2006 Volume 32 Issue 3 Pages 258-262
The right (left) bronchomedistinal lymph trunks are classified into the superiormost, superficial and deep (superior and inferior) groups. Because mediastinal nodes often issue these trunks to the venous angle or thoracic duct, most of the mediastinal nodes are considered as the last-intercalated node or end node. Cancer metastasis along the lymphatics from the neck to the medistinum seems to be caused by 1) thick vessels communicating between the pretracheal node and brachiocephalic angle node and 2) lymph flow reflux toward the periphery due to intranodal shunt and lymphatic valve insufficiency. Submucosal lymphatics of the esophagus seem to cause early skip metastasis. There is little information available as to whether famous fascial structures at the base of the neck are histologically proven structures or dissection artifacts.
