lyhmphatic drainage of limbs

Question 1

AXILLARY LYMPH NODES
There are 5 groups of axillary lymph nodes.

Answer 1

i. Lateral group
- Lies along the upper part of the humerus along (medial side of) axillary vein;
- It drains the upper limb.

ii. Pectoral (Anterior) group
- Lies at the lower border of the pectoralis minor along the lateral thoracic vessels.
- It drains the major part of the breast (and upper half of the trunk anteriorly).

iii. Subscapular (Posterior) group
- Lies along the posterior axillary fold along subscapular vessels.
- It drains the:
- shoulder region and upper half of trunk posteriorly
- axillary tail of the breast.

iv. Central group
- Lies in the fat at the center of the axilla.
- Receives lymph from the above nodes

v. Apical group
- Very, deeply placed.
- Lies behind clavipectoral fascia at the apex of axilla.
- Receives lymph from central node.
- Its efferents form the subclavian trunk which drains into:
a) either thoracic duct or right lymphatic duct.
b) directly into junction of subclavian and internal jugular veins.
(i.e. beginning of brachiocephalic vein)
c) few efferents from the apical nodes drain into supraclavicular (inferior deep cervical nodes).

Question 2

THE BREAST( type of gland and location)

Answer 2

Type of gland : Modified sweat gland.
Location : Embedded in the superficial fascia. : Lies - chiefly on pectoralis major
- partly on serratus anterior and external oblique muscles

Question 3

Axillary tail of Spence

Answer 3

Axillary tail of Spence
It is the extension of the gland that passes toward the axilla.

Question 4

Suspensory Ligaments of Cooper

Answer 4

Suspensory Ligaments of Cooper
They are the connecting strands of fibrous tissue which pass:
- from the skin of the breast, including the nipple
- to the underlying fascia covering the muscle on which the breast lie.

Question 5

Arterial supply

Answer 5

Arterial supply

(a) Superior thoracic artery
- From 1st part of the subclavian artery.
- Supplies the upper part of the breast and skin.

(b) Lateral thoracic artery
- From 2nd part of the axillary artery.
- Supplies the lateral part of the breast

(c) Internal thoracic artery [main supply]
- From 1st part of the subclavian artery.
- Supplies the medial part of the breast.

(d) Intercostal arteries

Question 6

Venous drainage of the breast:

Answer 6

Venous drainage of the breast:
- Superficial veins form an anastomotic network and follow the arterial paths.
- Deep veins drain:
- Principally into the internal thoracic and axillary vein via lateral thoracic vein.
- Some drains into the posterior intercostal veins.

Question 7

Lymphatic drainage of the breast (2 type)

Answer 7

Lymphatic drainage of the breast
A. Lymphatic drainage of the skin over the breast (excluding nipple and areola)
B. Lymphatic drainage of the parenchyma, (including nipple and areola)

Question 8

A. Lymphatic drainage of the skin over the breast (excluding nipple and areola)

Answer 8

A. Lymphatic drainage of the skin over the breast (excluding nipple and areola)
Outer part : drains mainly to the anterior/pectoral group of axillary lymph nodes.

Upper part : passes to the clavicular lymph nodes

Medial part : passes to the parasternal lymph nodes.

Lower part : passes to the abdominal lymph nodes.

Lymphatics draining the skin over the medial side of the breast communicate with the opposite breast across the midline; so that a unilateral disease may become bilateral by this route.

Question 9

B. Lymphatic drainage of the parenchyma, (including nipple and areola)

Answer 9

B. Lymphatic drainage of the parenchyma, (including nipple and areola)
- lymphatics accompany the veins draining the breast.
- 75 % (majority) of the lymphatics accompany the lateral thoracic vein and drain
into anterior axillary lymph nodes.
- A few, especially from axillary tail of breast, drain into posterior axillary lymph
nodes.
- 20% of lymphatics from medial side of the breast accompany the perforating
branches of the internal thoracic vein and pass to the parasternal lymph nodes.
- 5% of lymphatics from lateral parts of the breast follow the posterior intercostal
veins and drain into the posterior intercostal nodes.

Question 10

Clinical correlates

Answer 10

Clinical correlates
1. The supero-lateral quadrant of the breast contains large amount of glandular tissue and it is the area where most breast cancers occur.
2. In some cases the breast tumour infiltrates the ligaments of Cooper and causes retraction of the nipple and fixation of the breast to the underlying muscles.
3. When the lymphatic vessels of the skin of the breast are blocked, the skin of the breast become oedematous, a condition called “ peau d’ orange”.