The aortopulmonary window is a small space in the mediastinum that lies below the arch of the aorta and above the left pulmonary artery. It contains fat, the ligamentum arteriosum, lymph nodes and the left recurrent laryngeal nerve as it hooks around the aorta.
| Location | Superior mediastinum, between the arch of the aorta above and the left pulmonary artery below |
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A landmark space on chest imaging and in surgery; enlarged nodes here can compress the left recurrent laryngeal nerve and cause hoarseness.
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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