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Occipital lymph nodes

Occipital lymph nodes are small, superficial lymph nodes located at the posterior aspect of the scalp, along the inferior occipital region near the superior nuchal line, just lateral to the midline. They are typically 1–2 mm in healthy adults, often not palpable, and embedded in subcutaneous tissue overlying the occipital bone. These nodes are part of the posterior scalp lymphatic chain and primarily drain lymph from the posterior scalp and upper neck, ultimately directing lymph into the deep cervical lymph nodes. The occipital nodes play a key role in immune surveillance of the scalp, responding to infections, inflammation, or neoplastic processes.

Synonyms

  • Posterior scalp lymph nodes

  • Suboccipital lymph nodes

  • Occipital superficial nodes

Function

  • Drain lymph from the posterior scalp and upper neck

  • Participate in immune surveillance, trapping pathogens and initiating immune responses

  • Serve as early indicators of scalp infection, inflammation, or malignancy

  • Connect to deep cervical lymph nodes, maintaining lymphatic drainage of the head and neck

MRI Appearance

T1-weighted images:

  • Normal occipital lymph nodes appear as small, oval, hypointense to intermediate signal structures within subcutaneous fat

  • Surrounded by hyperintense subcutaneous fat, providing natural contrast

  • Pathological nodes may appear enlarged, rounded, or show cortical thickening

T1 Post-Contrast (Gadolinium-enhanced):

  • Normal nodes may show mild homogeneous enhancement

  • Enlarged or inflamed nodes demonstrate pronounced homogeneous or heterogeneous enhancement, highlighting cortical and hilar structures

  • Useful for detecting early metastatic involvement or inflammatory changes

T2-weighted images:

  • Nodes show intermediate to slightly hyperintense signal, with surrounding fat hyperintense

  • Fatty hilum (if present) may appear slightly brighter than cortex

  • Helps in identifying edema, inflammation, or infiltration

STIR (Short Tau Inversion Recovery):

  • Fat suppression highlights edema or pathology within nodes

  • Normal nodes remain low to intermediate signal, while inflamed or metastatic nodes appear hyperintense

  • Sensitive for detecting subtle lymphadenopathy

CT Appearance:

  • Occipital lymph nodes appear as small, soft tissue density structures embedded in the subcutaneous fat over the posterior scalp along the superior nuchal line

  • Surrounded by air in adjacent spaces (scalp does not contain air, but surrounding structures may), providing contrast with soft tissue

  • Enlarged or pathological nodes appear as well-defined or irregular soft tissue masses

  • CT is useful for evaluating lymphadenopathy, infection, metastasis, and surgical planning

MRI images

Occipital lymph nodes mri axial image -img-00000-00000