The peri-esophageal connective tissue layers andrelated compartments: visualization by histology andmagnetic resonance imaging

• T. J. Weijs ^[1] ; L. Goense ^[1] ; P. S. N. van Rossum ^[1] ; G. J. Meijer ^[1] ; A. L. H. M. W. van Lier ^[1] ; F. J. Wessels ^[1] ; M. N. G. Braat ^[1] ; I. M. Lips ^[1] ; J. P. Ruurda ^[1] ; M. A. Cuesta ^[2] ; R. van Hillegersberg ^[1] ; R. L. A. W. Bleys ^[1]
  1. [1] University Medical Center Utrecht Utrecht The Netherlands
  2. [2] Universiteit Medical Centre, Amsterdam, the Netherlands
• Localización: Journal of Anatomy, ISSN 0021-8782, Vol. 230, Nº. 2, 2017, págs. 262-271
• Idioma: inglés
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• Resumen

  • An organized layer of connective tissue coursing from aorta to esophagus was recently discovered in themediastinum. The relations with other peri-esophageal fascias have not been described and it is unclearwhether this layer can be visualized by non-invasive imaging. This study aimed to provide a comprehensivedescription of the peri-esophageal fascias and determine whether the connective tissue layer between aortaand esophagus can be visualized by magnetic resonance imaging (MRI). First, T2-weighted MRI scanning of thethoracic region of a human cadaver was performed, followed by histological examination of transverse sectionsof the peri-esophageal tissue between the thyroid gland and the diaphragm. Secondly, pretreatment motion-triggered MRI scans were prospectively obtained from 34 patients with esophageal cancer and independentlyassessed by two radiologists for the presence and location of the connective tissue layer coursing from aorta toesophagus. A layer of connective tissue coursing from the anterior aspect of the descending aorta to the leftlateral aspect of the esophagus, with a thin extension coursing to the right pleural reflection, was visualizedex vivo in the cadaver on MR images, macroscopic tissue sections, and after histologic staining, as well as onin vivo MR images. The layer connecting esophagus and aorta was named ‘aorto-esophageal ligament’ and thelayer connecting aorta to the right pleural reflection ‘aorto-pleural ligament’. These connective tissue layersdivides the posterior mediastinum in an anterior compartment containing the esophagus, (carinal) lymph nodesand vagus nerve, and a posterior compartment, containing the azygos vein, thoracic duct and occasionallylymph nodes. The anterior compartment was named ‘peri-esophageal compartment’ and the posteriorcompartment ‘para-aortic compartment’. The connective tissue layers superior to the aortic arch and at thediaphragm corresponded with the currently available anatomic descriptions. This study confirms the existenceof the previously described connective tissue layer coursing from aorta to esophagus, challenging the long-standing paradigm that no such structure exists. A comprehensive, detailed description of the peri-esophagealfascias is provided and, furthermore, it is shown that the connective tissue layer coursing from aorta toesophagus can be visualized in vivo by MRI