Sonography of the Cervical Vagus Nerve
Normal Appearance and Abnormal Findings
Francesco Giovagnorio1 and
Carlo Martinoli2
1
Cattedra di Radiologia, Università "La
Sapienza," Viale Regina Elena 324, 00161 Rome, Italy.
2
Cattedra di Radiologia "R," DICMI,
Università di Genova, Largo Rosanna Benzi 8,
16132 Genova, Italy.
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Fig. 1. —Drawing shows vagus nerve (arrows) inside major
neurovascular bundle, and behind common carotid artery (anteromedially) and
internal jugular vein (anterolaterally).
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Fig. 2A. —37-year-old man with no signs of vagal disease. Axial
sonogram (10 MHz) of left neurovascular bundle shows internal jugular vein
(IJV), common carotid artery (CCA), and vagus nerve (arrow). TR =
trachea.
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Fig. 2B. —37-year-old man with no signs of vagal disease. Sagittal
sonogram (10 MHz) shows vagus nerve (arrowheads) and internal jugular
vein (IJV).
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Fig. 2C. —37-year-old man with no signs of vagal disease. Axial
sonogram (15 MHz) of right neurovascular bundle shows vagus nerve
(arrow) with honeycomb appearance and two to four hypoechoic rounded
fascicles surrounded by hyperechoic epineurium.
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Fig. 2D. —37-year-old man with no signs of vagal disease. Sagittal
sonogram (15 MHz) clearly shows internal structure made of some hypoechoic
parallel fascicles separated by hyperechoic envelope
(arrowheads).
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Fig. 3A. —28-year-old woman with no signs of vagal disease. Axial
sonogram (7.5 MHz) of left neurovascular bundle at level of superior third of
thyroid shows vagus nerve in its normal position (arrow).
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Fig. 3B. —28-year-old woman with no signs of vagal disease. Axial
sonogram (7.5 MHz) at level of middle third of thyroid shows vagus nerve
crossing space between internal jugular vein and common carotid artery
(arrow).
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Fig. 3C. —28-year-old woman with no signs of vagal disease. Axial
sonogram (7.5 MHz) at level of inferior third of the thyroid shows vagus nerve
in abnormal anterior position (arrow).
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Fig. 4A. —15-year-old boy with type I neurofibromatosis and no signs of
vagal disease. Axial sonogram (10 MHz) of right neurovascular bundle at level
of superior third of thyroid shows multiple hypoechoic nodules
(asterisks and arrows) in neurovascular bundle displacing
internal jugular vein (IJV) externally and common carotid artery (CCA)
medially.
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Fig. 4B. —15-year-old boy with type I neurofibromatosis and no signs of
vagal disease. Longitudinal sonogram (10 MHz) clearly shows vagal origin of
two nodules (asterisks). Normal vagus nerve cranial to tumors is
indicated by arrowheads.
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Fig. 5. —45-year-old man with cough and dysphonia. Longitudinal
sonogram (7.5 MHz) of left vagus nerve shows hypoechoic nodule (T) arising
from nerve (arrowheads). Biopsy revealed neurinoma.
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Fig. 6A. —43-year-old man with cough, dysphonia, and biopsy-proven
chemodectoma. Axial sonogram (10 MHz) of right neurovascular bundle at level
of superior third of thyroid shows poorly defined tumor (T) (arrows)
inside neurovascular bundle that is displacing internal jugular vein (IJV) and
common carotid artery (CCA) anteriorly.
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Fig. 6B. —43-year-old man with cough, dysphonia, and biopsy-proven
chemodectoma. Longitudinal sonogram (10 MHz) clearly shows vagal origin of
tumor (T) (arrows). Normal vagus nerve cranial to tumor is indicated
by arrowheads. IJV = internal jugular vein.
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Fig. 6C. —43-year-old man with cough, dysphonia, and biopsy-proven
chemodectoma. CT scan at lower anatomic plane than A and B shows
calcified tumor (arrow) in anatomic location of vagus nerve, with
evident separation of common carotid artery from internal jugular vein.
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Fig. 7. —25-year-old woman with mild dysphagia. Longitudinal sonogram
(7.5 MHz) of right vagus nerve shows hypoechoic nodule (C) compressing vagus
nerve (arrowheads). Surgical excision revealed branchial cyst.
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Copyright © 2001 by the American Roentgen Ray Society.
