Diagram of location of lymph nodes. Thoracic Lymph Nodes: Anatomy, Function, and Clinical Significance

10.07.202309.06.2023 by alexxlab

What are thoracic lymph nodes. Where are thoracic lymph nodes located. How do thoracic lymph nodes function. Why are thoracic lymph nodes important for health. When should you be concerned about thoracic lymph nodes. How are thoracic lymph nodes examined.

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Understanding the Anatomy of Thoracic Lymph Nodes

Thoracic lymph nodes play a crucial role in the body’s lymphatic system and immune defense. These nodes are strategically positioned throughout the chest cavity, serving as filters and checkpoints for lymph fluid. They are categorized into two main types:

Parietal lymph nodes: Located in the thoracic wall
Visceral lymph nodes: Associated with internal organs

This classification helps medical professionals understand the specific areas these nodes serve and their potential implications in various health conditions.

Subcategories of Thoracic Lymph Nodes

For diagnostic purposes, thoracic lymph nodes are further divided into subcategories:

Lung lymph nodes: Found along the bronchi
Paratracheal lymph nodes: Located in the neck
Tracheobronchial lymph nodes: Situated at the junction where the trachea meets the bronchi
Posterior mediastinal lymph nodes: Positioned near the thoracic aorta
Chest wall thoracic lymph nodes: Receive drainage from the breasts, arms, and upper chest muscles

Each of these subcategories has specific drainage responsibilities and plays a unique role in maintaining the health of the thoracic region.

The Function and Importance of Thoracic Lymph Nodes

Thoracic lymph nodes serve as critical components of the body’s immune system. They act as filters, trapping harmful substances and abnormal cells that may be present in the lymph fluid. This filtering process helps prevent the spread of infections and diseases throughout the body.

The paratracheal and tracheobronchial groups of lymph nodes are particularly important as they accept drainage from vital organs such as the heart, lungs, bronchi, and thoracic trachea. They also receive lymph from other lymph nodes, creating an interconnected network of immune surveillance.

The posterior mediastinal group of lymph nodes, closely linked to the tracheobronchial group, primarily drains into the thoracic duct. This connection is crucial for the proper flow of lymph fluid and the maintenance of immune function in the chest cavity.

Clinical Significance of Thoracic Lymph Nodes

Changes in the size or number of thoracic lymph nodes can be indicative of various health issues. While these nodes are not easily detectable due to their location deep within the chest, medical imaging techniques can reveal abnormalities that may suggest underlying problems.

Enlarged thoracic lymph nodes may be a sign of:

Infections
Inflammatory conditions
Cancers, including lung cancer and lymphomas
Autoimmune disorders

It’s important to note that not all changes in lymph nodes are cause for immediate concern, but they should be evaluated by a healthcare professional to determine the underlying cause and appropriate course of action.

Diagnostic Approaches for Thoracic Lymph Nodes

Given the deep-seated location of thoracic lymph nodes, specialized diagnostic techniques are often required to assess their condition. Common methods include:

Computed Tomography (CT) scans
Positron Emission Tomography (PET) scans
Magnetic Resonance Imaging (MRI)
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)
Mediastinoscopy

These imaging and biopsy techniques allow doctors to visualize the lymph nodes, measure their size, and, if necessary, obtain tissue samples for further analysis.

When to Seek Medical Attention

While thoracic lymph nodes are not palpable from the outside, certain symptoms may indicate a need for medical evaluation:

Persistent cough
Chest pain or discomfort
Difficulty breathing
Unexplained weight loss
Night sweats
Fatigue

If you experience any of these symptoms, especially if they persist or worsen over time, it’s advisable to consult a healthcare provider for a thorough examination.

The Role of Thoracic Lymph Nodes in Cancer Staging

Thoracic lymph nodes play a crucial role in the staging of various cancers, particularly lung cancer. The involvement of these nodes can significantly impact treatment decisions and prognosis. The TNM staging system, which assesses the extent of the primary tumor (T), lymph node involvement (N), and distant metastasis (M), relies heavily on the status of thoracic lymph nodes for accurate classification.

In lung cancer staging:

N0 indicates no lymph node involvement
N1 signifies metastasis in ipsilateral peribronchial and/or hilar lymph nodes
N2 involves metastasis in ipsilateral mediastinal and/or subcarinal lymph nodes
N3 represents metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph nodes

Understanding the involvement of thoracic lymph nodes helps oncologists determine the most appropriate treatment strategy, whether it be surgery, radiation therapy, chemotherapy, or a combination of these approaches.

Thoracic Lymph Nodes and the Immune Response

The thoracic lymph nodes are integral to the body’s immune response, particularly in defending against respiratory pathogens. When the body encounters harmful microorganisms or foreign substances in the respiratory tract, these lymph nodes become activation sites for immune cells.

Key functions of thoracic lymph nodes in immune response include:

Antigen presentation: Dendritic cells capture antigens and present them to T-cells in the lymph nodes
T-cell activation: Naive T-cells are activated upon encountering their specific antigen
B-cell proliferation: B-cells multiply and differentiate into antibody-producing plasma cells
Cytokine production: Activated immune cells release cytokines to coordinate the immune response

This immunological activity in thoracic lymph nodes is crucial for mounting an effective defense against respiratory infections and maintaining overall lung health.

Thoracic Lymph Nodes in Lymphatic Drainage

The thoracic lymph nodes are essential components of the lymphatic drainage system in the chest. They form part of a complex network that helps maintain fluid balance and facilitates the removal of waste products and excess fluids from tissues.

Key aspects of thoracic lymphatic drainage include:

Breast tissue drainage: Lymph from the breast primarily drains to the axillary lymph nodes, but some also flows to the internal mammary nodes in the chest wall
Lung drainage: Pulmonary lymphatics drain through hilar and mediastinal lymph nodes before entering the thoracic duct
Heart drainage: Cardiac lymphatics primarily drain to tracheobronchial and paratracheal lymph nodes
Diaphragm drainage: Lymph from the diaphragm flows to phrenic and posterior mediastinal nodes

Understanding these drainage patterns is crucial for diagnosing and treating conditions such as breast cancer, lung diseases, and certain cardiac disorders.

Disorders Affecting Thoracic Lymph Nodes

Several disorders can affect the thoracic lymph nodes, leading to various symptoms and health complications. Some of these conditions include:

Lymphadenopathy: Enlarged lymph nodes due to infection, inflammation, or malignancy
Lymphoma: Cancer of the lymphatic system, which can originate in or spread to thoracic lymph nodes
Sarcoidosis: An inflammatory disease that often affects the lungs and lymph nodes in the chest
Tuberculosis: A bacterial infection that can involve the thoracic lymph nodes
Silicosis: An occupational lung disease that can cause calcification of thoracic lymph nodes

Proper diagnosis and management of these conditions often require a multidisciplinary approach, involving pulmonologists, oncologists, and thoracic surgeons.

Imaging Techniques for Thoracic Lymph Node Assessment

Advanced imaging techniques have revolutionized the assessment of thoracic lymph nodes. These methods allow for non-invasive evaluation and can guide further diagnostic procedures. Common imaging techniques include:

CT scans: Provide detailed cross-sectional images of the chest, allowing for precise measurement of lymph node size
PET scans: Use radioactive tracers to identify areas of high metabolic activity, which can indicate cancer or inflammation
MRI: Offers excellent soft tissue contrast and can be particularly useful in evaluating mediastinal structures
Ultrasound: While limited in its ability to visualize deep thoracic structures, it can be useful for guiding biopsies of accessible lymph nodes

These imaging modalities, often used in combination, provide valuable information for diagnosis, staging, and treatment planning.

Future Directions in Thoracic Lymph Node Research

Research into thoracic lymph nodes continues to evolve, with several exciting areas of investigation:

Immunotherapy: Targeting thoracic lymph nodes to enhance immune responses against lung cancer and other thoracic malignancies
Molecular imaging: Developing new tracers for more specific and sensitive detection of lymph node metastases
Minimally invasive sampling techniques: Improving methods for obtaining lymph node biopsies with less patient discomfort and risk
Artificial intelligence: Utilizing machine learning algorithms to improve the accuracy of lymph node assessment in medical imaging

These advancements promise to enhance our understanding of thoracic lymph nodes and improve patient care in the coming years.

The study of thoracic lymph nodes remains a critical area in medicine, with implications for numerous health conditions. As our understanding of these important structures grows, so too does our ability to diagnose and treat diseases affecting the chest cavity. Continued research and clinical focus on thoracic lymph nodes will undoubtedly lead to improved patient outcomes and advancements in thoracic medicine.

Thoracic Lymph Nodes Anatomy, Diagram & Function

Thoracic Lymph Nodes Anatomy, Diagram & Function | Body Maps

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Medically reviewed by the Healthline Medical Network — By The Healthline Editorial Team on July 6, 2020

Thoracic lymph nodes are separated into two types: parietal lymph nodes located in the thoracic wall, and visceral lymph nodes, which are associated with the internal organs. Due to their location, abnormalities of the lymph nodes in the thorax, or chest, are not easily detected. However, any changes in the size or amount of these lymph nodes could be indicative of several types of extrapulmonary or pulmonary diseases. For diagnostic purposes, lymph nodes of the thorax can be further divided into sub-categories. The lung lymph nodes can be found along the bronchi. The paratracheal and tracheobronchial groups of lymph nodes are located in the neck and also in the junction where the trachea meets the bronchi, respectively. These accept drainage from the heart, lungs, bronchi, and thoracic trachea as well as other lymph nodes. The posterior mediastinal group of lymph nodes, located near the thoracic aorta, is closely linked to the tracheobronchial group and primarily drains into the thoracic duct. The chest wall thoracic lymph nodes receive drainage from the breasts, arms, pectoral muscles, and other muscles and skin located in the upper section of the chest.

Last medically reviewed on July 6, 2020

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Medically reviewed by the Healthline Medical Network — By The Healthline Editorial Team on July 6, 2020

How to check your Lymph Nodes

Introduction

You have been diagnosed with a skin cancer that on occasions can spread into the lymphatic system. That is why, as part of your examination, your nodes are examined by your doctor or specialist nurse at your follow-up appointments. The lymph nodes examined depend on the location of your skin cancer, eg: if your skin cancer was on your leg then the lymph nodes in your inguinal area (groin) will be felt or if on your face then the nodes in your head and neck would be examined. The aim is to detect any enlargement of the lymph nodes and undertake investigations at an early stage. Some people express a wish to check their own lymph nodes between clinic appointments. This is why you have been given this information. Your doctor or nurse will show you how and which lymph nodes to check.

The Lymphatic System

This system consists of lymphatic vessels and tissue. Lymph is a fluid that contains proteins and waste materials, which is collected from around the cells in the body, eventually draining into larger vessels.

Lymphatic vessels

One way of describing this is to imagine a river that starts as a small stream, which then weaves its way between the cells and small blood vessels of the body’s connective tissue. On its journey more tissue and waste material is collected. The fluid (lymph) that accumulates firstly drains into larger lymph vessels, then into ducts in the neck, before emptying into the blood stream.

Lymphatic tissue

Lymph nodes are small oval clumps of lymphatic tissue found at intervals along the vessels. They are grouped like “beads on a string” both deep in the body and near the surface (see previous diagram). These lymph nodes filter out harmful organisms and cells from the lymphatic fluid before it is returned to the blood stream. Lymph nodes can only be felt in the areas listed:

head and neck
arms
axilla (armpits)
inguinal area (groin)
back of knees

Usually lymph nodes are not enlarged and thus not able to be felt, but if you have previously had an infection (such as tonsillitis) you may have noticed and felt lymph nodes becoming enlarged, painful and tender. Lymph nodes can also become enlarged due to cancer cells lodging in them. Checking your lymph nodes once a month is sufficient and this can be done at the same time as you check your skin for any changing moles. Checking them more often may result indifficulty noticing any change.

Do not panic if you feel a lymph node as it may well be due to an infection, but if it has not gone away in a week contact your doctor or specialist nurse.

How to Check Lymph Nodes in the Head and Neck

With your fingertips, in a gentle circular motion feel the lymph nodes shown.
Start with the nodes in front of the ear (1) then follow in order finishing just above the collar bone (10)
Always check your nodes in this order.
Check both sides for comparison. If you have an enlarged lymph node it may feel like a swelling the size of a pea, sometimes they can be larger.

When feeling the nodes in your neck (marked 8):

Tilt your head towards the side you are examining, this helps to relax the muscle.
Now press your fingers under the muscle.

When checking the lymph nodes above the collar bone:

Hunch your shoulders and bring your elbows forward to relax the skin.
Now feel above the collar bone (marked 10).

How to Check Lymph Nodes in the Armpit

Diagram how to check the lymph nodes in your armpitRemove all clothing down to the waist to get easy access to the armpits.

Sit in a comfortable position.
Check each armpit in turn.

To check the left side, lift your arm slightly then place the fingers of your right hand high into the armpit and then lower your arm.

Feel in the central area of the armpit.

Now move your fingers firmly against the chest wall as follows:

Along the front border of the armpit.
Along the back border of the armpit.
Feel along the inner border of the arm.
Now check the other armpit.

How to Check Lymph Nodes in the Groin

Diagram of the lymph nodes in the groinThere are two areas to look for inguinal (groin) nodes:

Feel the horizontal chain of nodes in the right groin just below the ligament (see above diagram).
Feel the vertical chain along the upper thigh (see above diagram).
Check the lymph nodes in the other groin.

Conclusion

The purpose of this information is to help you understand why you have your nodes checked at your follow-up appointments. It explains which lymph nodes you need to check and how to undertake this procedure yourself. The aim is to ensure that if in the unlikely case there is spread of your skin cancer to the lymph nodes, it is detected and reported to your doctor or nurse straight away rather than waiting until your next clinic appointment.

Lymphatic System Anatomy–Lymphosurgery Center

The lymphatic system is an important part of the human cardiovascular system and complements it.

Unlike the circulatory system, the lymphatic system does not have its own pump and is open. The lymph circulating in it moves slowly and under little pressure. Lymph is a fluid that is constantly formed by drainage of interstitial fluid into the lymphatic capillaries.

The structure of the lymphatic system includes:

• lymphatic capillaries
• lymphatic vessels
• lymph nodes
• lymphatic trunks and ducts

subclavian trunks; on the right into the right lymphatic duct, right jugular and right subclavian trunks. The ducts and trunks flow into the large veins of the neck, and then into the superior vena cava. In this way, lymph is transferred from the interstitial spaces back into the blood.

Lymphatic vessels pass through the lymph nodes. They are combined into several groups and are located along the vessels. Many afferent vessels carry lymph to the node, and it flows out from there only through one or two efferent vessels. Lymph nodes are small formations of a round, oval, bean-shaped, less often ribbon-shaped form up to 2 cm long. Here, lymph is filtered, foreign matter is separated and destroyed, and lymphocytes are produced here to fight infection. Lymph nodes that perform a barrier and immune role.

Main functions of the lymphatic system:

• Transport function – carrying lymph, metabolic products from tissues to the venous bed.

• Drainage function – the return of proteins, water, salts, toxins and metabolites from tissues to the blood. Removal of fluid, pus, effusion from the wound, cavities. Stability of the “capillary lymphatic pump”

• Lymphocytopoiesis, hematopoietic function – formation, maturation, differentiation of lymphocytes involved in immune reactions.

• Immune, protective functions – formation of the body’s immune defense, neutralization of foreign particles, bacteria, viruses, fungi, protozoa that enter the body. filtration from impurities, tumor particles and cells.

Any failure or blockage of the lymphatic vessels or nodes entails swelling or swelling of the tissues, lymphadenitis, erysipelas, lymphostasis occur. Experts, not without reason, believe that the lymph could tell about what the blood is “silent about”, because many of the waste products of the cells first enter the lymph, and then into the blood.

If most doctors can help us in the fight against many diseases, then only individual doctors – lymphologists – can diagnose and treat disorders in the lymphatic system.

According to the statistics of the doctors themselves, in the CIS there are only a few lymphologists – specialists in the lymphatic system.

Lymphologists say: Your health is the purity of your lymphatic system!

Be healthy and happy!

What are lymph nodes and what to do if they are enlarged?

Lymph nodes allow lymph to pass through, retaining and destroying bacteria, viruses and malignant cells. Sometimes they increase, which raises many questions.

Let’s figure out what lymph nodes are, how they are arranged and why it is impossible to follow the advice from the Internet when they increase.

What are lymph nodes and why are they needed?

Lymph node is a peripheral organ of the immune system, located on the path of lymphatic vessels from organs and tissues.

Lymph is the liquid part of the blood that is filtered into the intercellular space through the walls of the capillaries. It is rich in proteins, electrolytes and water. It is impossible to lose these valuable substances, and it is impossible to return them back to the blood vessels through the wall. The “filtrate” of the blood enters the lymphatic system, from where it enters the superior vena cava through a network of vessels, that is, it returns to the bloodstream.

Along the course of the lymphatic vessels there are lymph nodes – rounded formations the size of a pea. At its core, a lymph node is an accumulation of protective cells – lymphocytes and macrophages – on a “frame” of connective tissue. Lymph nodes allow the flow of lymph through them, and the protective cells that make up them delay and destroy foreign agents (bacteria, parasites, viruses, tumor cells) that have entered the human body.

That is why the lymph nodes are called biological filters, and they themselves resemble knight’s castles, located in the most important directions of medieval states and protecting them from enemy attacks.

Classification of lymph nodes

There are approximately 500 lymph nodes in the human body. They are located mainly in groups. Each group receives lymph from a specific area of the body or part of an organ. There are many classifications of lymph nodes, the simplest of them is a classification based on localization. There are no lymph nodes in the brain and spinal cord, bones, and the area of the hands and feet.

Swollen lymph nodes: symptom or disease?

Swollen lymph nodes, or lymphadenopathy, is a symptom of a large number of diseases. This is not an independent disease, but only one of its symptoms, such as headache or fever.

Doctors have many classifications of lymphadenopathy. In this article, we will give only a couple of the main ones that will help in understanding the stated problem.

Depending on the extent of the process, the enlargement of lymph nodes can be local and generalized ¹ . In the first case, the lymph nodes of 1-2 adjacent anatomical regions increase. For example, submandibular and cervical. In the second case, there is an increase in lymph nodes in two or more non-adjacent, located far from each other, zones. For example, in the inguinal and axillary regions.

The duration of lymph node enlargement can be short (less than 2 months) and protracted (more than 2 months) ¹ .

Why do lymph nodes enlarge?

Swollen lymph nodes can be a symptom of both a relatively harmless disease and a very serious disease. Therefore, you need not to self-medicate, but to look for the cause. And this is the prerogative of the doctor.

Here are just some of the possible causes of swollen lymph nodes:

infectious diseases . The entry of an infectious agent (virus, bacteria) into the lymph node leads to increased blood flow, active division of lymphocytes and enlargement of the lymph node. That is, this process is of a reciprocal protective nature. An increase in lymph nodes is observed with infections of the upper respiratory tract (adenoviral, tonsillitis), infectious mononucleosis, childhood infections (measles, rubella, mumps, chickenpox), cytomegalovirus infection, etc. In acute infectious diseases, an increase in lymph nodes is temporary and is accompanied by other symptoms (fever, general weakness, malaise, cough, runny nose). Also, swollen lymph nodes can be one of the symptoms of HIV infection;
autoimmune connective tissue diseases . With these diseases, the human immune system does not work quite adequately, which is why the body begins to attack its own cells. An increase in lymph nodes can be observed with rheumatoid arthritis, systemic lupus erythematosus;
pyoinflammatory processes skin, underlying structures and internal organs. Even panaritium or a bad tooth can cause an increase in lymph nodes;
vaccination . The introduction of a killed pathogen or its parts into the body leads to the development of an immune response. An increase in lymph nodes is not at all uncommon;
allergic reactions . Taking many medications (antibiotics, anti-inflammatory and lowering blood pressure) may be accompanied by an increase in lymph nodes;
neoplastic diseases . Enlarged lymph nodes are a common and sometimes the only sign of cancer. In oncological diseases, it can be primary and secondary.

Primary enlargement of lymph nodes

It is observed in tumors that directly affect the lymphatic system – lymphomas. Usually in these cases, the lymph nodes are more than 2 cm in diameter, painless, and their increase occurs against the background of apparent health, which is why the person does not immediately turn to the doctor.

Secondary enlargement of lymph nodes

It is observed in a malignant neoplasm of any localization. For example, with breast cancer, the only sign may be an increase in the lymph nodes in the armpit.

The fact is that as soon as malignant cells find themselves in the intercellular space, they quickly enter the lymphatic capillaries, and from there to the nearest lymph node. There, some of them are destroyed, and some settle and begin to divide, forming a secondary tumor focus.

The division of tumor cells and the increase in the number of protective cells over time leads to an increase in the size of the lymph node. This is a kind of “price” for curbing the growth of a tumor and the spread of tumor cells throughout the body, because if there were no lymph nodes, tumor cells would very quickly enter the bloodstream and give distant metastases.

With local lymphadenopathy, the tumor is detected in about half of the cases, and with generalized lymphadenopathy – in almost 90% of cases ¹ ! Therefore, it is so important to exclude the tumor origin of lymphadenopathy and understand its causes. You should not waste precious time on self-treatment, and if enlarged lymph nodes appear, you should consult a doctor as soon as possible.

What should I do if my lymph nodes are enlarged and which doctor should I visit?

The adult needs to see a general practitioner and the child/teen needs to be taken to see a pediatrician. Usually, a clinical examination and simple studies (general and biochemical blood tests, if necessary, X-ray examination or ultrasound of a certain area of the body) are enough for a specialist to make a preliminary diagnosis and prescribe treatment or refer the patient to a narrower specialist (oncologist, surgeon, rheumatologist, infectious disease specialist) for further examination.

What not to do when the lymph nodes are “swollen”: breaking the stereotypes

Having discovered enlarged lymph nodes, very many, instead of going to the doctor and understanding the causes of what is happening, begin to self-medicate: heat the area of the enlarged lymph node, drink antibiotics, use compresses, etc. You can find a great many similar tips on the Internet.

Should I do it? No way.

Warming up the lymph node area

Many people use salt or a freshly boiled egg to warm up the swollen lymph node area. This is usually done to reduce pain. But for most patients, this is absolutely impossible. In the presence of an inflammatory process, thermal exposure will lead to vasodilation and increased inflammation, and in the case of a tumor process, it can accelerate cell division. Both will make the situation worse.

Taking antibiotics

There are many people who uncontrollably “treat” any “suspicious” symptoms with antibiotics. Of course, this is wrong. Antibacterial drugs are prescribed only by a doctor and strictly according to indications. In most cases, with an increase in lymph nodes, taking antibiotics is simply not advisable and will not give a positive effect.

Use of compresses, ointments/gels

The result here is the same as when warming up – the situation only gets worse.