Objective To discuss the clinical value of spiral CT in diagnosing thoracic segment esophageal cancer lymph node metastasis, to provide reference basis for future clinical practices, and to improve the level of the diagnosis of thoracic segment esophageal cancer lymph node metastasis. Methods Eighty patients with thoracic segment esophageal cancer lymph node metastasis admitted by the Hospital during the period from January, 2010 to January, 2014 were selected as research subjects, retrospective analysis and summary were made according to clinical data, and clinical value of spiral CT in the diagnosis of thoracic segment esophageal cancer lymph node metastasis was explored. Results The sensitivity, specificity and accuracy rate of CT diagnosis in the diagnosis of thoracic segment esophageal cancer lymph node metastasis hit 84.2%, 78.3% and 82.5% respectively, the differences were not statistically significant when compared to results of pathological examination (p<0.05). The number of top mediastinal juxta-groups and paratracheal juxta--groups in the upper thoracic portion was the most, hitting 42.9% and 33.3% respectively, and the number of mediastinum groups, paratracheal juxta-groups and submental juxta-groups in the mid-thoracic portion was the most, hitting 22.9%, 37.5% and 25.0% respectively, and the number of cardia juxta-group and left gastric arteries in the lower thoracic portion was the most, hitting 54.5% and 27.2% respectively. Conclusions Spiral enhanced CT delivers important clinical value in the diagnosis of thoracic segment esophageal cancer lymph node metastasis, its images possess certain characteristics, and it can improve the diagnostic accuracy, clearly show the metastasis availability of lymph nodes, and provide important diagnostic basis for clinical treatment, being worth of wide application and promotion in clinical practices.