Mediastinal LN

DR/ Hytham Nafady

1. Highest mediastinal LNsUpper border: lower border or cricoid.Lower border: upper border of manubrium

and clavicles.Medial border: medial edge of CCA.Lateral boder: first rib.

2R. Right upper paratracheal LNs

• Upper border: upper border of manubrium.• Lower border: intersection between lower

border of left innominate vein and trachea.• Medial border: midline of the trachea.

2L. Left upper paratracheal LNs

• Upper border: superior border of the manuibrium.

• Lower border: superior border of aortic arch.

• Medial border: midline of the trachea.

3. Prevascular & prevertebral LNs

• Prevascular LNs (3A) are located anterior to the vessels.

• Prevertebral (retrotracheal) LNs (3B) are located anterior to the spine.

• Prevertebral LNs are not accessible through mediastnioscopy but only available through Endoscopic U/S.

4R. Right lower paratracheal LNs

4L. Left lower paratracheal LNs

5. Subaortic LNs(aortopulmonary window LNs)

6. para-aortic LNs• Anterior & lateral to the ascending thoracic

aorta & aortic arch.

7. Subcarinal LNs• Upper border: carina of the trachea.• Lower border: bronchus intermedius on

the right and left lower lobe bronchus on the left.

8. Paraesophageal LNs• Upper border: carinal LNs.• Lower border: diaphragm.

9. Pulmonary ligament LNs

• Pulmonary ligaments are inferior extension of mediastinal pleural reflections that surround the hila.

• Pulmonary ligaments LNs are located posterior and inferior to the inferior pulmonary veins.

10. Hilar LNs

Conventional medastinoscopy

Extended medasinoscopy

Endoscopic U/S