Lymphatic Drainage Routes Flashcards
What is lymphatic fluid?
Extracellular fluid that does not get reabsorbed into the capillary bed
What do lymphatic vessels contain?
Valves to create a unidirectional flow of fluid
What is the purpose of lymph nodes?
- Filtration
- Centres of antigen presentation
- Centres of lymphocyte activation, differentiation and proliferation
Label the parts of the lymph node on the image
What occurs in the secondary lymphoid follicles?
Activation of lymphocytes
Why do lymph vessels follow the arterial supply?
The pulsation of the arteries aids the return of lymphatic fluid back to the vascular system
Where do lymphatic networks drain back into the venous system?
Label the structures on the diagram
Left and right inferior neck
Where does the thoracic duct drain into?
Left subclavian vein
What regions of the body drain into the left subclavian vein?
How does the lymph enter the left subclavian vein?
- Left side of head and neck
- Left upper and lower limbs
- Left upper and lower trunk
- Right lower trunk
- Pelvic organs
- Right lower limb
Enters the left subclavian vein via the thoracic duct
What regions of the body drain into the right subclavian vein?
Which lymphatic vessel do they drain into before this?
- Right side of head and neck
- Right upper limb
- Right upper thorax
Drain into the right lymphatic duct
What could be the first sign of lung cancer?
Lymphadenopathy around the drainage point (right or left) for the affected area of lung
Where do lymphatic vessels of the skin and subcutaneous fluid drain into?
Lymph nodes located in the groin/axilla/knee/elbow
Where do the cubital lymph nodes sit?
Around the medial epicondyle
What should be checked if lymphangitis is present?
What can commonly cause lymphangitis?
The distal part of the limb
Can be commonly caused by infection
What can present similarly to lymphangitis?
Thrombophlebitis
Where do the deep inguinal nodes sit?
Where do they drain into?
Medial to the femoral vein
Drain into the external iliac nodes → common iliac → abdominal aortic
Where do the superficial inguinal lymph nodes sit?
Vertical: Along long saphenous vein
Horizontal: Under the inguinal ligament
Which perineal structures drain into the superficial and deep inguinal lymph nodes?
Superficial:
- Penis
- Scrotum
- Perineum
- Buttock
- Abdominal wall
Deep:
- Deep lymphatic trunks of the thigh (from lower limb)
Describe the lymphatic drainage of the abdominal wall
What is the clinical significance of this?
- Right upper quadrant: Right axillary lymph nodes
- Left upper quadrant: Left axillary lymph nodes
- Right lower quadrant: Left and right superficial inguinal lymph nodes
- Left lower quadrant: Left and right superficial inguinal lymph nodes
Skin cancers: for predicting the potential lymphatic spread of melanoma
Label the lymphatic vessels on the diagram
Where does the GI tract drain to?
Cisterna chyli
What does the bronchomediastinal trunk drain lymph from?
Lungs and tracheobronchial tree
Mediastinal organs: oesophagus, great vessels, heart
What might lymphadenopathy in the left supraclavicular lymph nodes indicate?
Why is this?
(Virchow’s nodes): May indicate stomach or upper GI cancers.
This is because upper GI organ lymphatic drainage follows a simpler drainage route through less nodes, therefore has more chance than a lower GI tract cancer of reaching the supraclavicular nodes.
What is mesenteric adenitis?
What age groups does it affect?
What does it mimic?
Inflammation of abdominal mesenteric lymph nodes, most commonly affecting children under 16. Can mimic appendicitis.
Commonly caused by infection and is most often self-limiting.
What other routes of lymphatic drainage may be available for the metastases of GI cancers?
Vertebral column (via venous drainage)
What is the collective name for the coeliac, superior mesenteric and inferior mesenteric lymph nodes?
Pre-aortic lymph nodes
What do the abdominal lymphatic vessels sit in close proximity to?
What is the clinical significance of this?
Autonomic nerve plexi
Lymph node resection around the aorta can damage autonomic nerve supply. Damage to the autonomic nerves around the aortic bifurcation may affect the secretory phase of male ejaculation, e.g. inferior mesenteric node resection in hindgut neoplasm metastasis.
What is this?
What structures can be compressed by this?
Thoracic X-ray showing mediastinal lymphadenopathy
Nerves, airways, blood vessels can be compressed.
What may be compressed by left hilar lymphadenopathy?
Vagus nerve
Left recurrent laryngeal nerves
Phrenic nerve (hiccups/ left hemidiaphragmatic palsy)
What can be compressed by subcarinal lymphadenopathy?
Broadening of carina
What structure has been compressed in this patient?
Superior vena cava (venous congestion in upper limbs, head and neck)
What is the relevance of the pectinate line in terms of lymph drainage?
Above the pectinate line: drains to internal iliac lymph nodes
Below the pectinate line: drains to superficial inguinal lymph nodes
Where do ovaries and testicles drain lymph to?
Why is this?
Para-aortic lymph nodes
Because of their development on the posterior abdominal wall, lymph follows the testicular/ovarian arteries.
Where do the nipples, aerolar and breast tissue drain lymphatic fluid into?
Axillary and deep lymph nodes
Where does the skin of the breast drain lymph into?
Deltopectoral lymph nodes
Inferior deep cervical nodes
What could lymphadenopathy of axillary lymph nodes compress?
Brachial plexus
What lymph nodes collectively make up Waldeyer’s ring?
Tonsilar, lingual, tubal, adenoid/nasopharyngeal lymph nodes
What could be a consequence of enlargement of adenoid lymph nodes?
Blockage of pharyngotympanic tube and impaired drainage of middle ear- middle ear infection.
Label the superficial lymph nodes numbered 1-5 on the diagram
What do they drain?
-
Submental:
- Lower lip
- Tip of tongue
-
Submandibular:
- Lip
- Lateral body of tongue
- Nose
- Face
-
Parotid (preauricular):
- Temporal scalp
- Eye
-
Mastoid:
- External auditory meatus
- Pinna
-
Occipital:
- Occipital scalp region to vertex
- Superficial cervical
Label the deep lymph nodes numbered 7-9 on the image
What do they drain?
-
Jugulo-digastric:
- Tonsil
- Pharynx
- Posterior tongue
-
Deep cervical chain:
- Superficial node groups
-
Jugulu-omohyoid:
- Superficial node groups and central tongue
