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Superior tracheobronchial lymph nodes

The superior tracheobronchial lymph nodes are part of the mediastinal lymphatic system, located at the bifurcation of the trachea (carina) and along the main bronchi. They lie superior to the bifurcation, adjacent to the lower end of the trachea, and are closely related to the right and left main bronchi.

These lymph nodes drain lymph from the trachea, bronchi, lungs, and portions of the mediastinum, eventually passing into the tracheobronchial chain and then to the bronchomediastinal lymph trunks. They are of high clinical relevance because they are often sites of metastatic spread (lung carcinoma), granulomatous disease (tuberculosis, sarcoidosis), and infections.

Synonyms

  • Carinal lymph nodes (superior group)

  • Superior mediastinal tracheobronchial nodes

  • Precarinal lymph nodes (closely related but distinct)

Function

  • Drain lymph from the trachea, main bronchi, and hilar lymph nodes

  • Serve as a relay station to the bronchomediastinal trunks

  • Participate in immune surveillance of the respiratory tract

  • Clinically important for cancer staging, infection, and inflammatory disease assessment

MRI Appearance

T1-weighted images:

  • Normal nodes: isointense to muscle, slightly hypointense compared to mediastinal fat

  • Enlarged or pathological nodes: may show intermediate to low signal, with altered morphology

T2-weighted images:

  • Normal nodes: mildly hyperintense relative to muscle

  • Pathological nodes (infected, necrotic, or malignant): may show marked hyperintensity with central necrosis

T2 TRUFISP (cardiac/respiratory-gated):

  • Provides sharp contrast between lymph nodes, adjacent bronchi, and vessels

  • Nodes appear as intermediate signal rounded structures

  • Helps differentiate nodes from vascular structures

STIR (Short Tau Inversion Recovery):

  • Suppresses fat signal, improving detection of edematous or inflamed nodes

  • Enlarged nodes with inflammation or malignancy appear bright hyperintense

T1 Post-Contrast (Gadolinium-enhanced MRI):

  • Normal nodes enhance homogeneously

  • Malignant nodes: heterogeneous or peripheral enhancement, with necrotic cores appearing as non-enhancing areas

  • Useful in assessing vascular invasion or extracapsular spread

CT Appearance

Contrast-Enhanced CT (CECT):

  • Normal nodes: oval, soft-tissue density, <10 mm short axis

  • Pathological nodes: enlarged (>10 mm), round, possibly necrotic or calcified

  • Provides high-resolution assessment of size, shape, and relationship to bronchi, trachea, and vessels

  • Critical for lung cancer staging (N2/N3 disease), lymphoma assessment, and infection

CT Coronary / Thoracic CTA:

  • Demonstrates nodes in relation to pulmonary vasculature and coronary arteries

  • Useful for mapping vascular involvement and surgical planning

MRI images

Superior tracheobronchial lymph nodes anatomy mri coronal image -img-00000-00000

MRI images

Superior tracheobronchial lymph nodes anatomy mri coronal image -img-00000-00000_00001

CT image

Superior tracheobronchial lymph nodes anatomy CTi coronal image -img-00000-00000