Jugular Notch of Sternum

incisura jugularis sterni

The jugular notch (suprasternal notch) is the concave superior margin of the manubrium sterni, palpable in the midline at the base of the neck between the two clavicular heads of the sternocleidomastoid. It lies at the level of the lower border of the second thoracic vertebra (T2). The brachiocephalic veins and the top of the superior vena cava lie immediately posterior to it, and the trachea and oesophagus are palpable at this level.

Region: Chest

Clinical Relevance

Clinical Notes

The jugular notch is a critical landmark for multiple clinical procedures: central venous line placement via the subclavian or internal jugular routes targets the SVC just posterior to the notch; thoracic outlet syndrome is assessed by palpating the scalene triangle adjacent to the notch; and the notch is the reference for the sternal angle (angle of Louis, 5 cm inferior) which marks the carina level and the second rib attachment. In resuscitation, sternotomy starts from the sternal notch. Substernal goitre and thyroid masses descend into the notch, causing tracheal compression.

Pathology

Common Injuries & Conditions

Substernal Goitre Notch Compression

A large goitre descending below the jugular notch into the superior mediastinum compresses the trachea and brachiocephalic veins within the thoracic inlet, producing stridor, dyspnoea on raising the arms (Pemberton sign), and dysphagia managed by thyroidectomy often via a cervical approach alone.