Lymphatic Drainage of Esophagus
The esophagus contains a rich network of lymphatic vessels, largely in the lamina propria of the mucosa but also in the other layers. From the cervical esophagus, lymph vessels course chiefly to the inferior deep cervical (internal jugular) lymph nodes and possibly also to the nearby paratracheal nodes situated in the groove between the esophagus and trachea. The internal jugular lymph nodes, a subdivision of the deep cervical nodes, lie along the internal jugular vein, stretching from the parotid gland to the clavicle. On the left side, they drain to the thoracic duct and on the right to the short right lymph duct, which opens into the right subclavian vein at the angle formed by the latter with the internal jugular vein.
From the thoracic esophagus, lymphatic fluid drains posteriorly to the posterior mediastinal and intercostal lymph nodes. The posterior parietal nodes are formed of the posterior mediastinal and intercostal nodes. The posterior mediastinal nodes lie alongside the vertebral column, and the intercostal nodes are in the nearby intercostal spaces. Both these groups drain generally superiorly and eventually empty into the thoracic duct or into the right lymph duct, which terminates at the right subclavian vein, where it joins the right jugular vein. The superior phrenic nodes near the posterior esophagus are closely associated with the posterior parietal nodes, to which they drain. Anteriorly, the thoracic esophagus drains to the paratracheal, superior tracheobronchial, and inferior tracheobronchial lymph nodes; more inferiorly, lymphatic fluid drains to juxtaesophageal and superior phrenic lymph nodes before flowing superiorly.
The paratracheal nodes form a chain on each side alongside the trachea along the course of the recurrent nerves. The superior and inferior tracheobronchial nodes are the group that is situated about the bifurcation of the trachea and in the angle formed by the bifurcation. These lymph nodes may be responsible for the formation of traction diverticula when they become fibrosed as a result usually of tuberculous involvement. The tracheal and tracheobronchial nodes drain superiorly and usually form on each side a bronchomediastinal trunk, which, in turn, joins either the thoracic duct or the right lymph duct. They may, however, also have independent openings into the veins or may unite with the internal thoracic chain or a low node of the internal jugular chain.
From the short abdominal portion of the esophagus, lymphatic drainage is similar to that from the upper portion of the lesser curvature of the stomach, chiefly to the cardiac nodes of the stomach, which are a subdivision of the left gastric lymph node group. From here, in turn, drainage is to the celiac lymph nodes. Some lymph vessels from this region also pass superiorly through the esophageal hiatus of the diaphragm and connect with the vessels and nodes above the diaphragm. Drainage from the left gastric nodes is along the course of the left gastric artery and coronary vein to the celiac nodes situated on the aorta in relation to the root of the celiac trunk. These nodes, in turn, empty into the cisterna chyli or the thoracic duct.