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Jugular notch

The jugular notch, also known as the suprasternal notch, is the superior concave depression located at the upper border of the manubrium of the sternum. It marks the anterior boundary of the superior thoracic aperture and serves as an important anatomical landmark for central venous access, tracheal assessment, and thoracic inlet evaluation.

It lies between the medial ends of the clavicles and forms a palpable midline notch visible externally at the base of the neck. Structurally, it represents the superior margin of the manubrium and provides attachment points for fascia, connective tissue, and superficial cervical structures.

Synonyms

  • Suprasternal notch

  • Manubrial notch

  • Incisura jugularis

Location and Structure

  • Position: Midline depression at the superior border of the manubrium of the sternum.

  • Boundaries:

    • Superiorly: Root of the neck

    • Laterally: Medial ends of both clavicles

    • Inferiorly: Upper manubrium

  • Shape: Concave, smooth bony indentation.

  • Structural role: Forms part of the anterior boundary of the thoracic inlet.

Relations

  • Anteriorly: Skin, superficial fascia, platysma.

  • Posteriorly: Trachea (upper thoracic portion), pretracheal fascia.

  • Laterally: Sternoclavicular joints and clavicular heads of the sternocleidomastoid muscles.

  • Inferiorly: Manubrium and upper sternum.

  • Superiorly: Inferior border of the neck, lower cervical fascia.

Attachments

  • Fascial: Superficial and deep cervical fascia invest the region.

  • Muscular (indirect via fascia):

    • Platysma overlying region

    • Sternohyoid and sternothyroid descend posteriorly behind the manubrium

  • Ligamentous/Connective:

    • Sternoclavicular joint capsule laterally

    • Fibrous tissue of the superior mediastinum behind the notch

Function

  • Serves as a palpable anatomical landmark for airway assessment and thoracic procedures.

  • Marks the anterior border of the thoracic inlet and transition from neck to mediastinum.

  • Provides support for cervical fascia surrounding trachea, vessels, and lymphatics.

  • Acts as a reference point for central line placement, tracheostomy, and mediastinal evaluations.

MRI Appearance

T1-weighted images

  • Bone cortex: Low signal (dark) at the superior manubrium.

  • Bone marrow of manubrium: Bright due to fatty content.

  • Adjacent soft tissues: Intermediate signal in fascia and muscle.

  • Suprasternal soft-tissue space: Intermediate signal with sharply defined fat planes.

T2-weighted images

  • Cortex: Dark low signal.

  • Marrow: Bright, slightly less intense than on T1.

  • Fascia and muscles: Intermediate-to-dark signal.

  • Pretracheal fat and connective tissue: Intermediate-to-bright signal distinguishing fascial layers.

STIR

  • Marrow: Intermediate-to-dark in normal conditions.

  • Soft-tissue fat: Suppressed to dark.

  • Fibrous and muscular tissue: Intermediate signal with clear contrast between fat-suppressed compartments.

T1 Fat-Saturated Post-Contrast

  • Manubrial bone marrow: Mild, uniform enhancement pattern.

  • Soft tissues: Thin, smooth enhancement of fascia and vascular structures.

  • Clavicular insertions and sternoclavicular joint capsule: Subtle linear enhancement from vascularized fibrous tissue.

CT Appearance

Non-Contrast CT

  • Manubrial cortex: High-density bone outlining the jugular notch.

  • Marrow cavity: Lower density compared to cortex, corresponding to fatty marrow.

  • Clavicular articulations: Well-defined sternoclavicular joints visible laterally.

  • Soft tissues: Clear depiction of pretracheal fat, strap muscle contours, and thoracic inlet anatomy.

MRI image

Jugular notch coronal MRI image-img-00000-00000

MRI image

Jugular notch MRI axial image

CT image

Jugular notch coronal CT image-img-00000-00000