HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sharma, A. Articles by Aquino, S. L. Search for Related Content PubMed PubMed Citation Articles by Sharma, A. Articles by Aquino, S. L. Related Collections Chest Radiology

Patterns of Lymphadenopathy in Thoracic Malignancies¹

¹ From the Departments of Radiology (A.S., S.L.L., S.L.A.) and Medicine (P.F.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders 202, Boston, MA 02114; and the Department of Radiology and Herbert J. Frensley Center for Imaging Research, Baylor College of Medicine, Houston, Tex (L.A.H., K.H.T.). Presented as an education exhibit at the 2002 RSNA scientific assembly. Received March 19, 2003; revision requested April 29; final revision received November 6; accepted November 7. Address correspondence to A.S. (e-mail: asharma2@partners.org).

View larger version (28K): [in a new window]   Figure 1a. Diagrams of the axial anatomy of the chest show the lymph nodes and drainage pathways for lung cancer in different lobes of the lung. All tumors drain to the interlobar and hilar nodes. The separate drainage pathways for tumors of the right upper lobe (black nodes), middle lobe (dark gray nodes), right lower lobe (striped nodes), left upper lobe (crosshatched nodes), and left lower lobe (dotted nodes) are shown. The corresponding American Thoracic Society (ATS) stations are labeled. E = esophagus, TD = thoracic duct. (a) Diagram shows the left paratracheal nodes (LPTN) (ATS station 2L) and right paratracheal nodes (RPTN) (ATS station 2R). LBCV = left brachiocephalic vein, LCCA = left common carotid artery, LSCA = left subclavian artery, RBCA = right brachiocephalic artery, RBCV = right brachiocephalic vein, Tr = trachea. (b) Diagram shows the left paratracheal nodes (LPTN) (ATS station 4L), right paratracheal nodes (RPTN) (ATS station 4R), and subaortic nodes (SAN) (ATS station 5). AA = ascending aorta, Ao = aorta, SVC = superior vena cava, Tr = trachea. (c) Diagram shows the hilar nodes (HN) (ATS station 10), interlobar nodes (ILN) (ATS station 11), lobar nodes (LN) (ATS station 12), and subcarinal nodes (SCN) (ATS station 7). Ao = aorta, BI = bronchus intermedius, LMB = left main bronchus, LPA = left pulmonary artery, LULB = left upper lobe bronchus, PA = pulmonary artery, RPA = right pulmonary artery, SPV = superior pulmonary vein, SVC = superior vena cava. (d) Diagram shows the left inferior pulmonary ligament node (LIPLN) (ATS station 9) and right inferior pulmonary ligament node (RIPLN) (ATS station 9). Ao = aorta, CS = coronary sinus, ECF = epicardial fat, LV = left ventricle, RA = right atrium, RV = right ventricle.

View larger version (25K): [in a new window]   Figure 1b. Diagrams of the axial anatomy of the chest show the lymph nodes and drainage pathways for lung cancer in different lobes of the lung. All tumors drain to the interlobar and hilar nodes. The separate drainage pathways for tumors of the right upper lobe (black nodes), middle lobe (dark gray nodes), right lower lobe (striped nodes), left upper lobe (crosshatched nodes), and left lower lobe (dotted nodes) are shown. The corresponding American Thoracic Society (ATS) stations are labeled. E = esophagus, TD = thoracic duct. (a) Diagram shows the left paratracheal nodes (LPTN) (ATS station 2L) and right paratracheal nodes (RPTN) (ATS station 2R). LBCV = left brachiocephalic vein, LCCA = left common carotid artery, LSCA = left subclavian artery, RBCA = right brachiocephalic artery, RBCV = right brachiocephalic vein, Tr = trachea. (b) Diagram shows the left paratracheal nodes (LPTN) (ATS station 4L), right paratracheal nodes (RPTN) (ATS station 4R), and subaortic nodes (SAN) (ATS station 5). AA = ascending aorta, Ao = aorta, SVC = superior vena cava, Tr = trachea. (c) Diagram shows the hilar nodes (HN) (ATS station 10), interlobar nodes (ILN) (ATS station 11), lobar nodes (LN) (ATS station 12), and subcarinal nodes (SCN) (ATS station 7). Ao = aorta, BI = bronchus intermedius, LMB = left main bronchus, LPA = left pulmonary artery, LULB = left upper lobe bronchus, PA = pulmonary artery, RPA = right pulmonary artery, SPV = superior pulmonary vein, SVC = superior vena cava. (d) Diagram shows the left inferior pulmonary ligament node (LIPLN) (ATS station 9) and right inferior pulmonary ligament node (RIPLN) (ATS station 9). Ao = aorta, CS = coronary sinus, ECF = epicardial fat, LV = left ventricle, RA = right atrium, RV = right ventricle.

View larger version (30K): [in a new window]   Figure 1c. Diagrams of the axial anatomy of the chest show the lymph nodes and drainage pathways for lung cancer in different lobes of the lung. All tumors drain to the interlobar and hilar nodes. The separate drainage pathways for tumors of the right upper lobe (black nodes), middle lobe (dark gray nodes), right lower lobe (striped nodes), left upper lobe (crosshatched nodes), and left lower lobe (dotted nodes) are shown. The corresponding American Thoracic Society (ATS) stations are labeled. E = esophagus, TD = thoracic duct. (a) Diagram shows the left paratracheal nodes (LPTN) (ATS station 2L) and right paratracheal nodes (RPTN) (ATS station 2R). LBCV = left brachiocephalic vein, LCCA = left common carotid artery, LSCA = left subclavian artery, RBCA = right brachiocephalic artery, RBCV = right brachiocephalic vein, Tr = trachea. (b) Diagram shows the left paratracheal nodes (LPTN) (ATS station 4L), right paratracheal nodes (RPTN) (ATS station 4R), and subaortic nodes (SAN) (ATS station 5). AA = ascending aorta, Ao = aorta, SVC = superior vena cava, Tr = trachea. (c) Diagram shows the hilar nodes (HN) (ATS station 10), interlobar nodes (ILN) (ATS station 11), lobar nodes (LN) (ATS station 12), and subcarinal nodes (SCN) (ATS station 7). Ao = aorta, BI = bronchus intermedius, LMB = left main bronchus, LPA = left pulmonary artery, LULB = left upper lobe bronchus, PA = pulmonary artery, RPA = right pulmonary artery, SPV = superior pulmonary vein, SVC = superior vena cava. (d) Diagram shows the left inferior pulmonary ligament node (LIPLN) (ATS station 9) and right inferior pulmonary ligament node (RIPLN) (ATS station 9). Ao = aorta, CS = coronary sinus, ECF = epicardial fat, LV = left ventricle, RA = right atrium, RV = right ventricle.

View larger version (25K): [in a new window]   Figure 1d. Diagrams of the axial anatomy of the chest show the lymph nodes and drainage pathways for lung cancer in different lobes of the lung. All tumors drain to the interlobar and hilar nodes. The separate drainage pathways for tumors of the right upper lobe (black nodes), middle lobe (dark gray nodes), right lower lobe (striped nodes), left upper lobe (crosshatched nodes), and left lower lobe (dotted nodes) are shown. The corresponding American Thoracic Society (ATS) stations are labeled. E = esophagus, TD = thoracic duct. (a) Diagram shows the left paratracheal nodes (LPTN) (ATS station 2L) and right paratracheal nodes (RPTN) (ATS station 2R). LBCV = left brachiocephalic vein, LCCA = left common carotid artery, LSCA = left subclavian artery, RBCA = right brachiocephalic artery, RBCV = right brachiocephalic vein, Tr = trachea. (b) Diagram shows the left paratracheal nodes (LPTN) (ATS station 4L), right paratracheal nodes (RPTN) (ATS station 4R), and subaortic nodes (SAN) (ATS station 5). AA = ascending aorta, Ao = aorta, SVC = superior vena cava, Tr = trachea. (c) Diagram shows the hilar nodes (HN) (ATS station 10), interlobar nodes (ILN) (ATS station 11), lobar nodes (LN) (ATS station 12), and subcarinal nodes (SCN) (ATS station 7). Ao = aorta, BI = bronchus intermedius, LMB = left main bronchus, LPA = left pulmonary artery, LULB = left upper lobe bronchus, PA = pulmonary artery, RPA = right pulmonary artery, SPV = superior pulmonary vein, SVC = superior vena cava. (d) Diagram shows the left inferior pulmonary ligament node (LIPLN) (ATS station 9) and right inferior pulmonary ligament node (RIPLN) (ATS station 9). Ao = aorta, CS = coronary sinus, ECF = epicardial fat, LV = left ventricle, RA = right atrium, RV = right ventricle.

View larger version (97K): [in a new window]   Figure 2. Adenocarcinoma of the left upper lobe in a 60-year-old woman. CT scan shows a 3-cm-diameter left hilar node (ATS station 10) (arrow). At lobectomy, this node contained tumor tissue, whereas all other nodes were negative. This finding corresponds to N1 disease.

View larger version (78K): [in a new window]   Figure 3. Adenocarcinoma of the left upper lobe in a 66-year-old man. CT scan obtained at the level of the aortopulmonary window shows a 7-mm-diameter subaortic node (ATS station 5) (arrow), which lies lateral to a calcified ligamentum arteriosum (arrowhead). The node contained tumor tissue at thoracotomy, a finding consistent with N2 disease. * = adenocarcinoma.

View larger version (87K): [in a new window]   Figure 4. Adenocarcinoma of the right upper and middle lobes in a 35-year-old man. CT scan obtained at the level of the aortopulmonary window shows enhancing low right paratracheal nodes (ATS station 4R) (arrowhead), subaortic nodes (ATS station 5) (straight arrows), and low left (contralateral) paratracheal nodes (ATS station 4L) (curved arrow). The subaortic nodes contained tumor tissue at anterior parasternal mediastinotomy. Therefore, the patient has N3 disease, which is inoperable. * = adenocarcinoma.

View larger version (42K): [in a new window]   Figure 5a. Axial diagrams show the main drainage pathways (black nodes) of breast cancer to the axillary, internal mammary, and supraclavicular lymph nodes. E = esophagus, Tr = trachea. (a) Diagram shows the axillary nodes (AN), anterior scalene/supraclavicular nodes (ASSCN), and pectoral nodes (PN). ASM = anterior scalene muscle, LCCA = left common carotid artery, LJV = left internal jugular vein, RCCA = right common carotid artery, RJV = right internal jugular vein. (b) Diagram shows the axillary nodes (AN), pectoral nodes (PN), and subclavian chain nodes (SCCN). LCCA = left common carotid artery, LJSCC = left jugulosubclavian confluence, LSCA = left subclavian artery, LSCV = left subclavian vein, RBCA = right brachiocephalic artery, RJSCC = right jugulosubclavian confluence, RSCV = right subclavian vein, TD = thoracic duct. (c) Diagram shows the axillary nodes (AN), internal mammary/retromanubrial nodes (IMRMN), and pectoral nodes (PN). LBCV = left brachiocephalic vein, LCCA = left common carotid artery, LSCA = left subclavian artery, RBCA = right brachiocephalic artery, RBCV = right brachiocephalic vein, TD = thoracic duct.

View larger version (40K): [in a new window]   Figure 5b. Axial diagrams show the main drainage pathways (black nodes) of breast cancer to the axillary, internal mammary, and supraclavicular lymph nodes. E = esophagus, Tr = trachea. (a) Diagram shows the axillary nodes (AN), anterior scalene/supraclavicular nodes (ASSCN), and pectoral nodes (PN). ASM = anterior scalene muscle, LCCA = left common carotid artery, LJV = left internal jugular vein, RCCA = right common carotid artery, RJV = right internal jugular vein. (b) Diagram shows the axillary nodes (AN), pectoral nodes (PN), and subclavian chain nodes (SCCN). LCCA = left common carotid artery, LJSCC = left jugulosubclavian confluence, LSCA = left subclavian artery, LSCV = left subclavian vein, RBCA = right brachiocephalic artery, RJSCC = right jugulosubclavian confluence, RSCV = right subclavian vein, TD = thoracic duct. (c) Diagram shows the axillary nodes (AN), internal mammary/retromanubrial nodes (IMRMN), and pectoral nodes (PN). LBCV = left brachiocephalic vein, LCCA = left common carotid artery, LSCA = left subclavian artery, RBCA = right brachiocephalic artery, RBCV = right brachiocephalic vein, TD = thoracic duct.

View larger version (37K): [in a new window]   Figure 5c. Axial diagrams show the main drainage pathways (black nodes) of breast cancer to the axillary, internal mammary, and supraclavicular lymph nodes. E = esophagus, Tr = trachea. (a) Diagram shows the axillary nodes (AN), anterior scalene/supraclavicular nodes (ASSCN), and pectoral nodes (PN). ASM = anterior scalene muscle, LCCA = left common carotid artery, LJV = left internal jugular vein, RCCA = right common carotid artery, RJV = right internal jugular vein. (b) Diagram shows the axillary nodes (AN), pectoral nodes (PN), and subclavian chain nodes (SCCN). LCCA = left common carotid artery, LJSCC = left jugulosubclavian confluence, LSCA = left subclavian artery, LSCV = left subclavian vein, RBCA = right brachiocephalic artery, RJSCC = right jugulosubclavian confluence, RSCV = right subclavian vein, TD = thoracic duct. (c) Diagram shows the axillary nodes (AN), internal mammary/retromanubrial nodes (IMRMN), and pectoral nodes (PN). LBCV = left brachiocephalic vein, LCCA = left common carotid artery, LSCA = left subclavian artery, RBCA = right brachiocephalic artery, RBCV = right brachiocephalic vein, TD = thoracic duct.

View larger version (38K): [in a new window]   Figure 6. Diagram shows the lymphatic drainage of the right breast. The axillary nodes are divided into three levels according to their positions relative to the pectoralis minor muscle.

View larger version (113K): [in a new window]   Figure 7. Metastatic breast cancer in a 68-year-old woman. CT scan obtained at the level of the aortic arch shows enlarged left axillary nodes that are located lateral to the pectoralis minor muscle (level I) (white arrow) and within the interpectoral space (level II) (black arrow). The nodes contained tumor tissue, a finding defined as N1 disease.

View larger version (91K): [in a new window]   Figure 8. Breast cancer in a 72-year-old woman. CT scan obtained at the level of the great vessels shows multiple left subpectoral nodes (level II) (white arrow), a left internal mammary node (black arrow), and a right paratracheal node (arrowhead). A left pleural effusion and multiple pulmonary metastases are also present. These findings are defined as stage IV disease due to the pulmonary metastases.

View larger version (43K): [in a new window]   Figure 9a. Axial diagrams show the main intrathoracic drainage pathways (black nodes) for lymphoma. E = esophagus, TD = thoracic duct. (a) Diagram shows the internal mammary/retromanubrial nodes (IMRMN), left bronchomediastinal trunk node (LBMTN), left paratracheal node (LPTN), preaortocarotid node (PACN), periesophageal/posterior mediastinum nodes (PEPMN), right brachiocephalic angle node (RBCAN), right phrenic node (RPN), and right paratracheal nodes (RPTN). LBCV = left brachiocephalic vein, LCCA = left common carotid artery, LSCA = left subclavian artery, RBCA = right brachiocephalic artery, RBCV = right brachiocephalic vein, Tr = trachea. (b) Diagram shows the internal mammary nodes (IMN), left phrenic node (LPN), periesophageal/posterior mediastinum nodes (PEPMN), right phrenic node (RPN), and right paratracheal nodes (RPTN). AA = aortic arch, LBCV = left brachiocephalic vein, RBCV = right brachiocephalic vein, Tr = trachea. (c) Diagram shows the extrapleural nodes (EPN), internal mammary nodes (IMN), lobar node (LN), left phrenic node (LPN), periesophageal/posterior mediastinum nodes (PEPMN), subcarinal node (SCN), and segmental node (SN). AA = ascending aorta, Ao = aorta, LMB = left main bronchus, PA = pulmonary artery, RMB = right main bronchus, RPA = right pulmonary artery, SVC = superior vena cava. (d) Diagram shows the pericardial fat nodes (PCFN) and periesophageal/posterior mediastinum nodes (PEPMN). Ao = aorta, CS = coronary sinus, ECF = epicardial fat, LV = left ventricle, PCF = pericardial fat, RA = right atrium, RV = right ventricle. (e) Diagram shows the anterior peridiaphragmatic nodes (APDN), extrapleural nodes (EPN), gastrohepatic ligament/celiac nodes (GHLCN), and periesophageal/posterior mediastinum nodes (PEPMN). Ao = aorta.

View larger version (36K): [in a new window]   Figure 9b. Axial diagrams show the main intrathoracic drainage pathways (black nodes) for lymphoma. E = esophagus, TD = thoracic duct. (a) Diagram shows the internal mammary/retromanubrial nodes (IMRMN), left bronchomediastinal trunk node (LBMTN), left paratracheal node (LPTN), preaortocarotid node (PACN), periesophageal/posterior mediastinum nodes (PEPMN), right brachiocephalic angle node (RBCAN), right phrenic node (RPN), and right paratracheal nodes (RPTN). LBCV = left brachiocephalic vein, LCCA = left common carotid artery, LSCA = left subclavian artery, RBCA = right brachiocephalic artery, RBCV = right brachiocephalic vein, Tr = trachea. (b) Diagram shows the internal mammary nodes (IMN), left phrenic node (LPN), periesophageal/posterior mediastinum nodes (PEPMN), right phrenic node (RPN), and right paratracheal nodes (RPTN). AA = aortic arch, LBCV = left brachiocephalic vein, RBCV = right brachiocephalic vein, Tr = trachea. (c) Diagram shows the extrapleural nodes (EPN), internal mammary nodes (IMN), lobar node (LN), left phrenic node (LPN), periesophageal/posterior mediastinum nodes (PEPMN), subcarinal node (SCN), and segmental node (SN). AA = ascending aorta, Ao = aorta, LMB = left main bronchus, PA = pulmonary artery, RMB = right main bronchus, RPA = right pulmonary artery, SVC = superior vena cava. (d) Diagram shows the pericardial fat nodes (PCFN) and periesophageal/posterior mediastinum nodes (PEPMN). Ao = aorta, CS = coronary sinus, ECF = epicardial fat, LV = left ventricle, PCF = pericardial fat, RA = right atrium, RV = right ventricle. (e) Diagram shows the anterior peridiaphragmatic nodes (APDN), extrapleural nodes (EPN), gastrohepatic ligament/celiac nodes (GHLCN), and periesophageal/posterior mediastinum nodes (PEPMN). Ao = aorta.

View larger version (41K): [in a new window]   Figure 9c. Axial diagrams show the main intrathoracic drainage pathways (black nodes) for lymphoma. E = esophagus, TD = thoracic duct. (a) Diagram shows the internal mammary/retromanubrial nodes (IMRMN), left bronchomediastinal trunk node (LBMTN), left paratracheal node (LPTN), preaortocarotid node (PACN), periesophageal/posterior mediastinum nodes (PEPMN), right brachiocephalic angle node (RBCAN), right phrenic node (RPN), and right paratracheal nodes (RPTN). LBCV = left brachiocephalic vein, LCCA = left common carotid artery, LSCA = left subclavian artery, RBCA = right brachiocephalic artery, RBCV = right brachiocephalic vein, Tr = trachea. (b) Diagram shows the internal mammary nodes (IMN), left phrenic node (LPN), periesophageal/posterior mediastinum nodes (PEPMN), right phrenic node (RPN), and right paratracheal nodes (RPTN). AA = aortic arch, LBCV = left brachiocephalic vein, RBCV = right brachiocephalic vein, Tr = trachea. (c) Diagram shows the extrapleural nodes (EPN), internal mammary nodes (IMN), lobar node (LN), left phrenic node (LPN), periesophageal/posterior mediastinum nodes (PEPMN), subcarinal node (SCN), and segmental node (SN). AA = ascending aorta, Ao = aorta, LMB = left main bronchus, PA = pulmonary artery, RMB = right main bronchus, RPA = right pulmonary artery, SVC = superior vena cava. (d) Diagram shows the pericardial fat nodes (PCFN) and periesophageal/posterior mediastinum nodes (PEPMN). Ao = aorta, CS = coronary sinus, ECF = epicardial fat, LV = left ventricle, PCF = pericardial fat, RA = right atrium, RV = right ventricle. (e) Diagram shows the anterior peridiaphragmatic nodes (APDN), extrapleural nodes (EPN), gastrohepatic ligament/celiac nodes (GHLCN), and periesophageal/posterior mediastinum nodes (PEPMN). Ao = aorta.

View larger version (42K): [in a new window]   Figure 9d. Axial diagrams show the main intrathoracic drainage pathways (black nodes) for lymphoma. E = esophagus, TD = thoracic duct. (a) Diagram shows the internal mammary/retromanubrial nodes (IMRMN), left bronchomediastinal trunk node (LBMTN), left paratracheal node (LPTN), preaortocarotid node (PACN), periesophageal/posterior mediastinum nodes (PEPMN), right brachiocephalic angle node (RBCAN), right phrenic node (RPN), and right paratracheal nodes (RPTN). LBCV = left brachiocephalic vein, LCCA = left common carotid artery, LSCA = left subclavian artery, RBCA = right brachiocephalic artery, RBCV = right brachiocephalic vein, Tr = trachea. (b) Diagram shows the internal mammary nodes (IMN), left phrenic node (LPN), periesophageal/posterior mediastinum nodes (PEPMN), right phrenic node (RPN), and right paratracheal nodes (RPTN). AA = aortic arch, LBCV = left brachiocephalic vein, RBCV = right brachiocephalic vein, Tr = trachea. (c) Diagram shows the extrapleural nodes (EPN), internal mammary nodes (IMN), lobar node (LN), left phrenic node (LPN), periesophageal/posterior mediastinum nodes (PEPMN), subcarinal node (SCN), and segmental node (SN). AA = ascending aorta, Ao = aorta, LMB = left main bronchus, PA = pulmonary artery, RMB = right main bronchus, RPA = right pulmonary artery, SVC = superior vena cava. (d) Diagram shows the pericardial fat nodes (PCFN) and periesophageal/posterior mediastinum nodes (PEPMN). Ao = aorta, CS = coronary sinus, ECF = epicardial fat, LV = left ventricle, PCF = pericardial fat, RA = right atrium, RV = right ventricle. (e) Diagram shows the anterior peridiaphragmatic nodes (APDN), extrapleural nodes (EPN), gastrohepatic ligament/celiac nodes (GHLCN), and periesophageal/posterior mediastinum nodes (PEPMN). Ao = aorta.

View larger version (40K): [in a new window]   Figure 9e. Axial diagrams show the main intrathoracic drainage pathways (black nodes) for lymphoma. E = esophagus, TD = thoracic duct. (a) Diagram shows the internal mammary/retromanubrial nodes (IMRMN), left bronchomediastinal trunk node (LBMTN), left paratracheal node (LPTN), preaortocarotid node (PACN), periesophageal/posterior mediastinum nodes (PEPMN), right brachiocephalic angle node (RBCAN), right phrenic node (RPN), and right paratracheal nodes (RPTN). LBCV = left brachiocephalic vein, LCCA = left common carotid artery, LSCA = left subclavian artery, RBCA = right brachiocephalic artery, RBCV = right brachiocephalic vein, Tr = trachea. (b) Diagram shows the internal mammary nodes (IMN), left phrenic node (LPN), periesophageal/posterior mediastinum nodes (PEPMN), right phrenic node (RPN), and right paratracheal nodes (RPTN). AA = aortic arch, LBCV = left brachiocephalic vein, RBCV = right brachiocephalic vein, Tr = trachea. (c) Diagram shows the extrapleural nodes (EPN), internal mammary nodes (IMN), lobar node (LN), left phrenic node (LPN), periesophageal/posterior mediastinum nodes (PEPMN), subcarinal node (SCN), and segmental node (SN). AA = ascending aorta, Ao = aorta, LMB = left main bronchus, PA = pulmonary artery, RMB = right main bronchus, RPA = right pulmonary artery, SVC = superior vena cava. (d) Diagram shows the pericardial fat nodes (PCFN) and periesophageal/posterior mediastinum nodes (PEPMN). Ao = aorta, CS = coronary sinus, ECF = epicardial fat, LV = left ventricle, PCF = pericardial fat, RA = right atrium, RV = right ventricle. (e) Diagram shows the anterior peridiaphragmatic nodes (APDN), extrapleural nodes (EPN), gastrohepatic ligament/celiac nodes (GHLCN), and periesophageal/posterior mediastinum nodes (PEPMN). Ao = aorta.

View larger version (85K): [in a new window]   Figure 10a. Non-Hodgkin lymphoma in a 66-year-old man. (a) CT scan obtained at the level of the great vessels shows bilateral axillary, right paratracheal (white arrow), left internal mammary (black arrow), and anterior mediastinal (arrowhead) nodes. (b) CT scan obtained at the level of the main pulmonary artery shows a left internal mammary node. Right hilar (arrow) and subcarinal (arrowhead) lymphadenopathy and bilateral pleural effusions are also present. (c) CT scan obtained at the level of the interventricular septum shows enlarged pericardial fat nodes (black arrow). Soft tissue in the extrapleural space (white arrows) and bilateral pleural effusions are also present.

View larger version (90K): [in a new window]   Figure 10b. Non-Hodgkin lymphoma in a 66-year-old man. (a) CT scan obtained at the level of the great vessels shows bilateral axillary, right paratracheal (white arrow), left internal mammary (black arrow), and anterior mediastinal (arrowhead) nodes. (b) CT scan obtained at the level of the main pulmonary artery shows a left internal mammary node. Right hilar (arrow) and subcarinal (arrowhead) lymphadenopathy and bilateral pleural effusions are also present. (c) CT scan obtained at the level of the interventricular septum shows enlarged pericardial fat nodes (black arrow). Soft tissue in the extrapleural space (white arrows) and bilateral pleural effusions are also present.

View larger version (110K): [in a new window]   Figure 10c. Non-Hodgkin lymphoma in a 66-year-old man. (a) CT scan obtained at the level of the great vessels shows bilateral axillary, right paratracheal (white arrow), left internal mammary (black arrow), and anterior mediastinal (arrowhead) nodes. (b) CT scan obtained at the level of the main pulmonary artery shows a left internal mammary node. Right hilar (arrow) and subcarinal (arrowhead) lymphadenopathy and bilateral pleural effusions are also present. (c) CT scan obtained at the level of the interventricular septum shows enlarged pericardial fat nodes (black arrow). Soft tissue in the extrapleural space (white arrows) and bilateral pleural effusions are also present.

View larger version (39K): [in a new window]   Figure 11a. Axial diagrams show the regional drainage pathways (black nodes) for esophageal cancer. Supraclavicular nodes are considered regional nodes (N1) for tumors that originate at the cervical esophagus but represent distant disease (M1) for intrathoracic esophageal tumors. E = esophagus. (a) Diagram shows the anterior scalene/supraclavicular nodes (ASSCN) and periesophageal/posterior mediastinum nodes (PEPMN). ASM = anterior scalene muscle, LCCA = left common carotid artery, LJV = left internal jugular vein, RCCA = right common carotid artery, RJV = right internal jugular vein, Tr = trachea. (b) Diagram shows the periesophageal/posterior mediastinum nodes (PEPMN) and right paratracheal nodes (RPTN). AA = aortic arch, LBCV = left brachiocephalic vein, RBCV = right brachiocephalic vein, TD = thoracic duct, Tr = trachea. (c) Diagram shows the periesophageal/posterior mediastinum nodes (PEPMN) and subcarinal node (SCN). AA = ascending aorta, Ao = aorta, LMB = left main bronchus, PA = pulmonary artery, RMB = right main bronchus, RPA = right pulmonary artery, SVC = superior vena cava, TD = thoracic duct. (d) Diagram shows the gastrohepatic ligament/celiac nodes (GHLCN) and periesophageal/posterior mediastinum nodes (PEPMN). Ao = aorta, TD = thoracic duct.

View larger version (37K): [in a new window]   Figure 11b. Axial diagrams show the regional drainage pathways (black nodes) for esophageal cancer. Supraclavicular nodes are considered regional nodes (N1) for tumors that originate at the cervical esophagus but represent distant disease (M1) for intrathoracic esophageal tumors. E = esophagus. (a) Diagram shows the anterior scalene/supraclavicular nodes (ASSCN) and periesophageal/posterior mediastinum nodes (PEPMN). ASM = anterior scalene muscle, LCCA = left common carotid artery, LJV = left internal jugular vein, RCCA = right common carotid artery, RJV = right internal jugular vein, Tr = trachea. (b) Diagram shows the periesophageal/posterior mediastinum nodes (PEPMN) and right paratracheal nodes (RPTN). AA = aortic arch, LBCV = left brachiocephalic vein, RBCV = right brachiocephalic vein, TD = thoracic duct, Tr = trachea. (c) Diagram shows the periesophageal/posterior mediastinum nodes (PEPMN) and subcarinal node (SCN). AA = ascending aorta, Ao = aorta, LMB = left main bronchus, PA = pulmonary artery, RMB = right main bronchus, RPA = right pulmonary artery, SVC = superior vena cava, TD = thoracic duct. (d) Diagram shows the gastrohepatic ligament/celiac nodes (GHLCN) and periesophageal/posterior mediastinum nodes (PEPMN). Ao = aorta, TD = thoracic duct.

View larger version (40K): [in a new window]   Figure 11c. Axial diagrams show the regional drainage pathways (black nodes) for esophageal cancer. Supraclavicular nodes are considered regional nodes (N1) for tumors that originate at the cervical esophagus but represent distant disease (M1) for intrathoracic esophageal tumors. E = esophagus. (a) Diagram shows the anterior scalene/supraclavicular nodes (ASSCN) and periesophageal/posterior mediastinum nodes (PEPMN). ASM = anterior scalene muscle, LCCA = left common carotid artery, LJV = left internal jugular vein, RCCA = right common carotid artery, RJV = right internal jugular vein, Tr = trachea. (b) Diagram shows the periesophageal/posterior mediastinum nodes (PEPMN) and right paratracheal nodes (RPTN). AA = aortic arch, LBCV = left brachiocephalic vein, RBCV = right brachiocephalic vein, TD = thoracic duct, Tr = trachea. (c) Diagram shows the periesophageal/posterior mediastinum nodes (PEPMN) and subcarinal node (SCN). AA = ascending aorta, Ao = aorta, LMB = left main bronchus, PA = pulmonary artery, RMB = right main bronchus, RPA = right pulmonary artery, SVC = superior vena cava, TD = thoracic duct. (d) Diagram shows the gastrohepatic ligament/celiac nodes (GHLCN) and periesophageal/posterior mediastinum nodes (PEPMN). Ao = aorta, TD = thoracic duct.

View larger version (39K): [in a new window]   Figure 11d. Axial diagrams show the regional drainage pathways (black nodes) for esophageal cancer. Supraclavicular nodes are considered regional nodes (N1) for tumors that originate at the cervical esophagus but represent distant disease (M1) for intrathoracic esophageal tumors. E = esophagus. (a) Diagram shows the anterior scalene/supraclavicular nodes (ASSCN) and periesophageal/posterior mediastinum nodes (PEPMN). ASM = anterior scalene muscle, LCCA = left common carotid artery, LJV = left internal jugular vein, RCCA = right common carotid artery, RJV = right internal jugular vein, Tr = trachea. (b) Diagram shows the periesophageal/posterior mediastinum nodes (PEPMN) and right paratracheal nodes (RPTN). AA = aortic arch, LBCV = left brachiocephalic vein, RBCV = right brachiocephalic vein, TD = thoracic duct, Tr = trachea. (c) Diagram shows the periesophageal/posterior mediastinum nodes (PEPMN) and subcarinal node (SCN). AA = ascending aorta, Ao = aorta, LMB = left main bronchus, PA = pulmonary artery, RMB = right main bronchus, RPA = right pulmonary artery, SVC = superior vena cava, TD = thoracic duct. (d) Diagram shows the gastrohepatic ligament/celiac nodes (GHLCN) and periesophageal/posterior mediastinum nodes (PEPMN). Ao = aorta, TD = thoracic duct.

View larger version (158K): [in a new window]   Figure 12. Lower esophageal carcinoma in a 71-year-old man. CT scan obtained at the level of the falciform ligament shows several gastrohepatic ligament nodes (arrow), which contained tumor tissue. These nodes are defined as distant disease for intrathoracic esophageal tumors but as regional nodes for tumors that originate at the gastroesophageal junction.

View larger version (39K): [in a new window]   Figure 13a. Axial diagrams show the main regional drainage pathways (black nodes) for malignant mesothelioma. E = esophagus. (a) Diagram shows the anterior scalene/supraclavicular nodes (ASSCN). ASM = anterior scalene muscle, LCCA = left common carotid artery, LJV = left internal jugular vein, RCCA = right common carotid artery, RJV = right internal jugular vein, Tr = trachea. (b) Diagram shows the extrapleural nodes (EPN), internal mammary nodes (IMN), lobar node (LN), subcarinal node (SCN), and segmental node (SN). AA = ascending aorta, Ao = aorta, LMB = left main bronchus, PA = pulmonary artery, RMB = right main bronchus, RPA = right pulmonary artery, SVC = superior vena cava, TD = thoracic duct. (c) Diagram shows the pericardial fat nodes (PCFN). Ao = aorta, CS = coronary sinus, ECF = epicardial fat, LV = left ventricle, PCF = pericardial fat, RA = right atrium, RV = right ventricle, TD = thoracic duct. (d) Diagram shows the anterior peridiaphragmatic nodes (APDN) and extrapleural nodes (EPN). Ao = aorta.

View larger version (39K): [in a new window]   Figure 13b. Axial diagrams show the main regional drainage pathways (black nodes) for malignant mesothelioma. E = esophagus. (a) Diagram shows the anterior scalene/supraclavicular nodes (ASSCN). ASM = anterior scalene muscle, LCCA = left common carotid artery, LJV = left internal jugular vein, RCCA = right common carotid artery, RJV = right internal jugular vein, Tr = trachea. (b) Diagram shows the extrapleural nodes (EPN), internal mammary nodes (IMN), lobar node (LN), subcarinal node (SCN), and segmental node (SN). AA = ascending aorta, Ao = aorta, LMB = left main bronchus, PA = pulmonary artery, RMB = right main bronchus, RPA = right pulmonary artery, SVC = superior vena cava, TD = thoracic duct. (c) Diagram shows the pericardial fat nodes (PCFN). Ao = aorta, CS = coronary sinus, ECF = epicardial fat, LV = left ventricle, PCF = pericardial fat, RA = right atrium, RV = right ventricle, TD = thoracic duct. (d) Diagram shows the anterior peridiaphragmatic nodes (APDN) and extrapleural nodes (EPN). Ao = aorta.

View larger version (42K): [in a new window]   Figure 13c. Axial diagrams show the main regional drainage pathways (black nodes) for malignant mesothelioma. E = esophagus. (a) Diagram shows the anterior scalene/supraclavicular nodes (ASSCN). ASM = anterior scalene muscle, LCCA = left common carotid artery, LJV = left internal jugular vein, RCCA = right common carotid artery, RJV = right internal jugular vein, Tr = trachea. (b) Diagram shows the extrapleural nodes (EPN), internal mammary nodes (IMN), lobar node (LN), subcarinal node (SCN), and segmental node (SN). AA = ascending aorta, Ao = aorta, LMB = left main bronchus, PA = pulmonary artery, RMB = right main bronchus, RPA = right pulmonary artery, SVC = superior vena cava, TD = thoracic duct. (c) Diagram shows the pericardial fat nodes (PCFN). Ao = aorta, CS = coronary sinus, ECF = epicardial fat, LV = left ventricle, PCF = pericardial fat, RA = right atrium, RV = right ventricle, TD = thoracic duct. (d) Diagram shows the anterior peridiaphragmatic nodes (APDN) and extrapleural nodes (EPN). Ao = aorta.

View larger version (38K): [in a new window]   Figure 13d. Axial diagrams show the main regional drainage pathways (black nodes) for malignant mesothelioma. E = esophagus. (a) Diagram shows the anterior scalene/supraclavicular nodes (ASSCN). ASM = anterior scalene muscle, LCCA = left common carotid artery, LJV = left internal jugular vein, RCCA = right common carotid artery, RJV = right internal jugular vein, Tr = trachea. (b) Diagram shows the extrapleural nodes (EPN), internal mammary nodes (IMN), lobar node (LN), subcarinal node (SCN), and segmental node (SN). AA = ascending aorta, Ao = aorta, LMB = left main bronchus, PA = pulmonary artery, RMB = right main bronchus, RPA = right pulmonary artery, SVC = superior vena cava, TD = thoracic duct. (c) Diagram shows the pericardial fat nodes (PCFN). Ao = aorta, CS = coronary sinus, ECF = epicardial fat, LV = left ventricle, PCF = pericardial fat, RA = right atrium, RV = right ventricle, TD = thoracic duct. (d) Diagram shows the anterior peridiaphragmatic nodes (APDN) and extrapleural nodes (EPN). Ao = aorta.

View larger version (104K): [in a new window]   Figure 14a. Malignant mesothelioma in a 56-year-old man. (a) CT scan obtained at the level of the left atrium shows a 4-mm-diameter lymph node in the left extrapleural space (arrow). (b) CT scan obtained at the level of the clavicles shows a 2-cm-diameter left supraclavicular node (arrow), which was confirmed to be metastatic. This finding is defined as N3 disease. (c) CT scan obtained at the level of the interventricular septum shows a cluster of enhancing left peridiaphragmatic nodes (arrow). Note the irregular, enhancing, nodular pleural thickening and the loculated pleural effusion.

View larger version (119K): [in a new window]   Figure 14b. Malignant mesothelioma in a 56-year-old man. (a) CT scan obtained at the level of the left atrium shows a 4-mm-diameter lymph node in the left extrapleural space (arrow). (b) CT scan obtained at the level of the clavicles shows a 2-cm-diameter left supraclavicular node (arrow), which was confirmed to be metastatic. This finding is defined as N3 disease. (c) CT scan obtained at the level of the interventricular septum shows a cluster of enhancing left peridiaphragmatic nodes (arrow). Note the irregular, enhancing, nodular pleural thickening and the loculated pleural effusion.

View larger version (104K): [in a new window]   Figure 14c. Malignant mesothelioma in a 56-year-old man. (a) CT scan obtained at the level of the left atrium shows a 4-mm-diameter lymph node in the left extrapleural space (arrow). (b) CT scan obtained at the level of the clavicles shows a 2-cm-diameter left supraclavicular node (arrow), which was confirmed to be metastatic. This finding is defined as N3 disease. (c) CT scan obtained at the level of the interventricular septum shows a cluster of enhancing left peridiaphragmatic nodes (arrow). Note the irregular, enhancing, nodular pleural thickening and the loculated pleural effusion.