The Lymph Node Stations in the Chest

[@Emily-ye1qy]

As a PGY2 rad onc resident, this video was SUPER helpful for contouring. Thank you thank you

[@ThoracicRadiology]

glad it was helpful and good luck with residency!

[@raveeshroy]

0:40 FIRST STATION-LOW CERVICAL SUPRACLAVICULAR AND STERNAL NOTCH LYMPH NODES 1:13 RIGHT SUPRACLAVICULAR LYMPH NODE 1:33 SUPRACLAVICULAR LYMPH NODES (N3) AND UPPER PARATRACHEAL LYMPH NODES (N2) 2:10 UPPER PARATRACHEAL NODE 2:18 DISTINGUISH BETWEEN UPPER PARATRACHEAL AND SUPRACLAVICULAR LYMPH NODE 3:00 SUPRACLAVULAR LYMPH NODES 3:09 PREVASCULAR LYMPH NODE 3:19 INFERIOR BORDER OF UPPER PARATRACHEAL LYMPH NODE -ON LEFT (TOP OF AORTIC ARCH) ON RIGHT ( BOTTOM OF LEFT INNOMINATE VEIN) 4:25 RIGHT AND LEFT PARATRACHEAL LYMPH NODES 6:08 PARA AORTIC NODES AND NOT PREVASCULAR NODES ( STATION 6 PARA AORTIC NODES) 6:28 RETROTRACHEAL LYMPH NODE 7:07 PARA AORTIC NODES 7:23 SUB AORTIC NODES OR AORTOPULMONARY WINDOW LYMPH NODES (STATION 5 LYMPH NODES) 7:58 SUBCARINAL OR STATION 7 LYMPH NODES 8:40 PARAESPHAGEAL OR STATION 8 LYMPH NODES 9:01 PULMONARY LIGAMENT OR STATION 9 LYMPH NODES 9:41 INTER LOBAR OR STATION 11 LYMPH NODES

[@fullofsoundandfury]

Very nice video, thank you. The IASLC nodal scheme describes the changeover between lower paratracheal and hilar node stations at the lower margin of the azygos vein on the right, and the upper rim of the left main pulmonary artery on the left, not the carina as you mention in the video. I appreciate the added description of other nodal disease not discussed in the IASLC framework.

[@ThoracicRadiology]

Thanks for your comment, yes you're right I should have mentioned that. The IASLC document describes these nodes as immediately adjacent to the mainstem bronchi and hilar vessels, so that's why I described it the way I did. The landmarks you point out are more accurate. Incidentally, nodes that are anterior to the carina, I would still classify as right paratracheal.

[@ranjusivakumar5801]

@@ThoracicRadiology thanks for helping out fellow dr in understanding

[@sandeepghosh4689]

Beautiful video, wonderfully explained, made it so easy to comprehend along with the precise definitions of the stations by IASLC 👍

[@ThoracicRadiology]

Thank you, glad it was helpful

[@vickyvicky2757]

Thank you for that great description.

[@LetsGetRadio93]

You are a gem man❤

[@kaushikn2038]

Fantastic. Lots of love from India

[@nope478]

Excellent video Dr. Thanks a lot

[@joeydoesntsharefood.]

Best explanation. thanks you

[@briangilcrease7179]

great review, succinct and exceptionally well demonstrated on multiplanar views. thx!

[@ThoracicRadiology]

thanks Brian!

[@francescoarico9812]

Top! Thank you very much. Greetings from Sicily

[@ThoracicRadiology]

Thank you too!

[@СергійШ-о7ы]

Thank you for your video!

[@luckypenny4263]

Excellent video

[@shashisigdelmd5837]

Great explaination. Please makeore slides for sub carinal area anatomy-clinically relevance.

[@kamraninamdar2086]

beautifully described .. thankyou so much

[@nikonikovic5844]

Great video! Thank you very much!!!

[@marchettobuzz]

Amazing, thank you

[@Sunshine-dg2xs]

Thank you Sir

[@rakeshbayapati3650]

Thank you

[@alshaymaaabdelghaffar8202]

Great lecture,,, Thank you

[@pau9342]

Thank you!

[@radiologicalman1623]

thanks for that great video.

[@mubashirhaq2651]

very succinctly explained...thanks a lot...

[@muazezghazi4816]

Very nice lecture..thanks alot..keep go on

[@DrrSara]

Very cool 👌 thanks 🤩

[@DrrSara]

Amazing 😊👏👏👏

[@hspak5675]

Great teaching!!

[@syedzaman1148]

nice and friendly lecture

[@santiagocanepa9099]

Great stuff! Keep it up.

[@vijayvarmann]

Very informative...

[@BJ-sp2cj]

Nicest Mediastinal LN review..awesome

[@radiologydarkroom7709]

fabulous.

[@drsayed121]

Thank you so much

[@vipersharma654]

Very informative video

[@dr.kapilbabbar5533]

love your class sir really excellent.. i don't have words to describe

[@mainakde1744]

Excellent

[@panasmyrnyi-oo2ht]

is it healthy patient?

[@eurastio]

how to differentiate normal vessels from lymph nodes on NCCT .???

[@sardardarwish9159]

How to measure lymph node what axis we should measure the long or short

[@valeriacustis372]

I would need to understand how to see ANTERIOR MEDIASTINUM masses in a Thoracic CT...Thank you

[@akulmunjal]

Great Video; super helpful. Do you by any chance know any good practice questions to re-enforce the material?

[@Islamic.videos78615]

V good 👍

[@sakinagadiyeva5900]

Thank you! I have a problem determining chest lymph nodes without iv contrast😣

[@ThoracicRadiology]

You'll master it soon. Takes a little time, that's all.

[@zohebmulla3670]

Colon or large intestine ulcers can be seen in ct scan?

[@ThoracicRadiology]

CT scan of the chest? Not usually, no.

[@wearefortniters]

what is mean hypermetabolic ap window in Petscan

[@ThoracicRadiology]

PET is an imaging modality that uses a radioactive tracer to cause certain tissues to light up. In the case of F-18 FDG PET, the radiotracer goes to tissues that are highly metabolically active. In the case of a hypermetabolic lymph node, that could be due to cancer, or it could be from other things like sarcoid, infection, or other inflammatory diseases. the AP window is a location in the chest.

[@JohnBaek-z3j]

Amazing video! Thank you I just uploaded a blog post about chest anatomy on my website and used some of the images from this video (with the reference). Please let me know if you don't want your contents to be reused and I will delete them.

[@Louloui636]

Can you see supracavicular nodes in a chest and neck ct without contrast???

[@ThoracicRadiology]

yeah the neck CT overlaps a little bit with a chest CT, so if you have an enlarged node in the lower neck/upper chest, it should be on one of those.

[@HMAsad-er9ei]

Hi Rishi, Thanks for sharing a nice talk. Just to ask regarding nodal chart you refereed, it is 8th edition. Are you still using same chart or any updated version (as this talk was uploaded about 3 years ago)? Secondly, i couldn't find any satisfactory answer about few subcentimeter thoracic nodes we see in our routine practice in patient with inflammatory conditions or in known malignancy situations. Referring services expect us to comment on these particularly on 1st / baseline study.

[@ThoracicRadiology]

Good question, the lymph node map is not updated on the same cycle as TNM staging, so yes it is still current.

[@ThoracicRadiology]

Yes I frequently see 9-10 mm nodes in connective tissue disease which I do mention in the report. In known malignancy, I don't usually mention small nodes unless they are unusual, for example enlarging nodes or nodes where there are usually no nodes like near diaphragm, pleura, and internal mammary.

[@navazshahrukhkatpitia1951]

Hi Rishi.. Can ypu pls explain this ultra sound report comment.. "Multiple upto 37 x 13.5 mm sized porta peri pancreatic enlarged lymph nodes" What could it be.. I am very scared

[@ThoracicRadiology]

Hi, better to ask your personal physician who knows more about your medical history. good luck.

[@navazshahrukhkatpitia1951]

@@ThoracicRadiology yes..thank you

[@pablovargas90]

Great video! Comes in super handy for a PG-2 Rad Res. Do you have articles like that but for abdominal node stations?

[@dr.shaishavishah8532]

Sir which book is considered good to read thoracic radiology for residents?

[@ThoracicRadiology]

try Webb thoracic imaging

[@tropylium1135]

Great video, Dr. Agrawal. What screen casting application and audio equipment do you use to make your lectures? Keep up the great content.

[@ThoracicRadiology]

Using QuickTime for the Mac to capture the video and audio. Using an Audio Technica microphone hooked up to my Mac via USB.

[@PhoeniX3-6-9]

Great

[@serialblesser]

I need ask what's reactive slightly mediastinal lymphadenopathy? I was diagnosed with them, I am worried? Help would be appreciated

[@ThoracicRadiology]

It means your lymph nodes are enlarged. This can be for many reasons. It is important to see your doctor to figure out why they are enlarged.

[@maryroddy3307]

Good luck to the team of physicians and consultants in endocrinoligy dental gynae and gastroentrogy and medical nano technology team looking into my care. From kathelizjenruddy

[@RagingTortoise]

Out of curiosity, are infraclavicular lymph nodes examined / visible on a thorax CT? You mentioned supraclavicular nodes, but not infra. Not a medical professional, just an enthusiast - so excuse my ignorance :)

[@ThoracicRadiology]

Great question, yes you can see those too but we call them something different. Like if they are under the pectoralis then subpectoral nodes.

[@mahso11]

So lymph nodes do not enhance after IV contrast?

[@ThoracicRadiology]

They do enhance, but they won't be as bright as the vessels. Without contrast, the vessels and lymph nodes look about the same density.

[@sushantnepal3530]

Sir,What is the meaning of few subcentrimetric sizes of lymphnodes noted In mediastinum

[@ThoracicRadiology]

One centimeter is the usual cutoff threshold for lymph nodes. If they are bigger than 1 cm, it is usually abnormal. Smaller than 1 cm usually means normal. Subcentimeter means less than 1 cm

[@sushantnepal3530]

@@ThoracicRadiology thank you sir.much appreciate

[@studymission5430]

Sir I had chest pain and was done a HRCT and found subcentimetric precarinal,​subcarinal,pre-,paratracheal and prevascular lymph nodes found ! Is it a cause of concern ?pls revert thank you @@ThoracicRadiology

[@medhaithemabidi7413]

great very helpful i have a Q: lobar segmental and subsegmental, are they assesed with CT? because i coudn"t find it :/

[@ThoracicRadiology]

Usually these are not described in detail because it doesn’t change the stage of the cancer nor the management very much.

[@tmorelli1982]

Is a "non-specific borderline prominent" subcarinal lymph node (1cm) something to worry about?

[@ThoracicRadiology]

can't say for sure. It depends on the rest of your medical history and findings on the chest CT. better to ask your doc for this.

[@panasmyrnyi-oo2ht]

so many lymph nodes, is this a healthy person?

[@surajkumarkushwaha8028]

sir plz help in ct scan report impression- few small neck nodes(?significance)

[@ThoracicRadiology]

Hi, I'm not sure. It could mean a lot of things. What else was seen on the CT? Did the report make any recommendations?

[@surajkumarkushwaha8028]

@@ThoracicRadiology no recommendation written in ct. thank sir

[@ThoracicRadiology]

Hi, it is probably ok, but every patient is different and you should speak to your doctor about it.

[@rendhyardian58]

Hi doctor. Are normal size mediastinal lymph node usually seen on ct scan of chest? Or only the abnormal one seen?

[@ThoracicRadiology]

Hi, yes, normal size lymph nodes are seen on CT scan of the chest.

[@rendhyardian58]

@@ThoracicRadiology thanks Doctor

[@rendhyardian58]

Sorry for asking 1 more question. If you found a patient with chest ct and there is 0.7 size paratracheal node, and the lung itself is normal. Do you think he need a repeated Ct?

[@ThoracicRadiology]

@@rendhyardian58 Prob not, but that's with limited info. What does the radiologist recommend?

[@rendhyardian58]

The radiologist did not recommend anything. Just said that there is a lymph node seen. The lung and others also normal

[@Shasharsh]

👏👏

[@ihsancetin1049]

gratias ago:spas bra

[@waleedwatfa3918]

Liiiiike

[@yasirjashami7977]

You are magnificent

[@vishnuchandrus6596]

thank you

[@emmagevorgyan1820]

Thank you!

[@jeffreylim7206]

Great