Lymph Drainage of the Limbs

Question 1

What are the components of the lymphatic system ?

Answer 1

Lymph vessels, lymph nodes as well as tonsils, thymus, spleen and intestinal wall

Question 2

What is the main function of the lymphatic system ?

Answer 2

Collecting interstitial fluid from capillary beds and delivering it back to the venous system.

Question 3

What substances can also be carried in lymph vessels, in addition to interstitial fluid ?

Answer 3

Cell debris, hormones, and pathogens

Question 4

What is the function of lymph nodes ?

Answer 4

Filter and phagocytose particulate matter with the help of macrophages and lymphocytes.

Question 5

Summarise the path of interstitial fluid inside the lymphatic system.

Answer 5

• Interstitial fluid from capillary bed absorbed by lymph capillaries
• Call debris, hormones and pathogens also absorbed by lymph capillaries
• Lymph (containing all of the above) carried through lymph vessel
• Lymph passes through lymph node where it it filtered
• Lymph returned to veinous system

Question 6

What kind of CT makes up lymph capillaries ? Are they thick or thin-walled ?

Answer 6

Thin-walled endothelium

Question 7

What are the superficial, palpable lymph node collections of the body ? What do superficial lymph nodes (all together, in general) drain ?

Answer 7

• Cervical lymph nodes
• Axillary lymph nodes
• Inguinal lymph nodes

Drain body wall and limbs

Question 8

What do the deep nodes of the body drain ?

Answer 8

Drain the viscera (abdomen, thorax)

Question 9

Which of superficial or deep nods follow veinous drainage, and which of the two is around/accompanies the arteries ?

Answer 9

Superficial nodes follow venous drainage

Deep nodes are around, or accompany the arteries

Question 10

Which structures do the channels which drain the lymph of the hand and forearm accompany ?

Answer 10

Basilic and cephalic veins

Question 11

Where do the lymph vessels accompanying the basilic vein drain ?

Answer 11

Drain to superficial and deep cubital lymph nodes around the elbow leading to the axillary nodes (lateral group)

Question 12

Where do the lymph vessels accompanying the cephalic vein drain ?

Answer 12

The lymph vessels accompanying the cephalic vein continue with the vein leading to the axillary nodes (apical group) near where the cephalic enters the axillary vein. Some may drain into deep brachial nodes or deltopectoral (with infraclavicular) nodes enroute.

Question 13

Where do the deep channels of the lymphatic system of the arm drain ?

Answer 13

Deep channels of the lymphatic system accompany the arteries and drain via the deep lymph nodes accompanying arteries in the forearm to the axillary nodes.

Question 14

Name the axillary lymph node groups.

Answer 14

1. Anterior (pectoral) group
2. Posterior (subscapular) group
3. Lateral (humeral) group
4. Central group
5. Apical group

Question 15

What do the axillary lymph node groups drain ?

Answer 15

• upper limb
• adjacent shoulder and neck regions
• breast (75%)
• posterior and anterior thoracic wall
• anterior abdominal wall (above the umbilicus)
• skin of the back (above the iliac crests)

Question 16

True or False: There is free communication between the axillary nodes and the cervical nodes.

Answer 16

True

Question 17

Describe the location within the axilla of the lateral (humeral) group, and state what it drains.

Answer 17

Location: at lateral wall of axilla, medial and posterior to axillary vein.

Drainage: Receive lymph from majority of upper
limb (expect from cephalic vessels).

Question 18

Describe the location within the axilla of the anterior (pectoral) group, and state what it drains.

Answer 18

Location: at medial wall of axilla near inferior border of pec minor.

Drainage: Receive lymph from the anterior thoracic wall and breast.

Question 19

Describe the location within the axilla of the posterior (subscapular) group, and state what it drains.

Answer 19

Location: at posterior axillary fold.

Drainage: Receive lymph from posterior thoracic
wall and scapula.

Question 20

Describe the location within the axilla of the central group, and state what it drains.

Answer 20

Location: Deep to pec minor within axilla.

Drainage: Receive lymph from anterior, posterior, lateral groups.

Question 21

Describe the location within the axilla of the apical group, and state what it drains.

Answer 21

Location: apex of axilla.

Drainage: Receive lymph from central nodes and lymph from vessels along cephalic vein.

Question 22

What is the proportion of breast/mammary glands lymph drains into pectoral group of the axillary nodes ?

Answer 22

75%

Question 23

What nodes are often palpated in breast exams ? Why ?

Answer 23

Pectoral group of axillary nodes.

Because breast cancer is most likely to metastasise to these nodes.

Question 24

Which structure can be damaged in a biopsy of the breast ?

Answer 24

Long thoracic nerve

Question 25

Where do the apical group (of axillary node) drain ?

Answer 25

To SUPRACLAVICULAR NODES, leading on to SUBCLAVIAN LYMPH TRUNK (SLT)

Question 26

Where does the SLT drain into the venous system ?

Answer 26

• At junction between internal jugular and subclavian veins (right side)
• Into thoracic duct (left side)

Question 27

What is the largest between right drainage area or left drainage area ?

Answer 27

Left drainage area

Question 28

What are the main lymphatic vessels of the lower limbs which drain lymph of the foot and leg ? What does each one specifically drain ?

Answer 28

Medial superficial vessels: drain the medial side of the dorsum of the foot and sole of foot and leg

Lateral superficial vessels: drain the lateral side of the foot, and posterolateral leg

Question 29

Identify the structures which are accompanied by the medial superficial vessels and lateral superficial vessels respectively.

Answer 29

Medial superfical vessels: accompany the great saphenous vein

Lateral superficial vessels: accompany the small saphenous vein

Question 30

Describe the path of the lymph following the medial and lateral superficial vessels respectively.

Answer 30

Medial superfical vessels –> superficial inguinal nodes –> deep inguinal nodes –> external iliac nodes

Lateral superficial vessels –> popliteal lymph nodes –> deep inguinal nodes (a few will go to superfical inguinal nodes first then to deep inguinal nodes) –> external iliac nodes

Question 31

What is the function of the deep channels of the leg, wrt lymphatic drainage ?

Answer 31

Accompany deep veins and enter the popliteal lymph nodes

Accompany femoral vein to the deep inguinal nodes.

Question 32

Where are the superficial inguinal nodes found ? What do they drain ?

Answer 32

-LOCATION: 
Form a T 
Along inguinal ligament and great saphenous vein and its tributaries
Outside femoral triangle
Superifical to fascia lata

-DRAIN:
Anterior abdominal wall (under umbilicus)
Skin of back (below line of iliac crests)
Perineum
Gluteal region
Superficial Lower limb

Question 33

Where are the deep inguinal nodes found ? What do they drain ?

Answer 33

-LOCATION:
In the femoral triangle, medial to femoral vein

-DRAIN:
Lower limb (accompanying the femoral vessels, including from popliteal nodes)
Superficial inguinal nodes (some can proceed directly to external iliac nodes)
External genitalia

Question 34

Where is the femoral canal found ?

What does the femoral canal contain ?

Answer 34

• Short and conical space between the medial wall of the femoral sheath and the femoral vein
• Contains deep inguinal lymph nodes

Question 35

What is the femoral ring ? What are its boundaries ?

Answer 35

Femoral ring is the base of the femoral canal

BOUNDARIES:
• Ant: the med part of the inguinal ligament
• Med: lacunar ligament
• Lat: septum between the femoral canal and vein
• Post: Pectineus muscle and fascia (superior ramus of the pubis)

Question 36

Describe the path of the lymph, from the superficial and deep inguinal nodes to the veinous system.

Answer 36

-deep inguinal nodes and superficial inguinal nodes (the latter will drain into deep inguinal nodes)
-external iliac nodes
-common iliac nodes
-lateral lumbar lymph nodes
-cisterna chyli
-thoracic duct
-Pirogov’s venous angle
-venous system