Intercostal nodes

At a glance

English

Intercostal nodes

Latin (TA2)

Nodi intercostales

System

Lymphatic

Region

Whole body

Side

Paired, left and right

About the intercostal nodes

The intercostal nodes lie towards the back of each intercostal space, near the heads and necks of the ribs, alongside the posterior intercostal artery and vein. They sit in the fat outside the parietal pleura, against the side of the vertebral column. Usually there are one or two in each space. Smaller lateral intercostal nodes are sometimes found further forward along the same vessels, partway round the chest.

They belong to the parietal group of thoracic nodes, those that serve the chest wall instead of the organs within it. Their opposite numbers at the front of the spaces are the parasternal nodes along the internal thoracic artery.

Lymph comes to them through the deep lymph vessels of the posterior and lateral chest wall: the intercostal muscles, ribs, parietal pleura and the deep tissues of the back. Some of these vessels pass through the small lateral intercostal nodes on the way. Their outflow differs with level and side. From roughly the lowest five spaces, the efferents join into a trunk on each side that runs down through the aortic opening of the diaphragm to the cisterna chyli or the very start of the thoracic duct. From the upper spaces, efferents on the left enter the thoracic duct, and those on the right enter the right lymphatic duct.

These nodes can receive spread from cancers of the lung or pleura that reach the chest wall, from mesothelioma, and from tumours of the ribs and vertebrae. Infections of the spine, such as tuberculosis, may also involve them. Enlarged nodes in this position can be seen on CT beside the vertebral bodies and may be confused with nerve tumours or other masses in the paravertebral gutter.

Course and drainage

Begins at

Afferent deep lymph vessels from the posterior and lateral chest wall, intercostal muscles, ribs and parietal pleura, some via small lateral intercostal nodes.

Drains into

Lower spaces: a descending trunk to the cisterna chyli or start of the thoracic duct. Upper spaces: thoracic duct on the left, right lymphatic duct on the right.

Drains

Filters lymph from the back and sides of the chest wall and the parietal pleura. May receive spread of pleural, lung and spinal disease and show as paravertebral masses on CT.