Lymphatic vessels and nodes of the thoracic region

In this note, we are going to discuss the main groups of lymph nodes in the thorax and the lymphatic drainage pathways from the various tissues and organs of this region.

Lymphatic vessels and nodes of the thorax

The thoracic cavity contains two major groups of lymph nodes: parietal and visceral.

The parietal nodes collect lymph from the walls of the thoracic cavity and the diaphragm.

The primary groups of parietal nodes include:

Parasternal nodes, which are located along the internal thoracic artery. They collect lymph from the anterior thoracic wall, pleura, pericardium, the diaphragmatic surface of the liver, and the medial regions of the breast.

Intercostal nodes, which are located along the posterior intercostal arteries. They collect lymph from the posterior thoracic wall.

Prevertebral nodes, which are located between the vertebral column and the esophagus, collecting lymph from the surrounding tissues.

Paramammary nodes, which are located at the lateral border of the breast, draining lymph from the breast tissue.

Superior diaphragmatic nodes, which are found on the superior surface of the diaphragm, collecting lymph from the diaphragm.

Visceral lymph nodes collect lymph from the internal organs of the thoracic cavity:

Anterior mediastinal nodes, which are located on the anterior surface of large vessels, such as the superior vena cava and aortic arch.

They drain lymph from the pericardium, diaphragm, thyroid gland, and thymus. Pericardial nodes are further divided into prepericardial nodes and lateral pericardial nodes.

Posterior mediastinal nodes, which are situated along the thoracic aorta, behind the esophagus.

Based on their location, they are categorized into three groups: paraesophageal nodes, paraaortic nodes, and intermediate or interaortic-esophageal nodes.

Bronchopulmonary nodes, which can be found at the bifurcation points of the bronchi, collecting lymph from the lungs.

Intrapulmonary lymph nodes, which are located within the lung parenchyma.

Tracheobronchial nodes, which are divided into superior and inferior nodes, located along the trachea. These nodes drain lymph from the bronchopulmonary nodes.

The lymph from the organs of the thoracic cavity drains firstly into the visceral nodes and then into the parietal nodes.

Eventually, the efferent vessels drain into the right or left bronchomediastinal trunk or directly into the thoracic duct.

Lymphatic drainage from the breast occurs via both superficial and deep lymphatic networks:

Lymph from the lateral quadrants of the breast flows into the deep axillary nodes.
Lymph from the medial quadrants drains into the parasternal nodes.
A portion of the lymph from the upper lateral quadrant is directed to the supraclavicular nodes.

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