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Research ArticleHead & Neck

The Pharyngolaryngeal Venous Plexus: A Potential Pitfall in Surveillance Imaging of the Neck

P.M. Bunch, R.T. Hughes, E.P. White, J.R. Sachs, B.A. Frizzell and C.M. Lack
American Journal of Neuroradiology May 2021, 42 (5) 938-944; DOI: https://doi.org/10.3174/ajnr.A7033
P.M. Bunch
aFrom the Department of Radiology (P.M.B., E.P.W., J.R.S., C.M.L.), Wake Forest School of Medicine, Winston Salem, North Carolina
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  • ORCID record for P.M. Bunch
R.T. Hughes
bDepartment of Radiation Oncology (R.T.H., B.A.F.), Wake Forest School of Medicine, Winston Salem, North Carolina.
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E.P. White
aFrom the Department of Radiology (P.M.B., E.P.W., J.R.S., C.M.L.), Wake Forest School of Medicine, Winston Salem, North Carolina
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J.R. Sachs
aFrom the Department of Radiology (P.M.B., E.P.W., J.R.S., C.M.L.), Wake Forest School of Medicine, Winston Salem, North Carolina
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B.A. Frizzell
bDepartment of Radiation Oncology (R.T.H., B.A.F.), Wake Forest School of Medicine, Winston Salem, North Carolina.
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C.M. Lack
aFrom the Department of Radiology (P.M.B., E.P.W., J.R.S., C.M.L.), Wake Forest School of Medicine, Winston Salem, North Carolina
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Article Figures & Data

Figures

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  • FIG 1.
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    FIG 1.

    Transverse histopathologic section of the hypopharynx of a full-term fetus at the level of the cricoid cartilage shows the locations of the PCVP and the PPVP. Reproduced from Butler5 with permission from BMJ Publishing Group Ltd.

  • FIG 2.
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    FIG 2.

    Labeled (A) and unlabeled (B) axial neck CT images with contrast at the level of the cricoarytenoid joints in a patient without visible PLVP demonstrate the expected locations of the PCVP (asterisk, A) between the larynx anteriorly and the hypopharyngeal mucosa (dashed line, A) posteriorly, and the PPVP (pound sign, A) between the hypopharyngeal mucosa anteriorly and the inferior constrictor musculature (solid line, A) posteriorly. Axial neck CT images with contrast in 2 additional patients (C and D) demonstrate visible PCVP (arrows, C) and visible PPVP (arrows, D).

  • FIG 3.
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    FIG 3.

    Axial contrast-enhanced neck CT images obtained before (A and C) and after (B and D) definitive radiation therapy for laryngeal squamous cell carcinoma (arrow, A). Posttreatment images demonstrate a substantial decrease in size of the treated tumor (arrow, B) as well as prominent PCVP (circle, D) that was not definitively identifiable on the baseline pretreatment neck CT (circle, C). The prominent PCVP (circle, D) was described as suspicious for progressive neoplasm but confirmed to be vascular after 22 months of imaging follow-up.

  • FIG 4.
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    FIG 4.

    Axial contrast-enhanced neck CT images obtained in 3 different patients demonstrate representative images of the PCVP (arrows, A–C) at the cricoid cartilage level (A), the arytenoid cartilage level (B), and the supra-arytenoid level (C).

  • FIG 5.
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    FIG 5.

    Axial contrast-enhanced neck CT images in 3 different patients demonstrate representative examples of bilobed (arrows, A), dot-dash (arrows, B), and linear (arrows, C) PCVP morphology.

  • FIG 6.
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    FIG 6.

    Axial contrast-enhanced neck CT images in 3 different patients demonstrate representative examples of linear (arrows, A), dot-dash (arrows, B), and bilobed (arrows, C) PPVP morphology.

Tables

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    Table 1:

    Characteristics of the study groups

    Laryngeal CancerLymphomaP-Value
    Sex
        Male33 (67%)33 (67%)1.00
        Female16 (33%)16 (33%)
    Age (yr)
        Mean [SD]58.9 [11.0]58.9 [11.1]1.00
        Minimum2525
        Maximum8384
    Smoking history
        Yes47 (96%)26 (53%)<.001
        No2 (4%)23 (47%)
    Radiation dose (Gy)
        Median70.0NA
        Minimum64.0NA
        Maximum70.2NA
    Neck CTs
        Total222226
        Per patient (mean) (SD)4.5 (2.8)4.6 (2.7).88
        Minimum22
        Maximum1614
    Months of CT follow-upa
        Total10051835
        Mean (SD)20.5 (13.5)37.4 (31.4)<.001
        Minimum41
        Maximum59162
    • Note:—NA indicates not applicable.

    • ↵a For patients with laryngeal cancer, follow-up ended when either no more neck CTs were available or the patient underwent salvage laryngectomy.

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    Table 2:

    Visibility of PLVP within the study groups with respect to patient characteristics

    Laryngeal CancerLymphoma
    PLVP Visible?
    YesNoPYesNoP
    Sex
        Male2310.502310.29
        Female133142
    Age (yr)
        Mean [SD]58.4 [11.5]60.3 [10.0].6059.3 [11.6]57.6 [9.6].64
    Smoking history
        Yes34131.00179.10
        No20203
    Radiation dose (Gy)
        Median (range)70.0 (64.0–70)70.0 (65.3–70.2).26NANANA
    • Note:—NA indicates not applicable.

    • View popup
    Table 3:

    Visibility of PCVP within the study groups with respect to patient characteristics

    Laryngeal CancerLymphoma
    PCVP Visible?
    YesNoPYesNoP
    Sex
        Male2013.362310.29
        Female124142
    Age (yr)
        Mean [SD]57.3 [10.9]61.9 [10.8].1759.3 [9.6]57.6 [11.6].64
    Smoking history
        Yes3017.54179.10
        No20203
    Radiation dose (Gy)
        Median (range)70.0 (64.0–70)70.0 (65.3–70.2).57NANANA
    • Note:—NA indicates not applicable.

    • View popup
    Table 4:

    Visibility of PPVP within the study groups with respect to patient characteristics

    Laryngeal CancerLymphoma
    PPVP Visible?
    YesNoPYesNoP
    Sex
        Male12211.001023.01
        Female511115
    Age (yr)
        Mean [SD]59.0 [13.9]58.8 [9.3].9662.6 [10.9]56.1 [10.6].04
    Smoking history
        Yes16311.00818.09
        No111310
    Smoking history
        Median (range)70.0 (64.0–70)70.0 (65.3–70.2).06NANANA
    • Note:—NA indicates not applicable.

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American Journal of Neuroradiology: 42 (5)
American Journal of Neuroradiology
Vol. 42, Issue 5
1 May 2021
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The Pharyngolaryngeal Venous Plexus: A Potential Pitfall in Surveillance Imaging of the Neck
P.M. Bunch, R.T. Hughes, E.P. White, J.R. Sachs, B.A. Frizzell, C.M. Lack
American Journal of Neuroradiology May 2021, 42 (5) 938-944; DOI: 10.3174/ajnr.A7033

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The Pharyngolaryngeal Venous Plexus: A Potential Pitfall in Surveillance Imaging of the Neck
P.M. Bunch, R.T. Hughes, E.P. White, J.R. Sachs, B.A. Frizzell, C.M. Lack
American Journal of Neuroradiology May 2021, 42 (5) 938-944; DOI: 10.3174/ajnr.A7033
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