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[Lymphatic system](https://durgical.com/en/anatomy/system/lymphatic-system/) · [Chest](https://durgical.com/en/anatomy/region/chest/)

# Parasternal lymph nodes

The parasternal lymph nodes lie beside the breastbone, along the internal thoracic vessels; they drain the [chest](https://durgical.com/en/anatomy/region/chest/) wall and the inner part of the breast.

Official name: Parasternal nodes

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## What it is

Lymph nodes along the internal thoracic vessels beside the [sternum](https://durgical.com/en/anatomy/sternum/), and between the [ribs](https://durgical.com/en/anatomy/ribs/).

## What it does

Drain the chest wall and part of the breast.

## Key points

- Most breast lymph drains to the axilla; the parasternal (internal mammary) nodes take a smaller share, mainly from the medial half of the breast
- Involved internal mammary nodes are regional disease in breast cancer staging (N2 without axillary spread, N3 with it)
- They link across the midline and with the anterior diaphragmatic nodes, so a medial breast cancer can reach the other side or the upper [abdomen](https://durgical.com/en/anatomy/region/abdomen/)

## Key facts

**Where**
Along internal thoracic vessels at anterior ends of intercostal spaces

**Drains**
Medial breast, anterior chest wall, anterior [diaphragm](https://durgical.com/en/anatomy/diaphragm/), upper anterior abdominal wall, upper surface of [liver](https://durgical.com/en/anatomy/liver/)

**Into**
Bronchomediastinal trunks (or directly into venous angles)

## Relations

**In front**
[Costal cartilages](https://durgical.com/en/anatomy/costal-cartilage/) and the front ends of the [internal intercostal muscles](https://durgical.com/en/anatomy/internal-intercostal-muscles/), mostly in the upper intercostal spaces

**Behind**
Endothoracic fascia and parietal [pleura](https://durgical.com/en/anatomy/pleura/); the [transversus thoracis muscle](https://durgical.com/en/anatomy/transversus-thoracis-muscle/) lower down

**Medial**
Sternal edge, with the [internal thoracic artery](https://durgical.com/en/anatomy/internal-thoracic-artery/) and veins running alongside the nodes

## How to find it

Not palpable. They lie in the upper intercostal spaces, mostly the 1st to 3rd, along the internal thoracic vessels about a finger-breadth from the sternal edge, deep to the costal cartilages and intercostal muscles. They are seen on CT, MRI and PET, and sentinel node mapping can show drainage to them.

## On imaging

Normally too small to see. On CT, MRI or PET-CT an enlarged node shows in the fat beside the internal thoracic vessels, mostly in the upper spaces; sentinel node scintigraphy sometimes shows drainage to them.

## Common problems

- Enlarge with infections, sarcoidosis or cancer; checking them is key to staging lung cancer.

## How it is diagnosed

CT and PET scans; biopsy through a bronchoscope (EBUS).

## Clinical notes

- Included in the radiotherapy field for some breast cancers, which brings part of the heart and lung into the field on the left
- A cancer in the medial half of the breast can spread here even when the axillary nodes are clear

## Related conditions

- [Breast cancer](https://durgical.com/en/conditions/breast-cancer/)

## Test yourself

Think of the answer, then tap the question to see it.

## Which part of the breast drains mainly to the parasternal (internal mammary) lymph nodes?

The medial half; most breast lymph still drains to the axilla.

## Along which vessels do the parasternal lymph nodes lie?

Along the internal thoracic artery and veins, at the front ends of the intercostal spaces beside the sternum.

## Why can a medial breast cancer reach the other side or the upper abdomen?

The parasternal nodes link across the midline and with the anterior diaphragmatic nodes.

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Educational information, not medical advice. For any symptom, see a health professional.

## Its names

**Official Latin (TA2)**
nodi parasternales TA2 5250

**Official Spanish (DeCS)**
Nódulos linfáticos paraesternales DeCS D008198

**English (TA2)**
Parasternal nodes

**Also called**
lymphonodi sternales

Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=8375); [Anatomy, Thorax, Internal Mammary (Internal Thoracic) Arteries](https://www.ncbi.nlm.nih.gov/books/NBK537337/); [Anatomy, Thorax, Breast](https://www.ncbi.nlm.nih.gov/books/NBK519575/).

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Representative model, for educational purposes only.

---
Source: https://durgical.com/en/anatomy/parasternal-nodes/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/parasternal-nodes/