Retropharyngeal, Danger, and Paraspinal Spaces Keivan Shifteh, MD, FACR Professor of Clinical Radiology Director of Head & Neck Imaging Program Director, Neuroradiology Fellowship Montefiore Medical Center Albert Einstein College of Medicine Bronx, New York Acknowledgment • Illustrations Courtesy Amirsys, Inc. Retropharyngeal, Danger, and Paraspinal Spaces • Although diseases affecting these spaces are relatively uncommon, they can result in significant morbidity. • Because of the deep location of these spaces within the neck, lesions arising from these locations are often inaccessible to clinical examination but they are readily demonstrated on CT and MRI. • Therefore, cross-sectional imaging plays an important role in the evaluation of these spaces. • It is a potential space traversing supra- & infrahyoid neck. Retropharyngeal Space (RPS) • It is seen as a thin line of fat between the pharyngeal constrictor muscles anteriorly and the prevertebral muscles posteriorly. Retropharyngeal Space (RPS) • It is bounded anteriorly by the MLDCF (buccopharyngeal fascia), posteriorly by the DLDCF (prevertebral fascia), and laterally by sagittaly oriented slips of DLDCF (cloison sagittale). Retropharyngeal Space (RPS)
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Shifteh Retropharyngeal Danger and Paraspinal Spaces …ventral to the longus colli muscles between the carotid sheath. Retropharyngeal nodes • Retropharyngeal nodes are normally
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Retropharyngeal, Danger, and
Paraspinal Spaces
Keivan Shifteh, MD, FACR
Professor of Clinical Radiology
Director of Head & Neck Imaging
Program Director, Neuroradiology Fellowship
Montefiore Medical Center
Albert Einstein College of Medicine
Bronx, New York
Acknowledgment
• Illustrations Courtesy Amirsys, Inc.
Retropharyngeal, Danger, and
Paraspinal Spaces
• Although diseases affecting these spaces are
relatively uncommon, they can result in
significant morbidity.
• Because of the deep location of these spaces
within the neck, lesions arising from these
locations are often inaccessible to clinical
examination but they are readily demonstrated
on CT and MRI.
• Therefore, cross-sectional imaging plays an
important role in the evaluation of these spaces.
• It is a potential space traversing supra- & infrahyoid neck.
Retropharyngeal Space (RPS)
• It is seen as a thin line of fat between the pharyngeal
constrictor muscles anteriorly and the prevertebral
muscles posteriorly.
Retropharyngeal Space (RPS)
• It is bounded anteriorly by the MLDCF (buccopharyngeal
fascia), posteriorly by the DLDCF (prevertebral fascia), and
laterally by sagittaly oriented slips of DLDCF (cloison sagittale).
Retropharyngeal Space (RPS)
• Coronally oriented slip of DLDCF (alar fascia) extends from
the medial border of the carotid space on either side and
divides the RPS into 2 compartments:
Alar fascia (AF)
Scali F et al. Annal Otol
Rhinol Laryngol. 2015
May 19.
• The anterior compartment is true or proper RPS and the
posterior compartment is danger space.
Retropharyngeal Space
• The true RPS extends from the clivus inferiorly to a variable
level between the T1 and T6 vertebrae where the alar fascia
fuses with the visceral fascia to obliterate the true RPS.
Retropharyngeal Space
• The danger space extends further inferiorly into the posterior
mediastinum just above the diaphragm.
• Danger space is named as such because it provides a conduit
for spread of infection from the pharynx to the mediastinum.
Danger Space (DS)
• In suprahyoid RPS a median raphe which is a weak midline
fascia may sometimes be seen (~50%) separating the true
RPS into two lateral compartments (spaces of Gillette),
preventing spread of disease from crossing midline.
Median Raphe • The normal contents of the suprahyoid RPS include adipose
tissue, fibroareolar tissue, small vessels, and lymph nodes,
whereas the infrahyoid RPS contains only adipose tissue,
thus, can be involved only by non-nodal disease.
• Only areolar connective tissue is present between the alar
and prevertebral fasciae (danger space).
Contents of the RPS and DS
Retropharyngeal nodes • The suprahyoid retropharyngeal nodes are divided into medial
and lateral groups.
• The medial group of nodes is not consistently present and is
situated close to the midline.
• The lateral group, also known as the nodes of Rouvière, lies
ventral to the longus colli muscles between the carotid sheath.
Retropharyngeal nodes • Retropharyngeal nodes are normally present in children and
then atrophy in puberty. Small nodes may be present in two-
thirds of asymptomatic adults.
• Normal RP nodes should be less than 6-8 mm in diameter in
adult.
• Retropharyngeal lymphadenopathy is a radiological
diagnosis as these nodes cannot be palpated.
• The retropharyngeal nodes drain the nasopharynx,