eRadiograph Volume 7: Imaging of Oral Cavity | Page 304
Introduction and Anatomy
This is a space lying deep in the neck surrounding the vertebral column extending from
the skull base to mediastinum. This space is enveloped by the deep cervical fascia
which separates it from the retropharyngeal space which is anterior to the perivertebral
space. This space consists of two components the perivertebral space and the
paraspinal space.
Content
The perivertebral space is mainly composed of muscles. The longus capitis and longus
colli muscles as well as the scalene muscles. The scalene muscles are important for
neck flexion, lateral bending and inspiration. Many nerves traverse this space – the
phrenic nerve is seen in the prevertebral space from C3 – C5, the dorsal scapular nerve
and the middle scalene muscle .The brachial plexus also traverses this space.
Paraspinal Space
The bulk is occupied by muscles. Splenis capitis, semisplenalis capitis, longissmus
capitis are the major extensors of the head and neck. The semi spinalis capitis, long
issmus capitis lies deep to the splenis capitus.
Longus Colli Tendinitis
This occurs due to rupture of calcium Hydroxy apatite deposits within longus Colli
tendon resulting in an inflammatory response – patients present with acute neck pain.
On imaging there is calcification in the longus capitus – colli tendinous insertions
usually at the C1/C2 level. There is associated oedema in the retropharyngeal space.
There is no enhancement, though the muscles may appear to be bulky in size.
Tumors of Osseous Origin
Metastatic Disease
Sclerotic areas are seen in prostate, bladder and carcinoid tumors.
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Perivertebral Space
Lemierre Syndrome
In this syndrome there is an acute oropharyngeal infection with secondary septic
thrombophlebitis in the internal jugular vein. Nearly always this is caused by
fusobacterium the infection starts as a pharyngitis and then spreads to the
parapharyngeal space, RPS, PVS There is thrombosis of the internal jugular vein. The
infection then spreads by the venous system to the rest of the body. The typical clinical
triad is pain, a tender swollen neck (due to IJV thrombosis) non cavitatory pulmonary
infiltrates due to metastatic septic thrombophlebitis on imaging there is evidence of
tonsillar/peritonsillar oedema, inflammation, abscess, IJV thrombosis septic metastases
elsewhere.