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Gluteal lymph nodes

The gluteal lymph nodes are a small but clinically important group of lymph nodes located in the buttock region. They are divided into superficial and deep gluteal nodes, which lie along the gluteal vessels. These nodes are responsible for lymphatic drainage of the gluteal region and communicate with both pelvic and inguinal lymphatic pathways. They are important in evaluating infection, trauma, and malignancies of the pelvis and lower limb.

Synonyms

  • Buttock lymph nodes

  • Nodes of the gluteal region

  • Superficial and deep gluteal lymphatic nodes

Location and Groups

  • Superficial gluteal lymph nodes:

    • Located in the superficial fascia of the buttock

    • Drain skin and subcutaneous tissue of the gluteal region

  • Deep gluteal lymph nodes:

    • Situated along the superior and inferior gluteal vessels, deep within the gluteal region

    • Drain muscles and deeper structures of the gluteal region

Relations

  • Anteriorly: Gluteal muscles (gluteus maximus, medius, minimus)

  • Posteriorly: Subcutaneous tissue and skin of buttock

  • Superiorly: Iliac crest and pelvic lymphatic connections

  • Inferiorly: Continuity with inguinal lymph nodes

  • Medially: Sacrum and sacral lymphatic chain

  • Laterally: Greater trochanter and thigh lymphatic communications

Function

  • Drain lymph from the skin, subcutaneous tissue, and muscles of the gluteal region

  • Provide a lymphatic link between superficial inguinal nodes and pelvic/iliac lymph nodes

  • Participate in immune surveillance by trapping foreign material, pathogens, and tumor cells

Clinical Significance

  • Enlargement may occur due to infection, trauma, or malignancy

  • Involved in oncologic staging, particularly for melanoma of the buttock, pelvic cancers, or sarcomas of the gluteal muscles

  • Can mimic soft tissue tumors on imaging if markedly enlarged

  • May serve as sentinel nodes in certain malignancies

MRI Appearance

T1-weighted images:

  • Lymph nodes show low-to-intermediate signal intensity

  • Fatty hilum, if present, appears bright

  • No fluid: nodes remain solid, well-defined

  • Surrounding fat: bright signal, aiding in node delineation

T2-weighted images:

  • Nodes show intermediate-to-high signal intensity

  • No fluid: nodes are solid with preserved hilum

  • Inflammation or pathology: signal becomes more hyperintense

  • Surrounding fat: moderately bright

STIR (Short Tau Inversion Recovery):

  • Normal nodes: intermediate to bright signal

  • Pathological nodes (inflamed or malignant): bright hyperintensity, often with loss of fatty hilum

  • Surrounding fat suppressed, appearing dark

T1 Fat-Sat Post-Contrast:

  • Normal nodes: mild homogeneous enhancement

  • Malignant nodes: irregular or heterogeneous enhancement

  • Abscessed nodes: rim enhancement with central non-enhancing necrosis

  • Fat suppressed: perinodal fat appears dark, highlighting enhancement better

CT Appearance

Non-Contrast CT:

  • Lymph nodes appear as soft tissue density nodules in the gluteal fat

  • Fatty hilum appears as central low density if preserved

  • Enlarged nodes lose fatty hilum, appearing as solid soft tissue masses

  • Surrounding fat: low attenuation, providing contrast

Post-Contrast CT:

  • Normal nodes: mild homogeneous enhancement

  • Reactive nodes: uniform, more prominent enhancement

  • Malignant nodes: heterogeneous or irregular enhancement, loss of fatty hilum

  • Necrotic or abscessed nodes: rim enhancement with central low attenuation

  • Surrounding fat: may show stranding in inflammation or infection

MRI image

Gluteal lymph nodes MRI axial anatomy image-img-00000-00000

CT image

Gluteal lymph nodes ct axial