Para-aortic lymph nodes !
The lumbar nodes are lymph nodes along the aorta and vena cava at the back of the abdomen; they drain the kidneys, the testes or ovaries and the legs' lymph.
Official name: Intermediate lumbar nodes
Opens in the Durgical app, no sign-up needed.
What it is
Lymph nodes around the aorta and vena cava (para-aortic).
What it does
Collect lymph from the kidneys, testes, legs and pelvis; testicular cancer spreads here first.
Key facts
- Where
- Para-aortic chain around aorta and IVC: left lumbar (lateral aortic), intermediate (aortocaval) and right lumbar (caval) nodes
- Drains
- Kidneys, adrenals, testes or ovaries, uterine tubes, posterior abdominal wall; common iliac nodes (pelvis, lower limbs)
- Into
- Right and left lumbar trunks, then cisterna chyli
Relations
- In front
- Preaortic node groups and the left renal vein crossing the aorta; the third part of the duodenum and the pancreas
- Behind
- Lumbar vertebral bodies, lumbar vessels and the origins of psoas major; retroaortic and retrocaval nodes
- Lateral
- Left group on the left psoas major near the left ureter and sympathetic trunk; right group around the inferior vena cava
- Above
- The lumbar lymph trunks rising to the cisterna chyli at about L1–L2
- Below
- The common iliac nodes below the aortic bifurcation
How to find it
Not palpable when normal. They lie around the aorta and the inferior vena cava from the renal vessels down to the aortic bifurcation; in retroperitoneal dissection they are cleared from the paracaval, interaortocaval and para-aortic zones, within templates that spare the sympathetic nerves needed for ejaculation.
On imaging
CT or MRI stages them; bulky retroperitoneal nodes can lift the aorta off the spine (the floating aorta sign, typical of lymphoma). PET-CT is used in lymphoma and other cancers.
Common problems
- Cancers of the stomach and pancreas spread to them; surgeons remove them with the tumour.
Clinical notes
- Testicular cancer: the retroperitoneal nodes are the first station; orchiectomy is done through the groin, not the scrotum, so as not to open new lymph routes
- Retroperitoneal lymph node dissection can cause chylous ascites and, if nerves are not spared, loss of ejaculation
- Para-aortic spread upstages cervical and endometrial cancer and widens the radiotherapy field
- Lymphoma and tuberculosis cause retroperitoneal node enlargement with fever and weight loss; both are relevant in Colombia
Test yourself
Think of the answer, then tap the question to see it.
To which nodes does the testis drain, and why?
To the para-aortic nodes near the renal vessels (about L1–L2), not the groin, because the testis descended from the posterior abdominal wall with its lymphatics.
Where does the lymph of the scrotal skin drain?
To the superficial inguinal nodes, unlike the testis.
What is the first nodal station for right and left testicular cancer?
Right testis: the interaortocaval nodes. Left testis: the left para-aortic nodes just below the left renal vein.
Why is orchiectomy for testicular cancer done through the groin?
So as not to open new lymph routes through the scrotum; the retroperitoneal nodes are the first station.
What does the floating aorta sign on CT suggest?
Lymphoma: bulky retroperitoneal nodes lift the aorta off the spine.
Educational information, not medical advice. For any symptom, see a health professional.
Its names
- Official Latin (TA2)
- nodi lumbales intermedii; nodi preaortici; nodi lumbales sinistri TA2 5274
- Official Spanish (DeCS)
- Nódulos linfáticos lumbares DeCS D008198
- English (TA2)
- Intermediate lumbar nodes
- Also called
- nodi lumbares intermedii
Sources: Terminologia Anatomica (TA2); DeCS; Anatomy, Abdomen and Pelvis: Lymphatic Drainage.
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Representative model, for educational purposes only.
