The suprasternal notch is a visible depression at the base of the throat, just above the breastbone. Its depth varies significantly between individuals. While a prominent notch usually reflects natural body structure, its appearance can sometimes indicate underlying medical conditions. Understanding the difference between a natural variation and a sign of pathology is important.
Anatomy of the Jugular Notch
The medical term for the suprasternal notch is the jugular notch. This indentation is defined by the superior border of the manubrium, the uppermost part of the sternum (breastbone). It is positioned between the medial ends of the two clavicles (collarbones) where they connect to the sternum.
The notch is a gap where the bones of the chest and neck meet, with only soft tissue beneath it. It serves as an anatomical landmark for healthcare professionals to locate structures like the trachea and major blood vessels. The visibility and depth of the notch reflect the underlying skeletal structure and the amount of tissue covering it.
Natural Causes of Depth Variation
For most people, a deep notch is a benign result of their physical composition. Genetic predisposition plays a major role; some individuals are born with a more prominent manubrium or a chest shape that accentuates the area. The depth is often an inherited trait.
Body composition also influences the notch’s appearance. Individuals with low body fat have less subcutaneous tissue covering the upper chest and neck. This reduction in soft tissue makes the underlying bony structures, including the sternum and clavicles, appear more defined, making the notch seem deeper.
Posture can temporarily influence the notch’s perception. Slouching or a forward head posture shifts the neck and chest position, which may make the notch appear more recessed or prominent. This mechanical effect normalizes when correct posture is resumed. These variations are normal and require no medical intervention.
Underlying Medical Explanations
An unusually deep or prominent suprasternal notch may be associated with specific medical conditions. One structural cause is Pectus Excavatum, or “funnel chest,” a congenital chest wall deformity. This condition involves an inward growth of the sternum and rib cartilage, creating a concave appearance in the middle of the chest.
Since the notch is the superior boundary of the sternum, this inward depression can visually exaggerate its depth. The severity of Pectus Excavatum varies widely; severe cases can reduce space for the heart and lungs, potentially causing shortness of breath or fatigue.
The notch can also be a dynamic sign of difficulty breathing, known as suprasternal retractions. This occurs when a person struggles to inhale, using accessory muscles to pull air into the lungs. The intense negative pressure causes the soft tissues above the sternum to visibly sink inward with each breath, indicating respiratory distress, often due to an upper airway obstruction. Finally, a local mass, such as an enlarged thyroid gland (goiter), can shift or distort surrounding tissues. This displacement may make the area appear asymmetrical or alter the visual depth of the notch.
Signs That Require Medical Attention
While most variations are harmless, certain signs require consultation with a healthcare provider. Any sudden, noticeable change in the notch’s depth or shape should be evaluated, especially if new symptoms coincide.
Urgent medical attention is required if the notch sinks inward with every breath (retractions), as this indicates significant difficulty breathing. Other concerning indicators warranting a medical assessment include:
- The appearance of a hard, palpable lump or mass within the notch.
- Pain and tenderness in the area.
- Accompanying symptoms such as unexplained rapid weight loss.
- Chronic shortness of breath or a persistent cough.