1. The document describes the five deep neck spaces: anterior visceral space, carotid space, retropharyngeal space, posterior cervical space, and perivertebral space. 2. Each space is defined by its anatomical boundaries and contents, which can include viscera, blood vessels, nerves, lymph nodes, and pathologies such as tumors, infections, cysts. 3. CT and MRI images are presented to illustrate normal anatomy as well as various diseases found within the deep neck spaces, such as abscesses, aneurysms, lymphadenopathy, tumors.

1. Head & Neck
Deep Neck Spaces

2. Mohamed Zaitoun
Assistant Lecturer-Diagnostic Radiology
Department , Zagazig University Hospitals
Egypt
FINR (Fellowship of Interventional
Neuroradiology)-Switzerland
zaitoun82@gmail.com

5. Knowing as much as
possible about your enemy
precedes successful battle
and learning about the
disease process precedes
successful management

6. Deep Neck Spaces
1-Anterior Visceral Space
2-Carotid Space
3-Retropharyngeal Space
4-Posterior Cervical Space
5-Perivertebral Space

7. 1-Visceral space :
-Central compartment containing
several viscera like the larynx,
thyroid, hypopharynx and cervical
esophagus
2-Carotid space :
-Paired space just lateral to the visceral
compartment which contains the internal
carotid artery, internal jugular vein and
several neural structures
3-Retropharyngeal space :
-A small virtual space containing only fat
continuous with the suprahyoid space and
the middle mediastinum
4-Posterior Cervical Space :
-Paired space posterolateral to the carotid
space
-It contains fat, lymph nodes and neural
elements
5-Perivertebral space :
-This large space completely
encircles the vertebral body including
the pre- and paravertebral muscles

8. 1-Anterior Visceral Space :
a) Extension :
From the hyoid to the anterior mediastinum
& doesn’t extend into the suprahyoid
space

9. b) Contents :
1-Larynx (Laryngocele, SCC & Chondrosarcoma)
2-Hypopharynx / Esophagus (Zenker’s
diverticulum & SCC)
3-Trachea (Carcinoma & Benign stenosis)
4-Thyroid Gland
5-Parathyroid
6-Embryonal remnants (Thyroglossal cyst , 3rd
Branchial cyst)
7-Paratracheal lymph nodes (Mets, Lymphoma)
8-Recurrent laryngeal nerve paralysis

11. Laryngocele Types
Internal External Combined

12. Glottic SCC, axial contrast CT image shows a glottis mass in the left true cord
reaching the anterior commissure (black asterisk), mild thickening of
posterior commissure is noted (thick black arrow) with sclerosis of left
arytenoid and left lamina of thyroid cartilage

13. Advanced SCC, axial CT+C shows a left cord mass (thin white arrows)
reaching anterior commissure (asterisk), note the sclerosis of the
left thyroid lamina and left cricoarytenoid joint (thin black arrows)

14. Zenker’s diverticulum

15. Cancer esophagus

16. CXR (a) shows an upper right paratracheal opacity narrowing the tracheal
lumen (arrow) , CT+C (b) confirms the eccentric lobulated soft tissue mass
that origins from the right anterolateral tracheal wall and narrows the lumen
of the upper trachea , coronal MPR image at mediastinal window setting (c)
better depicts the entire extent of the lesion

17. Mediastinal mass arising from the posterolateral wall of the trachea (a
characteristic feature) with invasion of mediastinal fat and
esophagus , Cystic adenoid carcinoma

18. Multinodular goiter Strap muscles on right side (yellow arrow) and
presumed position of strap muscles on the left (blue arrow)

19. Multinodular goiter with intrathoracic extension

20. Medullary thyroid carcinoma in a 32-year-old man, (a) Transverse
sonogram of the right lobe of the thyroid shows a large nodule with
coarse calcification and posterior acoustic shadowing (arrows),
(b) Axial CT shows the nodule with an internal focus of coarse
calcification (arrows)

21. Anaplastic thyroid carcinoma in an 84-year-old woman, (a) Transverse
sonogram of the left lobe of the thyroid shows an advanced tumor
with infiltrative posterior margins (arrows) and invasion of
prevertebral muscle, (b) Axial CT+C shows a large tumor that has
invaded the prevertebral muscle (arrows)

23. Axial CT images in noncontrast (A) early post-contrast (B) and delayed post-
contrast (C) phases demonstrate an intrathyroidal lesion with subtle
hypodensity on precontrast imaging and delayed enhancement, this
enhancement pattern is seen less commonly than early enhancement and
washout

24. A 63-year-old woman with primary hyperparathyroidism, CT demonstrates
avidly enhancing lesions in the orthotopic superior location (arrows)
bilaterally with rapid washout of contrast greater than that of the adjacent
thyroid gland (A and D: noncontrast phase; B and E: initial postcontrast
“arterial” phase; C and F: delayed postcontrast phase), this patient
underwent bilateral exploration, and bilateral superior parathyroid adenomas
were found at surgery

25. Thyroid ectopia associated with the hyoid bone in three patients, (a) Axial CT+C of a 36-
year-old man shows a thyroglossal duct cyst (arrowhead) intimately involved with the
anterior aspect of the hyoid bone (black arrow); normal fat is preserved in the
preepiglottic space (white arrow), (b, c) Sagittal (b) and axial (c) CT+C of a 49-year-
old man depict a thyroglossal duct cyst that conforms to the embryologic course of
the thyroglossal duct (magenta line in b), both anterior and posterior to the hyoid
bone, and compresses the preepiglottic fat (arrow), (d) Axial CT+C image of a 28-
year-old woman shows ectopic thyroid tissue in the same position as in c, appearing
both anterior and posterior to the hyoid bone

26. Paramedian thyroglossal duct cyst

27. Third branchial cleft cyst, CT+C at the level of the thyroid cartilage
reveals a large, well-defined, nonenhancing, water attenuation mass
(m) deep to the right sternocleidomastoid muscle (s), medially
displacing the common carotid artery and internal jugular vein

28. Axial view of CT scan of the chest (mediastinal windows) showing an
enlarged left paratracheal lymph node in the aortopulmonary
window (arrow)

29. Specific imaging characteristics of vocal cord paralysis (right side),
a Widening of the right laryngeal ventricle (arrow), b Medial
deviation and thickening of the right aryepiglottic fold (arrow),
c Dilatation of the right piriform sinus (arrow)

30. Left RLN palsy, axial CT scan obtained at the level of the hypopharynx
during quiet respiration shows left RLN palsy, note the distention of
the ipsilateral piriform fossa with air (*) and the medially rotated,
thickened ipsilateral aryepiglottic fold (arrow)

31. 2-Carotid Space :
a) Extension :
-From skull base to the aortic arch
-It traverses the suprahyoid & infrahyoid
b) Contents :
1-Carotid artery (Aneurysm, Thrombosis, Dissection)
2-IJV (Thrombosis)
3-Cranial Nerves (9-12), schwannoma & neurofibroma
4-Lymph nodes (IJV chain of nodes), mets & lymphoma
5-Embryologic remnants : 2nd
Branchial cleft cyst
6-Sympathetic Plexus : Paraganglioma (Carotid body
tumor)

33. Carotid aneurysm, (a) Non-contrast-enhanced axial CT shows a round
soft tissue density mass in the right carotid space is seen, (b) CT+C
shows a round mass showing homogeneous enhancement is seen
in the right carotid space, (c) CT+C, coronal multiplanar reformation
(MPR) shows the right internal carotid fusiform aneurysm and its top
and bottom continuity with the internal carotid artery are shown

34. Thrombosis of IJV

35. Thrombosis of jugular vein

36. Thrombosis of the left internal jugular vein

37. Paraganglioma : T1+C at the level of the supraglottic larynx

38. Paraganglioma, (a) T1-weighted non-contrast MR, (b)
CT+C

39. IJV lymph nodes, T- Thyroid gland, CA- Carotid Artery, IJV- Internal
Jugular Vein, SCM- Sternocleidomastoid mu

40. 2nd
branchial cleft cyst

41. Carotid body tumor

42. 3-Retropharyngeal Space :
a) Extension :
-Posterior potential midline space extends
superiorly to the base of the skull & inferiorly to
the posterior mediastinum at the level of the
tracheal bifurcation (T3 level)
b) Contents :
1-Retropharyngeal abscess
2-Fat (Lipoma & Liposarcoma)
3-Lymph Nodes (Mets ,infection & Lymphoma)

44. Retropharyngeal abscess in a 3-year-old girl with fever and throat pain,
(a) Lateral neck radiograph shows diffuse prevertebral soft tissue
swelling (arrows), (b) CT+C demonstrates a mildly enhancing, thick-
walled retropharyngeal fluid collection (arrow), these findings are
indicative of an abscess

45. Retropharyngeal abscess, CT+C shows a large retropharyngeal fluid
collection (arrows) with peripheral rimlike enhancement

46. Retropharyngeal lipoma

47. Axial CT+C of the skull base at the level of the hard palate shows an
enhancing right lateral retropharyngeal lymph node (asterisk) and 2
enhancing left superficial parotid masses

48. 4-Posterior Cervical Space :
-Contents :
1-Fat
2-Cranial nerve XI (schwannoma, neurofibroma)
3-Brachial plexus :
-Schwannoma, neurofibroma
-Direct invasion of apical lung (Pancoast tumor), breast
carcinoma & lymphoma
4-Primitive Embryonic Lymph sacs (Cystic hygroma)
5-Lymph nodes (Lymphoma, metastases, TB)

50. Lipoma, The mass has the signal intensity of fat on a T1 (a) and the
signal is completely suppressed with fat suppression (b)

51. Cystic hygroma, axial CT+C show low-attenuation insinuating cystic
mass (arrows) in the posterior triangle of left side of neck in a 3
month old child

52. Lymphangioma

53. Lymphoma, CT image at the level of the hyoid bone shows multiple
rounded lesions medial to the sternocleidomastoid muscles and
dorsal to the internal jugular veins, these bilateral multiple lesions
are located in the posterior cervical space

54. 5-Perivertebral Space :
-Contents :
1-Spine (OM, Tumors)
2-Paraspinous muscles (Myositis, abscess ,
sarcoma, fibromatosis)
3-Brachial plexus
4-Vertebral artery

56. Sarcoma, large soft tissue mass adjacent to the vertebral
body centered in the perivertebral space

57. Benign fibrous tumor, T1+C

58. Vertebral artery dissection, high signal in the location of the right
vertebral artery (click image for arrow), consistent with dissection

59. Vertebral artery dissection, T1 fat-saturated axial images show a dissection of
the right vertebral artery between C1 and the foramen magnum, (A) T1
signal hyperintensity surrounding the right vertebral artery (upper arrow) as
the artery courses between the posterior arch of C1 and the foramen
magnum, the lower arrow points to hyperintensity in a different portion of the
artery, indicating slow flow or occlusion, (B) The arrow points to a right
vertebral artery hyperintensity, indicating slow flow or occlusion