Anterior diaphragmatic lymph nodes

In evaluating patients for malignant disease, involved or uninvolved anterior diaphragmatic lymph nodes (ADLNs) may be observed at computed tomography (CT) evaluation of either the chest or abdomen. While ADLNs have been described on both chest radiography and CT, lymph nodes lateral to the cardiophrenic angles have not been as well illustrated. In this review, we examine the anatomy of the entire group of ADLNs and emphasize the importance of the more laterally placed ADLNs. ADLNs were identified at CT in 125 patients. Lymphoma (41%) was the malignancy most commonly associated with enlarged ADLNs followed by breast cancer (12%), colon cancer (10%) and lung cancer (6%). Twenty other malignancies accounted for 30% of the series. ADLNs lateral to the cardiophrenic angles were half as common as the other ADLNs. Right-sided nodes were more common than left-sided ones. Of 71 patients with two or more CT scans, 53 showed change in size of the nodes on follow-up examination. Our data do not support prior reports that suggest that a particular site of origin of malignancy exclusively involves one side or other of the ADLNs. In our experience, knowledge of the location and appearance of the entire group of ADLNs, including those nodes lateral to the cardiophrenic angles, has been useful in planning radiotherapy portals in Hodgkin disease, as well as staging and follow-up of other malignancies.