Common iliac lymph nodes

Last revised by Dr Bahman Rasuli on 18 Sep 2021

The common iliac lymph nodes are found surrounding the common iliac artery and vein which is located above the bifurcation of the external and internal iliac vessels and distal to the aortic bifurcation (in a majority of patients at the L4 level and a minority at the L3 or L5 level) and medial to psoas muscle 4.

Gross anatomy

The common iliac lymph nodes are located in the lumbosacral fossa and can be subdivided into three main groups according to their anatomic location in relation to the common iliac vessels 3.

  • Medial

  • Lateral

  • Middle or Intermediate​

The common iliac lymph nodes primarily drain the external iliac lymph nodes and internal iliac lymph nodes while the efferent channels drain into the periaortic lymph nodes.

Radiologic features

CT and MRI is the most common imaging modality in patients when pelvic metastatic disease is considered. The normal appearance of lymph nodes predominately have smooth borders except for vessels in the hilum 3. In regards to sizes, there is discussion to cutoff when considering metastatic pathology due to the wide variety in non-pathologic lymph node size. One specific study (Koh,2006) recommends a size threshold of 8 mm (short-axis diameter) for pelvic nodes when considering metastatic disease 2. In regards to lymph node involvement with staging, the common iliac lymph nodes are regional for the cervix, endometrium, and ovary and considered non-regional for the bladder, anus, penis, prostate, rectum, testis, vulva, and vagina 1.

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