{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:17:55Z","timestamp":1787735875599,"version":"build-2784847793"},"reference-count":36,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: The suprasternal notch (SN) is the conventional landmark for front-of-neck airway access and anterior cervical surgery, yet the great vessels may extend to or above it. To our knowledge, no previous study has jointly classified the aortic arch (AA), brachiocephalic trunk (BCT), left brachiocephalic vein (LBCV), and sternoclavicular joint (SCJ) configuration relative to the SN in a single adult cohort. Methods: In this single-centre retrospective study, 100 consecutive adult computed tomography angiography (CTA) studies were reviewed. Using a horizontal SN reference plane, the AA, BCT, and LBCV were each graded as mediastinal, cervicomediastinal, or cervical\/high-riding; the bilateral SCJ manubrial joining grade was scored on four levels and integrated into three categories (mild, clear, marked). Two observers independently classified all cases (weighted Cohen kappa = 0.89). Associations were assessed with Spearman correlation and chi-square tests. Results: The BCT was the most variable structure, cervical\/high-riding in 49% and reaching or crossing the SN in 64%; the AA and LBCV were cervical\/high-riding in 3% and 5%, respectively. Complete SCJ manubrial joining was absent in all cases, and the integrated SN space was marked in 15% of cases. Cervical\/high-riding BCT was more frequent in women (63.5% vs. 33.3%; p = 0.005). Five of six pairwise correlations remained significant after Benjamini\u2013Hochberg adjustment, with the strongest association for AA\u2013BCT (rho = 0.406). Conclusions: The BCT was the principal great vessel extending to or above the SN in this cohort, whereas cervical\/high-riding AA and LBCV were uncommon. The SN-referenced classification provides a reproducible descriptive framework for this topography. These findings represent cohort frequencies rather than population-based prevalence estimates, and their potential procedural relevance requires prospective validation.<\/jats:p>","DOI":"10.3390\/diagnostics16172724","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:11:15Z","timestamp":1787731875000},"page":"2724","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Major Vessels of the Interclavicular Suprasternal Space: A Suprasternal Notch-Referenced Topographic Classification with Potential Procedural Relevance"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1464-5021","authenticated-orcid":false,"given":"Ionu\u021b M\u0103d\u0103lin","family":"Munteanu","sequence":"first","affiliation":[{"name":"Clinic of Anaesthesia and Intensive Care, Institute for Cardiovascular Diseases of Timi\u0219oara, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300310 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelina Maria","family":"Jianu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Department of Radiology and Medical Imaging, Emergency Clinical Municipal Hospital of Timi\u0219oara, 300254 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4655-4574","authenticated-orcid":false,"given":"R\u0103zvan Costin","family":"Tudose","sequence":"additional","affiliation":[{"name":"Division of Anatomy, Department 1, Faculty of Dentistry, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8723-0540","authenticated-orcid":false,"given":"Mugurel Constantin","family":"Rusu","sequence":"additional","affiliation":[{"name":"Division of Anatomy, Department 1, Faculty of Dentistry, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra Diana","family":"Vrapciu","sequence":"additional","affiliation":[{"name":"Division of Anatomy, Department 1, Faculty of Dentistry, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0122-2436","authenticated-orcid":false,"given":"George","family":"Triantafyllou","sequence":"additional","affiliation":[{"name":"Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4831-8005","authenticated-orcid":false,"given":"Maria","family":"Piagkou","sequence":"additional","affiliation":[{"name":"Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iulian","family":"Brezean","sequence":"additional","affiliation":[{"name":"Discipline of General Surgery and Qualified Care in Surgical Specialties, Department of Specific Disciplines, Faculty of Midwifery and Nursing, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of General Surgery, \u201cDr. Ion Cantacuzino\u201d Clinical Hospital, 030167 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1007\/s00256-009-0689-7","article-title":"Variations in normal sternoclavicular joints; a retrospective study to quantify SCJ asymmetry","volume":"38","author":"Tuscano","year":"2009","journal-title":"Skelet. Radiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1007\/s00276-026-03924-9","article-title":"Concurrent thyroid ima artery, high-riding brachiocephalic trunk, and supreme intercostal artery in thoracic vertebral artery configuration: A computed tomography angiography case report","volume":"48","author":"Rusu","year":"2026","journal-title":"Surg. Radiol. Anat."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s00276-026-03937-4","article-title":"Segmental vertebral artery agenesis with deep cervical reconstitution in a cervicothoracic variant cluster","volume":"48","author":"Rusu","year":"2026","journal-title":"Surg. Radiol. Anat."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1016\/j.bja.2018.07.013","article-title":"Prevalence of major vessels anterior to the trachea at sites of potential front-of-neck emergency airway access in adults","volume":"121","author":"Weightman","year":"2018","journal-title":"Br. J. Anaesth."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.ijscr.2019.04.007","article-title":"Anatomical variation of the trajectory of the brachiocephalic artery encountered during parathyroid adenoma excision. A rare case report and a surgical challenge","volume":"58","author":"Zarokosta","year":"2019","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1097\/RCT.0b013e3181888343","article-title":"Variants and anomalies of thoracic vasculature on computed tomographic angiography in adults","volume":"33","author":"Berko","year":"2009","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"231","DOI":"10.4250\/jcvi.2022.0058","article-title":"Aortic Arch Variants and Anomalies: Embryology, Imaging Findings, and Clinical Considerations","volume":"30","author":"Bae","year":"2022","journal-title":"J. Cardiovasc. Imaging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"176","DOI":"10.3348\/kjr.2009.10.2.176","article-title":"Congenital anomalies of the aortic arch: Evaluation with the use of multidetector computed tomography","volume":"10","author":"Turkvatan","year":"2009","journal-title":"Korean J. Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Baudo, M., Varrica, A., Reali, M., Saracino, A., Carminati, M., Frigiola, A., Giamberti, A., and Lo Rito, M. (2023). Cervical aortic arch in the pediatric population: A meta-analysis of individual patient\u2019s data. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1266956"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Gaeta, G., Fesslova, V., Villanacci, R., Morano, D., Candiani, M., Pozzoni, M., Papale, M., Spinillo, S.L., Chiarello, C., and Cavoretto, P.I. (2022). Prenatal Diagnosis and Postnatal Outcomes of Left Brachiocephalic Vein Abnormalities: Systematic Review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11071805"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"110758","DOI":"10.1016\/j.clinimag.2026.110758","article-title":"CTA of the adult native aorta: Everything you wanted to know (but were never told)","volume":"133","author":"Vaz","year":"2026","journal-title":"Clin. Imaging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41073-019-0064-8","article-title":"SANRA\u2014A scale for the quality assessment of narrative review articles","volume":"4","author":"Baethge","year":"2019","journal-title":"Res. Integr. Peer Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2202","DOI":"10.1016\/j.jtcvs.2019.03.143","article-title":"Surgical repair of cervical aortic arch: An alternative classification scheme based on experience in 35 patients","volume":"159","author":"Zhong","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1053\/j.jvca.2024.03.041","article-title":"Clinical Presentation and Management of the Cervical Aortic Arch in the Adult Population: A Review of Case Reports","volume":"38","author":"Baudo","year":"2024","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2716","DOI":"10.1161\/CIRCULATIONAHA.107.755264","article-title":"Images in cardiovascular medicine. The cervical aortic arch: A rare vascular anomaly","volume":"117","author":"Poellinger","year":"2008","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e210195","DOI":"10.1148\/ryct.2021210195","article-title":"Cervical Aortic Arch with Hypoplastic Left Common Carotid Artery and Subaortic Left Brachiocephalic Vein","volume":"3","author":"Yahaya","year":"2021","journal-title":"Radiol. Cardiothorac. Imaging"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1148\/114.3.675","article-title":"The cervical aortic arches","volume":"114","author":"Haughton","year":"1975","journal-title":"Radiology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1007\/s11845-022-03196-3","article-title":"Anatomical variation in the branching pattern of the aortic arch: A literature review","volume":"192","author":"Murray","year":"2023","journal-title":"Ir. J. Med. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.jvs.2017.06.097","article-title":"A systematic review and meta-analysis of variations in branching patterns of the adult aortic arch","volume":"68","author":"Popieluszko","year":"2018","journal-title":"J. Vasc. Surg."},{"key":"ref_21","first-page":"1541","article-title":"Bovine aortic arch variant in humans: Clarification of a common misnomer","volume":"27","author":"Layton","year":"2006","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1016\/j.jtcvs.2015.02.019","article-title":"Atypical aortic arch branching variants: A novel marker for thoracic aortic disease","volume":"149","author":"Dumfarth","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e032963","DOI":"10.1161\/JAHA.123.032963","article-title":"Association of Bovine Arch Anatomy with Incident Stroke After Transcatheter Aortic Valve Replacement","volume":"13","author":"Alarouri","year":"2024","journal-title":"J. Am. Heart Assoc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/j.otohns.2004.09.075","article-title":"Abnormally high bifurcation of the brachiocephalic trunk as a potential operative hazard: Case report","volume":"133","author":"Racic","year":"2005","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"221802","DOI":"10.1136\/bcr-2017-221802","article-title":"High-riding brachiocephalic (innominate) artery during surgical tracheostomy","volume":"2018","author":"Dalati","year":"2018","journal-title":"BMJ Case Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"79","DOI":"10.5535\/arm.20057","article-title":"Unusual Pharyngo-Esophageal Dysphagia Caused by a High-Riding Right Brachiocephalic Artery","volume":"45","author":"Park","year":"2021","journal-title":"Ann. Rehabil. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"100433","DOI":"10.1016\/j.opresp.2025.100433","article-title":"Stridor and Respiratory Failure as Presentation of a Aneurysm of the Brachiocephalic Trunk Mimicking a Mediastinal Tumor","volume":"7","year":"2025","journal-title":"Open Respir. Arch."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"E96","DOI":"10.1002\/hed.28148","article-title":"Bilateral Thyroid Ima Arteries Arising from the Brachiocephalic Trunk: A First Case Report","volume":"47","author":"Wang","year":"2025","journal-title":"Head Neck"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"51","DOI":"10.5644\/ama2006-124.402","article-title":"The Brachiocephalic Trunk Variant Origin and High-Riding Course: Two Cadaveric Cases","volume":"52","author":"Tsakotos","year":"2023","journal-title":"Acta Med. Acad."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3878","DOI":"10.1007\/s12070-023-03944-6","article-title":"High-Riding Inominate Artery: Challenge During Tracheostomy","volume":"75","author":"Saniasiaya","year":"2023","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/j.jemermed.2015.12.002","article-title":"Evaluation of the Aortic Arch from the Suprasternal Notch View Using Focused Cardiac Ultrasound","volume":"50","author":"Kinnaman","year":"2016","journal-title":"J. Emerg. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3004","DOI":"10.1016\/j.radcr.2024.04.032","article-title":"Flowreversal in the left internal jugular vein due to a prominent brachiocephalic trunk: A case report","volume":"19","author":"Tennigkeit","year":"2024","journal-title":"Radiol. Case Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1002\/ca.22768","article-title":"Ultrasound-guided central venous catheterization: A review of the relevant anatomy, technique, complications, and anatomical variations","volume":"30","author":"Hoffman","year":"2017","journal-title":"Clin. Anat."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"51","DOI":"10.5603\/FM.a2016.0031","article-title":"Anomalous left brachiocephalic vein: Important vascular anomaly concomitant with congenital anomalies and heart diseases","volume":"76","author":"Kahkouee","year":"2017","journal-title":"Folia Morphol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"448","DOI":"10.4103\/0028-3886.158265","article-title":"A rare case of an aberrant innominate vein causing posttracheostomy haemorrhage","volume":"63","author":"Naik","year":"2015","journal-title":"Neurol. India"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2309499019879213","DOI":"10.1177\/2309499019879213","article-title":"Aberrant left brachiocephalic vein is a contraindication for anterior cervicothoracic approach","volume":"27","author":"Ong","year":"2019","journal-title":"J. Orthop. Surg."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/17\/2724\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:22:03Z","timestamp":1787732523000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/17\/2724"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":36,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16172724"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16172724","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]}}}