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- 1. Lymphatic System Subdivision of the circulatory system Removes foreign material and cell debris Destroy cells through action of lymphocytes Returns tissue fluid from intercellular spaces to venous system
- 2. Usually not palpable Vessels are lined with a single layer of epithelial cells Comprises: lymph capillaries, vessels, lymph nodes, aggregation of lymph tissue (spleen, thymus & tonsils) Collects from tissue via: lymphatic capillaries vessels ducts Lymphatic System
- 4. Lymph nodes Small Prevent infections F1: production of lymphocytes F2: Production of antibodies and antitoxins F3: Filters bacteria & foreign material Bean-shaped Fibrous capsule Network of reticular fibers Dense arrangement of lymphocytes Lymphatic System
- 5. Thoracic Duct Drains: whole body Except: R side of head & neck R side of thorax R arm Continuation of the cisterna chyli T12-L2 Enters thorax posterior to aorta Through the diaphragm (T12) Runs along vertebral column
- 6. Thoracic Duct Ascends through posterior mediastinum Between thoracic aorta & azygos vein Crosses from right to left posterior to oesophagus T5 – T7 Enters superior mediastinum Runs to the root of neck C7 arches left, opens in venous angle Subclavian & internal jugular unite
- 7. Right Lymphatic Duct Short duct Drains remaining parts of body Runs in root of neck Formed by the junction of R jugular, subclavian & bronchomediastinal trunks Opens – brachiocephalic vein
- 10. Thorax
- 11. Lymphatic Drainage Thoracic Wall Skin (superficial to deep fascia) Superior to plane of umblicus drain to the anterior & posterior axillary lymph nodes Inferior to plane of umblicus drain to the inguinal lymph nodes Muscular wall & pleura (deep to deep fascia) 3 groups – parasternal, posterior intercostal & diaphragmatic nodes
- 13. Areas Lymph nodes Intercostal spaces Anteriorly – parasternal nodes Posteriorly – posterior intercostal nodes Wall (periphery of diaphragm) Diaphragmatic nodes Parietal pleura Parasternal, posterior intercostal & diaphragmatic Lymphatic Drainage Thoracic Wall Left & right thoracic wall drain into thoracic duct and right lymphatic duct, respectively
- 14. Lymphatic Drainage Thoracic Contents 3 groups of lymph nodes Superior mediastinal lymph nodes Posterior mediastinal lymph nodes Tracheobronchial lymph nodes Superior mediastinal Posterior mediastinal Tracheobronchial
- 15. Groups of lymph nodes Afferent Vessels Efferent Vessels Superior Mediastinal Thymus, thyroid & pericardium Form right & left bronchomediastinal Posterior Mediastinal Oesophagus, post. part of pericardium & diaphragm Mainly into thoracic duct, few into tracheobronchial Tracheobronchial Lungs, bronchi, thoracic part trachea & heart Form right & left bronchomediastinal trunks Lymphatic Drainage Thoracic Contents
- 16. Lymphatic Drainage Thoracic Contents Tracheobronchial nodes – 5 groups Paratracheal Superior tracheobronchial Inferior tracheobronchial Bronchopulmonary Pulmonary Left & right bronchomediastinal trunks drain into thoracic duct & right lymphatic duct Paratracheal Paratracheal Inferior tracheobronchial Superior tracheobronchial Bronchiopulmonary Bronchiopulmonary Pulmonary Pulmonary Superior tracheobronchial
- 19. Lymph nodes in Axilla Six groups Lateral group – medial aspect of arm Pectoral/anterior group – lateral & anterior chest, breast & upper abdominal wall Subscapular/posterior group – back, shoulder & neck Central group – lateral, posterior & anterior groups Deltopectoral group – lateral aspect of arm Apical/infraclavicular group – lymph of arm drains directly or indirectly into this group
- 20. 1. Anterior lymph nodes 2. Central lymph nodes 3. Posterior lymph nodes 4. Lateral lymph nodes 5. Apical lymph nodes 6. Parasternal lymph nodes 5 4 3 1 6 2
- 21. Upper Limb 2 groups of vessels: Superficial group drain the skin Medial vessels: basilic vein – drain to axillary nodes Lateral vessels: cephalic vein – drain apical nodes Deep group drains, bone and muscle Run with deep veins to drain the forearm via the supratrochlear nodes lateral group apical nodes
- 22. Lymph nodes in Axilla All the lymph nodes eventually drain into: Right Into the right subclavian lymphatic trunk then into the right lymphatic duct Left Into the left subclavian lymphatic trunk then into the thoracic duct
- 24. The Breast Lymph is drained directly/indirectly via: Seven groups: (7th parasternal nodes)
- 25. The Breast Breast tissue..1 Drain along vascular tributaries to Sappey’s subareolar lymph plexus Medial border – drains to parasternal nodes Inferiomedial quadrant – drains to abdominal lymph nodes 75% of lymph drains to axillary nodes – tail of Spence via pectoral nodes
- 26. Breast tissue..2 Lateral border – drains via lateral branches of intercostal a. – parasternal or posterior intercostal nodes Deep surface drains through pectoralis major terminates in apical nodes The Breast
- 27. Skin of Breast Drains radially to surrounding glands e.g. laterally to axillary nodes, medially to parasternal nodes Lymphatic drainage from left and right breast do communicate Axillary nodes infraclavicular nodes subclavian lymphatic trunk R lymphatic duct or thoracic duct The Breast
- 28. Lymphatic drainage Subdiaphragmatic to abdomen / liver Parasternal to other breast Axillary lymph nodes (75%) Clavicular lymph nodes Intrapectoral
- 30. Axillary Lymph Nodes (75%) Subdiaphragmatic to abdomen / liver Pectoral / anterior** along lateral thoracic v Subscapular / post along subscapular v Lateral / humeral along axillary v Central Related to the intercosto- brachial n Apical above the level of pectoralis minor
- 32. Head & Neck
- 33. Lymphatic Drainage of H&N No lymphatics in CNS Only superficial nodes in head Superficial & Deep nodes in neck Associated with veins & organized around fascia
- 34. Lymphatic Drainage of the Head and Neck Deep cervical lymph nodes Terminal lymph nodes Superior eg. Jugulo-digastric or Inferior eg. Jugulo-omohyoid Regional lymph nodes for superficial structures Occipital, Pre and Posterior auricular, parotid and Buccal, Superficial cervical, submandibular and Submental, Anterior jugular, External jugular Regional lymph nodes for deep structures Prelaryngeal, pretracheal, paratracheal, infrahyoid, retropharyngeal Scalp Eyelids Nose Lips Nasal cavity, paranasal air sinuses, nasopharynx, middle ear, larynx, thyroid gland, oral cavity, teeth, tonsil, tongue, pharynx, cervical oesophagus Deep structures Superficial structures
- 35. Regional Nodes for Superficial Structures of the Head occipital posterior auricular pre auricular parotid buccal
- 36. Submental Superficial cervical Anterior jugular Submandibular External jugular Regional nodes for Superficial Structures of the Neck
- 37. occipital posterior auricular superficial cervical ant. auricular superficial parotid buccal submandibular submental Horizontal superficial ring (Cervical Collar Nodes) Regional Nodes for Superficial Structures of the Head and Neck
- 38. Regional Nodes for Deep Structures of the Head and Neck Pretracheal Superior deep cervical Prelaryngeal Paratracheal Inferior deep cervical
- 39. Regional Nodes for Deep Structures of the Head and Neck Retropharyngeal Infrahyoid
- 40. Jugulo- digastric Jugulo- omohyoid Deep Cervical Nodes – Terminal Nodes
- 42. Lymphatic Drainage of H&N Deep cervical (terminal) nodes Efferent lymph vessels unite – jugular lymph trunks Right open – brachiocephalic vein Left open – thoracic duct
- 43. Lymphatic Drainage of Specific Structures Scalp Rich lymphatic network Vertex Spreads in all direction
- 44. Eyelids & Conjunctiva Lateral ¾ - parotid group Medial ¼ - submandibular group Lymphatic Drainage of Specific Structures
- 45. Nose Surface – submandibular group Root – parotid group Anterior nasal cavity – submandibular group Posterior nasal cavity – deep cervical nodes Sinuses – retropharyngeal group Lymphatic Drainage of Specific Structures
- 46. Lips Upper lip – submandibular group Lower lip – submental & submandibular nodes Lymphatic Drainage of Specific Structures
- 47. Submandibular nodes Deep cervical nodes Submental nodes Deep cervical nodes Tongue Lymphatic Drainage of Specific Structures
- 48. Thyroid Drains to pretracheal nodes Apex – retropharyngeal nodes Mediastinal nodes – inferior thyroid vein Lymphatic Drainage of Specific Structures
- 49. Tonsils Drains to jugulodigastric nodes Adenoids Drain to retropharyngeal nodes Accessory chain Lymphatic Drainage of Specific Structures
- 50. Abdomen
- 51. Lymphatic Drainage of Abdomen Terminal lymph node Aortic lymph node 2 types Pre-aortic Coeliac nodes Superior mesenteric Inferior mesenteric Para-aortic Lumbar Lateral aortic
- 52. Lymphatic Drainage of Abdomen
- 53. Lymphatic Drainage of Anterior & Posterior Abdominal Wall Skin Superior to plane of umblicus drain to the anterior & posterior axillary lymph nodes Inferior to plane of umblicus drain to the superficial inguinal lymph nodes Skin of scrotum drain to superficial inguinal lymph nodes
- 54. Deep lymphatic vessels Drain to nodes adjacent to internal thoracic a. & external iliac a. Drain in relation to iliac vessels, aorta and inferior vena cava Lymphatic Drainage of Anterior & Posterior Abdominal Wall
- 55. Lymphatic drainage of the GIT Organ Regional node Central (terminal) node Abdominal oesophagus Left gastric Coeliac Stomach Gastric Gastro-omental Pancreaticosplenic Coeliac Duodenum anterior Pancreaticoduodenal Coeliac Duodenum posterior Pyloric Superior mesenteric Jejunum and Ileum Mesenteric Superior mesenteric Pancreas Pancreaticosplenic Pyloric Coeliac Superior mesenteric
- 56. Organ Regional node Central (terminal) node Liver Hepatic mainly Phrenic partly Coeliac Posterior mediastinal Gall Bladder Hepatic Coeliac Terminal ileum, Caecum, Appendix Iliocolic Superior mesenteric Ascending & Proximal 2/3rds of transverse colon Paracolic Middle colic Superior mesenteric Distal 1/3rd & descending transverse colon, Sigmoid colon Paracolic Left colic Inferior mesenteric Spleen Pancreaticosplenic Coeliac Lymphatic drainage of the GIT
- 57. Organ Area Central (terminal) node Kidneys Right & Left lumbar Suprarenal glands Lumbar Ureters Superior part Join those of kidney Directly to lumbar Middle part Common iliac nodes Inferior part Common, external or internal iliac nodes Lymphatic drainage of the Kidney, Ureters and Suprarenal glands
- 58. Pre-Aortic Nodes Region Coeliac group Structures part of abdominal foregut Receive lymph from superior and inferior mesenteric nodes Superior mesenteric group Structures part of abdominal midgut Receive lymph from the inferior mesenteric nodes Inferior mesenteric group Structures part of abdominal hindgut Lymphatic drainage of the GIT Summary
- 60. Pelvis
- 61. Lymphatic Drainage of Pelvis 4 Primary groups lie in relation to great blood vessels External, internal & common iliac vessels Sacral nodes lie in relation to sacrum All drain into common iliac nodes lumbar nodes Common iliac nodes directly or indirectly drain lower limb, lower part of abdominal wall & pelvic organs
- 62. Organ Region Lymph nodes Bladder Apex & body External iliac nodes Neck Common iliac nodes Rectum Superior half Pararectal inferior mesenteric nodes via sacral nodes Inferior half Sacral nodes or internal iliac nodes Anal canal Superior to pectinate line Internal iliac common iliac lumbar nodes Inferior to pectinate line Superficial inguinal nodes Lymphatic drainage of Pelvis
- 63. Male Organs Region Lymph nodes Prostate Internal iliac & sacral nodes Urethra Proximal & intermediate Internal iliac external iliac nodes Distal Deep inguinal nodes Vas deferens External iliac nodes Seminal glands Superior part External iliac nodes Inferior part Internal iliac nodes Ejaculatory ducts External iliac nodes Lymphatic drainage of Intrapelvic Sex Organs
- 64. Female Organs Region Lymph nodes Uterus Fundus Lumbar & superficial inguinal nodes Body External iliac nodes Cervix External, internal or sacral nodes Vagina Upper part External, internal or sacral nodes Middle part Internal iliac nodes Lower part Superficial inguinal nodes Ovaries & uterine tubes Lumbar nodes Female urethra Proximal part Internal iliac & sacral nodes Distal urethra Inguinal nodes Lymphatic drainage of Intrapelvic Sex Organs
- 65. Lymphatic drainage of External Genital Organs Male organs Region Lymph nodes Penis Skin Superficial inguinal nodes Glans Deep inguinal & external iliac nodes Carvenous bodies Internal iliac nodes Scrotum Superficial inguinal nodes Testis & epididymis Lumbar nodes Female organs Region Lymph nodes Vulva Superficial inguinal nodes Glans clitoris & labia Deep inguinal nodes
- 66. Lymphatic Drainage of Pelvis & Perineum
- 67. Lower limb
- 68. Lymphatic Drainage Lymph passes from lower limb intermediate nodes inguinal nodes external iliac nodes Inguinal nodes - divided into 2 groups: Superficial groups Deep groups
- 69. Superficial Inguinal Nodes Subdivided further into 2: Horizontal chain - inferior inguinal ligament Vertical chain - along great saphenous vein
- 70. Superficial Inguinal Nodes Drains lymph from the following regions: Gluteal region Lower abdominal wall External genitalia and perineum Vagina Anal canal Uterus via round ligament Surface lower limb Skin of thigh Medial leg and foot
- 71. Great saphenous vein Superficial inguinal lymph nodes Vertical group Horizontal group Superficial Inguinal Nodes Inguinal ligament
- 72. Deep Inguinal Nodes Vary in number between 1-3 Lie medial to femoral vein Nodes located as follows: Great saphenous vein join femoral vein In femoral sheath Lateral part of femoral ring
- 73. Deep Inguinal Nodes Receive afferent vessels deeper structures Glans of penis Connection with superficial inguinal groups also exists
- 74. Great saphenous vein Femoral sheath Femoral vein Deep inguinal lymph nodes External iliac lymph nodes Deep Inguinal Nodes
- 75. Intermediate Nodes 5-6 nodes surround popliteal vessels - fossa Drain deep inguinal nodes external iliac nodes 1 lies below deep fascia Next to small saphenous vein Drains same area as small saphenous vein
- 77. Lymphatic drainage: Overview Superficial popliteal lymph nodes Deep popliteal lymph nodes Superficial inguinal lymph nodes Deep inguinal lymph nodes External iliac lymph nodes Common iliac lymph nodes Lumbar lymph nodes Superficial drainage: Follow superficial veins Superficial inguinal lymph nodes External iliac lymph nodes Common iliac lymph nodes Lumbar lymphatic trunks Deep drainage: Deep lymphatic vessels popliteal lymph nodes deep inguinal lymph nodes external iliac lymph nodes Common iliac lymph nodes Lumbar lymphatic trunks GSV LSV Femoral v Popliteal v S I M L
- 78. 1. Lymphatics vessels of thigh 2. Inguinal lymph nodes 3. External iliac lymph nodes