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The azygos arch is located at 24–25 cm from the incisors. The aortopulmonary (AP) window (station 5) is situated between the aortic arch and the pulmonary artery. The AP window is found by following the aorta cephalad until its arch, rotating clockwise approximately 90 degrees, then advancing 1–2 cm with slight tip up of the echoendoscope. The aorta will be the echo‐poor structure on the right and the pulmonary artery will be to the left; the AP window is the space between the two just outside the AP ligament (which is not seen by EUS). The 4L region is immediately medial (close to the esophagus and EUS scope) to the AP window (Figure 3.5). Alternatively, from the subcarinal area, rotating 90 degrees counterclockwise, crossing the left main bronchus and pulling it back 2–3 cm will put you in the same location. Further withdrawal of the echoendoscope with slight rotation will show the origin of the left subclavian artery. Occasionally, the left carotid artery can be seen above the brachiocephalic (innominate) vein.

Figure 3.5 Aortopulmonary window station (stations 4L, 5 and 6). AO, aorta; L node; lymph node; PA, pulmonary artery.