Penetrating Neck Injuries

Penetrating neck injuries are usually evaluated in zones. 

• Zone I: 
• extends from the sternal notch to the cricoid cartilage
• contents - branches of the inominate artery and brachiocephalic veins, branches of subclavian arteries and veins, common carotid and vertebral arteries, trachea, esophagus, thyroid
• Zone II:
• extends from the cricoid cartilage to the angle of the mandible
• contents - common, internal, and external carotid arteries, larynx, upper esophagus, pharynx
• most commonly surgically explored
• Zone III: 
• extends from the angle of the mandible to the base of the skull
• contents - internal cartoid, vertebral, and branches of the external carotid arteries, internal jugular vein, pharynx

Due to the various vascular structures in each of the zones, CTA is often used to evaluate neck trauma. 

The above images are from a patient with bilateral penetrating neck injuries (note the subcutaneous and intramuscular emphysema). The second image shows the bifurcation of the left common carotid artery (arrowhead). In more cephlad images, the left internal carotid artery is not opacified (arrowhead, third image). Surgical exploration demonstrated a Zone II injury to the left common carotid artery as well as to the left internal jugular vein.

REFERENCES

Nunez DB, Torres-Leon M, Munera F. Vascular injuries of the neck and thoracic inlet: helical CT-angiographic correlation. Radiographics 2004;24:1087-98.

Steenburg SD, Sliker CW, Shanmuganathan K, et al. Imaging evaluation of penetrating neck injuries. Radiographics 2010;30:869-86.