly, level
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five, posterolaterally, and level six, anteriorly
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and medially.
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So, using this pre-contrast T1 weighted imaging,
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I swould like to demonstrate some landmarks for you.
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Firstly, you need to be aware of the
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superior and inferior boundaries.
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The superior boundary is the inferior
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border of the cricoid cartilage.
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The cricoid cartilage is this structure
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here, so the inferior boundary is there.
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The inferior boundary of level 4
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is the clavicle and adjacent,
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manubrium, or suprasternal notch.
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So I have the manubrium on this slice here,
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so anything above that, we are in level 4.
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Level 7 is there, and level 3 is here.
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On the axial projection, we need to be familiar with
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the posterior margin of sternocleidomastoid. But at this point, we also need to be
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aware of the scalenus anterior muscles on each side.
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The boundary between level 5 laterally and posteriorly
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and level 4 is an oblique line drawn through the
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posterior border of sternocleidomastoid and the
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posterolateral border of scalenus anterior, like so.
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Anything
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posterolateral to that is within level 5B.
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Anything medial and anterior to that
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is within level 4 at this level.
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The only other thing to remember is that sometimes
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there are lymph nodes which are in the anterior
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compartment, in the vicinity of the thyroid gland.
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These are within level 6, and you just need to
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remember that the boundary between levels 3 and 4
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laterally and level 6 medially and anteriorly is
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the medial border of the common carotid artery.
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So I'll just show you that.
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So that gives us level 4.
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In our next vignette, we will discuss level 5.
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Thank you.
Sidney Levy, PhD, MBBS
Radiologist and Nuclear Medicine Specialist
I-MED
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