Retropharyngeal lymph nodes

Last revised by Ammar Ashraf on 19 Aug 2023

The retropharyngeal lymph nodes are paired groups of cervical lymph nodes located in the suprahyoid portion of the retropharyngeal space.

Located in the retropharyngeal space between the visceral (buccopharyngeal) fascia and the alar fascia, there are two groups 1:

  • medial retropharyngeal lymph nodes
    • located near the midline immediately anterior to the prevertebral muscles
    • less common: visible on imaging in only a minority of children and rarely present in adults 2; usually unilateral
    • usually located at the C2-C3 level
  • lateral retropharyngeal lymph nodes
    • immediately anterior to the lateral margins of the prevertebral muscles
    • more common: found in the vast majority of children and most adults; usually bilateral
    • usually located more superiorly, at the skull base (C1) or C1-C2 level

The node of Rouvière refers to the superior most lateral retropharyngeal lymph node, although the term "nodes of Rouviere" has also been used to refer to the lateral retropharyngeal lymph node group in general.

The retropharyngeal lymph nodes decrease in size and number with age 3. In one study of healthy subjects using MRI, the upper limit of normal (2 standard deviations above the mean) of minimal axial diameter of lateral retropharyngeal lymph nodes was 9 mm in children (6-19 years), 6.4 mm in young and middle aged adults (20-38 years), and 5.2 mm in older adults (42-74 years) 3.

The existence of retropharyngeal lymph nodes was first described by the French anatomist Henri Rouvière (1876-1952) in 1928 4,7.

Metastatic lymphadenopathy, such as from nasopharyngeal carcinoma, may be suggested in older adults by the presence of retropharyngeal nodes with particular imaging features 5:

  • short axis diameter >6 mm
  • central necrosis
  • ipsilateral grouping of two or more nodes
  • presence of medial group nodes
  • superior cervical ganglia: nodular structures located slightly more posterolaterally than the lateral retropharyngeal lymph nodes, anterior to the C2 transverse process and immediately medial/anteromedial to the internal carotid artery 6

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