title: Cascade of metastatic colorectal carcinoma from the liver to the anterior diaphragmatic lymph nodes.
abstract: OBJECTIVE
  Metastases of colon carcinoma from the liver to porta hepatis and celiac axis lymph nodes constitute a contraindication to hepatic metastatic resection. Our objective was to determine the frequency of anterior diaphragmatic lymph node (ADLN) enlargement, another efferent pathway of hepatic lymphatic drainage, in patients with colon carcinoma.
  
  
  METHODS
  Abdominal computed tomography scans from 50 patients with colon carcinoma in whom hepatic metastases were either present (n = 25) or absent (n = 25) were reviewed. ADLNs greater than or equal to 5 mm were considered enlarged.
  
  
  RESULTS
  Thirteen of 25 patients with hepatic metastases had ADLNs greater than or equal to 5 mm; three of 25 patients without hepatic metastases had ADLNs greater than or equal to 5 mm. The difference was statistically significant (p = .002).
  
  
  CONCLUSIONS
  Metastases of colon carcinoma from the liver to the ADLNs probably are not rare. ADLN involvement would obviate hepatic resection. The ADLNs should be assessed preoperatively in surgical candidates with hepatic metastases of colon carcinoma.
authors.affiliation: University of Texas, M. D. Anderson Cancer Center, Diagnostic Radiology Department, Houston, USA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Graham
authors.forename: H I
authors.initials: HI
authors.lastname: Libshitz
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000473:pathology*; D003964:Diaphragm; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed