The aortic arch space is the concave inferior aspect of the aortic arch creating the aortopulmonary window — the mediastinal space between the transverse aortic arch and the left pulmonary artery. This space contains lymph nodes, the left recurrent laryngeal nerve, and the ductus arteriosus ligament.
The aortopulmonary window lymph nodes (level 5) are the primary drainage for left upper lobe lung cancer and are accessed via mediastinoscopy or VATS for staging. Left recurrent laryngeal nerve palsy from aortic arch aneurysm or left upper lobe tumour is caused by nerve compression in this space. The ligamentum arteriosum in this space is the site of traumatic aortic transection in deceleration injuries.
Enlarged lymph nodes in the aortic arch space from lung cancer, lymphoma, or sarcoidosis producing left recurrent laryngeal nerve palsy and hoarseness, accessed by mediastinoscopy or VATS for tissue diagnosis.
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