THE ASSOCIATION OF PARACARDIAL ADENOPATHY WITH HEPATIC METASTASIS FOUND ON CT ARTERIAL PORTOGRAPHY

Background: The association of paracardial lymphadenopathy with hepati c metastases in patients undergoing computed tomographic arterial port ography (CTAP) prior to possible resection of hepatic metastases is do cumented. Methods: CTAP was performed on 45 patients with hepatic meta stasis, including 30 with colorectal carcinoma, using 1 cm increments from the dome of the diaphragm through the liver. Two radiologists, bl inded to the diagnosis and surgical results, reviewed all portograms a nd identified all paracardial lymph nodes larger than 8 cm. Results: E nlarged paracardial lymph nodes were found in three of the 30 colorect al carcinoma patients and two of the remaining 15 patients. All three colorectal patients with paracardial lymphadenopathy demonstrated mass ive metastatic involvement of the anterior segment of the right hepati c lobe (segment 8: Couinaud nomenclature). Additional metastasis in th e superior aspect of the liver was seen in two of these patients as we ll. Both patients without colorectal carcinoma with paracardial lympha denopathy had metastasis involving the superior aspect of the liver. P aracardial lymphadenopathy was right-sided in all five patients and bi lateral in one. By contrast, 48% (19 of 40) of patients without enlarg ed paracardial lymph nodes had metastasis in the anterior segment of t he right lobe. Conclusions: This study suggests that paracardial lymph adenopathy is associated with metastatic disease to specific areas wit hin the liver. This nodal involvement can be attributed to lymphatic d rainage from the diaphragmatic surface of the liver.