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Paraesophageal lymph nodes

The paraesophageal lymph nodes are part of the mediastinal lymphatic system, located adjacent to the thoracic and abdominal portions of the esophagus. They run alongside the esophagus from the thoracic inlet to the esophageal hiatus of the diaphragm, often clustered in the posterior mediastinum.

They serve as important relay nodes for the lymphatic drainage of the esophagus, but also receive tributary lymphatics from the trachea, bronchi, lungs, diaphragm, pericardium, and stomach. Inferiorly, they connect with abdominal lymph nodes near the celiac axis.

Paraesophageal nodes are of critical clinical significance in esophageal carcinoma, gastric carcinoma, and thoracic malignancies, as well as in infectious and inflammatory conditions such as tuberculosis or sarcoidosis. They are included in the IASLC mediastinal lymph node map (station 8) for cancer staging.

Synonyms

  • Station 8 lymph nodes (IASLC classification)

  • Esophageal lymph nodes

  • Periesophageal mediastinal nodes

Function

  • Drain lymph from the esophagus (primary function)

  • Receive tributaries from trachea, bronchi, diaphragm, stomach, and pericardium

  • Form part of the mediastinal lymphatic pathway connecting thoracic and abdominal lymphatic systems

  • Serve as key sentinel nodes in esophageal and gastric cancer spread

MRI Appearance

T1-weighted images:

  • Normal nodes: low-to-intermediate signal intensity

  • Enlarged or pathological nodes may appear rounded with loss of fatty hilum

T2-weighted images:

  • Normal nodes: intermediate signal

  • Malignant or inflamed nodes: hyperintense signal, often heterogeneous

STIR:

  • Enhances conspicuity by suppressing surrounding fat

  • Pathological nodes appear bright hyperintense, useful for detecting small metastatic deposits or inflammatory enlargement

T1 Fat-Saturated (Pre-contrast):

  • Nodes appear as intermediate signal intensity structures against suppressed mediastinal fat

T1 Fat-Saturated Post-Contrast (Gadolinium):

  • Normal nodes: mild homogeneous enhancement

  • Malignant nodes: heterogeneous or irregular enhancement

  • Inflamed nodes (infectious or reactive): often intense homogeneous enhancement

MRI Non-Contrast 3D Imaging:

  • Provides a 3D overview of nodal distribution along the esophagus

  • Useful in surgical mapping and staging

CT Appearance

CT Pre-Contrast:

  • Nodes appear as soft-tissue density masses adjacent to the esophagus

  • Enlarged nodes >10 mm in short-axis are suspicious but not specific

CT Post-Contrast:

  • Normal nodes enhance mildly

  • Malignant nodes show heterogeneous or necrotic enhancement

  • Helpful for esophageal and gastric cancer staging, lymphoma, or inflammatory disease

CT Venography (CTV):

  • Useful in differentiating lymph nodes from adjacent vascular structures

  • 3D reconstructions assist in surgical planning and oncology mapping

CT image

Paraesophageal lymph nodes ct axial image