Superior diaphragmatic nodes

At a glance

English

Superior diaphragmatic nodes

Latin (TA2)

Nodi phrenici superiores

System

Lymphatic

Region

Whole body

Side

Single, on the midline

About the superior diaphragmatic nodes

The superior diaphragmatic nodes, also called the superior phrenic nodes, rest on the chest side of the diaphragm, under the bases of the lungs and the heart. They are divided by position into three sets. The anterior set lies at the front: two or three tiny nodes tucked behind where the xiphoid process joins the sternal body, and one or two on each side where the seventh rib meets its costal cartilage. The middle set lies on each side near the points where the phrenic nerves reach the diaphragm; on the right, some of these sit inside the fibrous pericardium, in front of the terminal part of the inferior vena cava. Last, a posterior set is placed behind the diaphragmatic crura, near the aorta.

These nodes are the meeting point between the lymph of the chest and that of the upper abdomen. Through them, and through vessels piercing the diaphragm, the liver and the space below the diaphragm are linked with the mediastinum.

The anterior set receives lymph from the convex upper surface of the liver and from the diaphragm's anterior portion, and sends it to the parasternal nodes. The middle set drains the central zone of the diaphragm and, on the right, more of the upper liver surface; its outflow goes to the posterior mediastinal nodes. The posterior set connects with the lumbar nodes below the diaphragm and with the posterior mediastinal nodes above it.

Because they link the abdomen and chest, these nodes carry disease across the diaphragm. Liver tumours, abscesses below the diaphragm and cancers spreading over the peritoneum can reach them, and they may also enlarge in lymphoma. Enlarged anterior nodes near the heart, often called cardiophrenic nodes, show on CT beside the heart border, and their presence can change staging in abdominal cancers.

Course and drainage

Begins at

Afferent vessels from the convex upper surface of the liver and from the anterior, middle and posterior parts of the diaphragm.

Drains into

Anterior set: to the parasternal nodes. Middle set: to the posterior mediastinal nodes. Posterior set: linked to the lumbar and posterior mediastinal nodes.

Drains

Filters lymph from the diaphragm and the top of the liver. A bridge that lets liver and upper abdominal disease, including cancer, spread into the chest.