Lymph Drainage of Limbs

Question 1

where do axillary lymph nodes receive drainage from?

Answer 1

• upper limb
• adjacent shoulder and neck regions
• breast
• post. and ant. thoracic wall
• ant. wall (above umbilicus)
• skin of back (above iliac crests)

Question 2

what are the 5 groups of axillary lymph nodes?

Answer 2

• lateral (humeral)
• anterior (pectoral)
• posterior (subscapular)
• central
• apical

Question 3

to which lymph nodes does the anterior thoracic wall and breast drain?

Answer 3

anterior (pectoral)

Question 4

where is the lateral lymph node located?

Answer 4

lateral wall of axilla, medial and posterior to axillary vein

Question 5

where is the anterior lymph node located?

Answer 5

medial wall of axilla near inf. border of pec. minor

Question 6

where is the posterior lymph node located?

Answer 6

posterior axillary fold

Question 7

where is the central lymph node located?

Answer 7

deep to pec. minor within axilla

Question 8

where is the apical lymph node located?

Answer 8

apex of axilla

Question 9

why is breast cancer most likely to metastasise to anterior (pectoral) lymph nodes?

Answer 9

• 75% of lymph from breast/mammary gland drains there

- palpation of these nodes common in breast exams

Question 10

what care must be taken when breast cancer in nodes is biopsied or removed?

Answer 10

care not to damage long thoracic nerve - damage results in ‘winged’ scapula

Question 11

where do lateral/humeral nodes receive lymph from??

Answer 11

majority of upper limb (except cephalic vessels)

Question 12

where do anterior/pectoral nodes receive lymph from?

Answer 12

anterior thoracic wall and breast

Question 13

where do posterior/subscapular nodes receive lymph from?

Answer 13

posterior thoracic wall and scapula

Question 14

where do central nodes receive lymph from?

Answer 14

• lateral/humeral nodes
• ant./pectoral nodes
• post./ subscapular nodes

Question 15

where do apical nodes receive lymph from?

Answer 15

• central nodes

- cephalic vessels

Question 16

where do apical axillary nodes drain to?

Answer 16

to the suprasclavicular nodes and eventually to the subclavian lymph trunk (SLT)

Question 17

where does the SLT drain to?

Answer 17

• venous system at junction between internal jugular and subclavian veins
• may also drain to thoracic duct on left)

Question 18

where do lymph vessels of great saphenous drain?

Answer 18

> superficial inguinal lymph nodes
deep inguinal nodes
external iliac nodes

Question 19

where do lymph vessels of small saphenous drain?

Answer 19

> popliteal lymph nodes

> deep inguinal nodes

Question 20

what type of vessels drain the medial side of the dorsum and sole of the foot?

Answer 20

medial superficial vessels, accompanying great saphenous vein

Question 21

where do medial superficial vessels accompanying great saphenous vein drain to?

Answer 21

> superficial inguinal nodes

> deep inguinal nodes

Question 22

what type of vessels drain the lateral side of dorsum of foot?

Answer 22

lateral superficial vessels, accompanying small saphenous vein

Question 23

where do lateral superficial vessels accompanying small saphenous vein drain to?

Answer 23

> popliteal nodes

> deep inguinal nodes

Question 24

where do superficial inguinal nodes lie?

Answer 24

• “T” along inguinal ligament and saphenous vein
• outside femoral triangle
• superficial to fascia lata
• along great saphenous

Question 25

where do the superficial nodes receive lymph from?

Answer 25

• ant. abdominal wall (below umbilicus)
• skin of back (below iliac crests)
• perineum
• gluteal region (via sup. and inf. gluteal nodes)
• sup. lower limb

Question 26

where are the deep inguinal nodes located?

Answer 26

medial to femoral vein, in femoral triangle

Question 27

where do deep nodes receive lymph from?

Answer 27

• lower limb (accompanying fem. vessels, incl. from popliteal nodes)
• most drainage from superficial inguinal nodes
• external genitalia

Question 28

where do the deep and superficial inguinal nodes drain to?

Answer 28

external iliac nodes accompanying femoral vein

Question 29

where does lymph from external iliac nodes drain to?

Answer 29

> common iliac nodes
lateral lumbar nodes
cisterna chyli and thoracic duct

Question 30

what is the femoral sheath?

Answer 30

continuation of abdominal transversalis fascia

Question 31

what does the femoral sheath contain?

Answer 31

• femoral artery, vein and canal

- not nerve

Question 32

where is a common site for femoral hernia?

Answer 32

• femoral sheath

- femoral ring

Question 33

what is the function of the femoral canal?

Answer 33

• allows for expansion of femoral vein upon increased venous return
• sometimes contains deep inguinal nodes

Question 34

what is the femoral ring?

Answer 34

• an opening of femoral canal at abdominal side

- weak area of anterior abdominal wall

Question 35

what are the femoral ring boundaries?

Answer 35

anterior:
- med. part of inguinal ligament
medial:
- lacunar ligament
lateral:
- septum between femoral canal and vein
posterior:
- pectineus muscle and fascia (sup. ramus of pubis)

Question 36

what is the femoral canal?

Answer 36

• a short and conical space between medial wall of femoral sheath and femoral vein
• contains deep inguinal lymph nodes