Background: The association of paracardial lymphadenopathy with hepatic metastases in patients undergoing computed tomographic arterial portography (CTAP) prior to possible resection of hepatic metastases is documented.
Methods: CTAP was performed on 45 patients with hepatic metastasis, including 30 with colorectal carcinoma, using 1 cm increments from the dome of the diaphragm through the liver. Two radiologists, blinded to the diagnosis and surgical results, reviewed all portograms and identified all paracardial lymph nodes larger than 8 cm.
Results: Enlarged paracardial lymph nodes were found in three of the 30 colorectal carcinoma patients and two of the remaining 15 patients. All three colorectal patients with paracardial lymphadenopathy demonstrated massive metastatic involvement of the anterior segment of the right hepatic lobe (segment 8: Couinaud nomenclature). Additional metastasis in the superior aspect of the liver was seen in two of these patients as well. Both patients without colorectal carcinoma with paracardial lymphadenopathy had metastasis involving the superior aspect of the liver. Paracardial lymphadenopathy was right-sided in all five patients and bilateral in one. By contrast, 48% (19 of 40) of patients without enlarged paracardial lymph nodes had metastasis in the anterior segment of the right lobe.
Conclusions: This study suggests that paracardial lymphadenopathy is associated with metastatic disease to specific areas within the liver. This nodal involvement can be attributed to lymphatic drainage from the diaphragmatic surface of the liver.