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    Related Topics

    From Lymphatic System

    Anterior Mediastinal Nodes
    Drain anterior thoracic structures.
    Jugular Trunk
    Drains lymph from the head and neck.
    Preaortic Nodes
    Located in front of the aorta.
    Cisterna Chyli
    Dilated sac at the start of the thoracic duct.
    Spleen
    Filters blood and initiates immune response.
    Iliac Lymph Nodes
    Include external, internal, and common iliac nodes.
    Waldeyer’s Ring
    Ring of lymphoid tissue surrounding the naso- and oropharynx.
    Inguinal Lymph Nodes
    Drain the lower limbs and external genitalia.
    Intestinal Trunk
    Drains lymph from the intestines.
    Retroaortic Nodes
    Located behind the aorta.
    Lymph Nodes
    Small structures that filter lymph and store immune cells.
    Appendix
    Lymphoid-rich structure of the large intestine.
    Peyer’s Patches
    Lymphoid nodules in the small intestine.
    Mesenteric Lymph Nodes
    Drain the intestines and abdominal structures.
    Subscapular Axillary Nodes
    Located along the posterior chest wall.
    BALT
    Bronchus-associated lymphoid tissue.
    Thymus
    Primary lymphoid organ for T-cell maturation.
    Lateral Axillary Nodes
    Located along the humerus in the axilla.
    Pectoral Axillary Nodes
    Located along the anterior chest wall.
    GALT
    Gut-associated lymphoid tissue.
    Lymphatic Collecting Vessels
    Carry lymph through lymph nodes.
    Occipital Lymph Nodes
    Drain the back of the scalp.
    Subclavian Trunk
    Drains lymph from the upper limbs.
    Red Bone Marrow
    Produces lymphocytes; site of B-cell maturation.
    Palatine Tonsils
    Located on each side of the oropharynx.

    Paratracheal Nodes

    Reviewed by our medical team

    Located lateral to the trachea.

    1. Overview

    The paratracheal lymph nodes are a group of deep lymph nodes located alongside the trachea in the neck and upper thorax. They are critical components of the deep cervical and superior mediastinal lymphatic chains and serve as primary drainage points for lymph from the trachea, esophagus, larynx, thyroid gland, and portions of the lungs. Due to their proximity to vital thoracic structures and involvement in many diseases, they are of high clinical importance, especially in oncology, pulmonology, and head & neck surgery.

    2. Location

    Paratracheal nodes are located bilaterally along the trachea and are generally subdivided based on their position:

    • Cervical paratracheal nodes: Found in the lower neck, adjacent to the trachea and medial to the carotid sheath, often in continuity with deep cervical nodes.

    • Thoracic paratracheal nodes: Extend from the thoracic inlet (above the aortic arch) to the level of the carina, along the trachea and major bronchi.

    They are classified as station 2 (upper) and station 4 (lower) in the IASLC lymph node map used for lung cancer staging:

    • Station 2R and 2L – Upper paratracheal nodes (above the aortic arch)

    • Station 4R and 4L – Lower paratracheal nodes (below the aortic arch to the carina)

    3. Structure

    Paratracheal lymph nodes are typical deep lymph nodes, encapsulated and bean-shaped, with organized internal architecture:

    • Cortex: Contains lymphoid follicles with B cells for humoral immunity.

    • Paracortex: Rich in T lymphocytes and antigen-presenting dendritic cells.

    • Medulla: Contains plasma cells, macrophages, and sinusoids through which filtered lymph exits.

    • Afferent vessels: Carry lymph from adjacent thoracic structures into the node.

    • Efferent vessels: Drain toward the tracheobronchial and mediastinal lymphatic chains, then into bronchomediastinal trunks.

    4. Function

    The paratracheal nodes perform several vital immune and drainage functions:

    • Lymph filtration: Remove antigens, pathogens, cancer cells, and debris from lymph collected from tracheal, esophageal, laryngeal, and pulmonary tissues.

    • Immune activation: Serve as a site for antigen presentation and lymphocyte activation.

    • Lymph relay: Act as intermediate stations that drain into the deeper thoracic lymphatic network, including the bronchomediastinal trunks.

    5. Physiological Role(s)

    Paratracheal nodes are essential for both regional immunity and systemic lymphatic integration:

    • Respiratory defense: Monitor and respond to pathogens entering the airways and lungs.

    • Thyroid and esophageal surveillance: Filter lymph from endocrine and digestive tissues in the neck and upper thorax.

    • Tumor surveillance: Detect and respond to malignant cells spreading from thyroid, esophagus, lung, or laryngeal cancers.

    • Maintenance of interstitial fluid balance: Help prevent fluid accumulation around thoracic and neck structures.

    6. Clinical Significance

    Cancer Staging

    Paratracheal nodes are frequently involved in various cancers and serve as critical markers for staging and prognosis:

    • Lung cancer: Involvement of station 2 or 4 nodes indicates mediastinal spread (N2 or N3 staging).

    • Thyroid cancer: Metastatic papillary and medullary carcinomas often involve cervical and upper paratracheal nodes.

    • Laryngeal and esophageal cancer: Spread commonly involves these nodes due to direct lymphatic drainage.

    Evaluation of paratracheal nodes influences decisions regarding surgery, chemotherapy, and radiation therapy.

    Lymphadenopathy

    Enlargement of paratracheal nodes (paratracheal lymphadenopathy) may result from:

    • Infections: Tuberculosis, fungal infections (e.g., histoplasmosis), or viral illnesses.

    • Granulomatous diseases: Sarcoidosis commonly causes bilateral hilar and paratracheal lymph node enlargement.

    • Lymphomas: Hodgkin and non-Hodgkin lymphomas may present with mediastinal mass composed of enlarged paratracheal nodes.

    Diagnostic Evaluation

    Paratracheal nodes are not accessible by physical examination and require imaging or invasive procedures:

    • CT scan: Assesses size and morphology of mediastinal lymph nodes.

    • PET-CT: Detects metabolic activity in potentially malignant or inflamed nodes.

    • EBUS-TBNA (Endobronchial ultrasound-guided transbronchial needle aspiration): Minimally invasive method to biopsy paratracheal and subcarinal nodes.

    • Mediastinoscopy: Surgical procedure to biopsy paratracheal lymph nodes if less invasive techniques are inconclusive.

    Surgical Relevance

    During procedures like thyroidectomy, esophagectomy, or mediastinal lymphadenectomy, paratracheal nodes may be dissected for oncologic staging or therapeutic purposes. The close proximity of these nodes to the recurrent laryngeal nerve, trachea, and esophagus makes such surgeries delicate and potentially high risk.

    Airway Compression

    Severely enlarged paratracheal lymph nodes may cause compression of the trachea or esophagus, leading to:

    • Dyspnea or stridor (tracheal narrowing)

    • Dysphagia (esophageal compression)

    Such symptoms often prompt further imaging and biopsy to determine the underlying cause.

    Did you know? The lymphatic system works alongside the circulatory system to help regulate fluid balance and immune function.