LYMPHATIC DRAINAGE TABLE UW Flashcards
Submandibular (mandibular angle)? area drained
oral cavity (Tongue, gum, cheek, lips)
Submandibular? pathology
Malignancy of oral cavity (metastasis and turmors), tonsilitis
Deep cervical (sternocleido, accompany internal jugular and carotid)? area drained
Lymph fluid drainage of all superficial lymph node groups of the HEAD and NECK + OROPHARYNX
Drain into the right lymphatic duct and thoracic duct
Deep cervical? pathology
Upper respiratory tract infections
Infectious mononucleosis
Kawasaki disease
Malignancy of the head, neck, and oropharynx
LEFT Supraclavicular (Virchow nodes)? area drained
Left thorax, Lungs, Left upper extremity
Abdomen, Pelvis
LEFT Supraclavicular (Virchow nodes)? pathology
Lung carcinoma
Sarcoidosis
+!!!!!
Left supraclavicular lymphadenopathy (Troisier sign) is usually indicative of a possible abdominopelvic malignancy (especially metastatic gastric or pancreatic carcinoma).
RIGHT Supraclavicular? area drained
Right supraclavicular nodes drain into the right lymphatic duct and collect:
Neck, Right thorax, Right upper extremity, Right mediastinum, Lungs, Esophagus
RIGHT Supraclavicular? pathology
Lung carcinoma
Sarcoidosis
Mediastinal = paratracheal? area
Occurs in anterior mediastinum;
Drain structures within the mediastinum (trachea, esophagus, hila of the lungs, heart and pericardium, thymus)
Mediastinal = paratracheal? pathology
Mediastinal malignancies: Lung carcinoma; Esophageal carcinoma; Hodgkin lymphoma
Metastatic malignancies (e.g., breast carcinoma, thyroid carcinoma)
Granulomatous pulmonary diseases e.g., tuberculosis (unilateral), sarcoidosis (bilateral), histoplasmosis, pneumoconiosis, mycoplasma
Hilar? area
Occurs: Adjacent to main stem bronchus (hila of the lungs)
Drains LUNGS
Hilar? pathology
Lung carcinoma
Granulomatous pulmonary diseases e.g., tuberculosis (unilateral), sarcoidosis (bilateral), histoplasmosis, pneumoconiosis, mycoplasma
Where drains mediastinal and hilar lymph nodes?
thoracic duct
In sarcoidosis which side of lymph nodes is affected?
Sarcoidosis (bilateral hilar)
In TB which side of lymph nodes is affected?
Pulmonary TB (unilateral hilar)
Lung carcinoma, sarcoidosis and TB, pneumoconiosis, mycoplasma. What lymph nodes?
BOTH MEDIASTINAL AND HILAR
Mestastatic malignancies affect which chest lymphnodes?
mediastinal
Supra/Epitrochlear? location ?
Subcutaneous fat above medial epicondyle of humerus (∼ 3 cm from elbow)
Supra/Epitrochlear? area drained
Ulnar forearm and hand
Drain into the axillary lymph nodes
Supra/Epitrochlear? pathology
SECONDARY SYPHILIS Melanoma Lymphoproliferative disorders Infections of hand and forearm Tularemia
Periumbilical (Sister Mary Joseph node)? location?
Grouped around the umbilicus
Periumbilical (Sister Mary Joseph node)? drained area
Abdomen and pelvis (umbilical area)
Drain into axillary, inguinal, and para-aortic lymph nodes
Periumbilical (Sister Mary Joseph node)? pathology
metastasis of malignant cancer in the abdominopelvic region (e.g., GASTRIC cancer, pancreatic cancer, ovarian cancer)
Celiac? location
Around the origin of the celiac trunk
Celiac? area drained
Stomach, UPPER duodenum, pancreas, spleen, liver and biliary tract (foregut)
Pre-aortic lymph nodes group? 3
celiac, superior mesenteric, inferior mesenteric
Superior mesenteric? location
Around the origin of the superior mesenteric artery
Superior mesenteric? area drained
Lower duodenum, small intestine (jejunum, ileum) and colon to the splenic flexure (midgut)
Inferior mesenteric? location
Around the origin of the inferior mesenteric artery
Inferior mesenteric? area drained
Colon from splenic flexure to the uppermost part of the rectum (hindgut)
Where drains all groups of pre-aortic lymph nodes?
Cisterna chyli (via intestinal lymphatic trunk)
Pre-aortic lymph nodes. Pathologies?
Infectious focus in the bowel (e.g., appendicitis, colitis, typhoid fever)
Mesenteric lymphadenitis
Inflammatory bowel disease (e.g., ulcerative colitis)
Celiac disease
Colon cancer
PARA-aortic (lumbar)? location
In front of the lumbar vertebrae near the aorta, around the renal vein
PARA-aortic (lumbar)? area drained
Kidneys and suprarenal glands
Females: ovaries, uterus, fallopian tubes
Males: testes
Receive lymph from the common iliac nodes
PARA-aortic (lumbar)? pathology
Endometrial cancer
Ovarian cancer
Testicular cancer
METASTASIS
PARA-aortic (lumbar)? drains to
Cisterna chyli (via lumbar lymphatic trunk)
External iliac? location
Around the external iliac arteries
External iliac? area drained
Body of the uterus Fundus of the bladder (superior bladder) Cervix Upper third of the vagina Lymph from the deep inguinal nodes
External iliac? pathology
Sexually transmitted infections (STI)
Metastasis
Where drains external and internal iliac?
common iliac lymph nodes
Internal iliac? location
Surrounding the internal iliac arteries
Internal iliac? drained area
Lower rectum and anal canal (above the dentate line)
Bladder (except the fundus)
Cervix, lower uterus, and middle third of the vagina
Prostate and corpora cavernosum
Internal iliac? pathology
Bladder cancer
Cervical cancer
Prostate cancer
Sexually transmitted infections (STI)
Common iliac lymph nodes? location
Around the common iliac vessels
Common iliac lymph nodes? area drained
Lymph from the internal and external iliac nodes
Common iliac lymph nodes? pathology
Metastasis
where drains common iliac lymph nodes?
para-aortic
Inguinal lymph nodes consist of…..?
superficial and deep inguinal
Superficial inguinal? location
Superficial fascia of the thigh in the region of the femoral triangle
Superficial inguinal? area drained
from FA: Anal canal (below pectinate line), skin below umbilicus (except popliteal area), scrotum, vulva
- Horizontal group:
Inguinal region
Inferior abdominal wall (below the umbilicus)
Gluteal region
Scrotum, vulva, lower third of the vagina, penis except for the glans
Distal anal canal (below the pectinate line) - Vertical group: lower limb with the exception of the gluteal region, popliteal area, and the lateral surface of the lower leg
Drain into the deep inguinal lymph nodes
Superficial inguinal? pathology
STDs (e.g., lymphogranuloma venereum, genital herpes, chancroid, syphilis)
Pelvic malignancy (e.g., anal or vulvar cancer)
Infection of the lower extremity
Melanoma of the lower extremity
Medial foot and leg cellulitis
Deep inguinal? location
Medial thigh (femoral triangle), parallel to the junction of the great saphenous vein and the femoral vein
Deep inguinal? area drained
Lower limbs
Glans penis or clitoris
Lymph from the superficial inguinal and popliteal lymph nodes
Drain into the external iliac lymph nodes
Deep inguinal? pathology
STDs
Infections of the MEDIAL leg or foot (e.g., cellulitis)!!!!!!!!!!
Melanoma
Popliteal lymph nodes? area drained
Dorsolateral aspect of the foot and the posterior calf
Drain into the deep inguinal lymph nodes
Popliteal lymph nodes? patholgoy
Infections of the LATERAL leg or foot (e.g., cellulitis)
Melanoma
The testicles, epididymis, and seminal ducts are drained by ,………
The testicles, epididymis, and seminal ducts are drained by the deep, iliac, and lumbar lymph nodes.
What lymph nodes are not palpable?
(CHEST) Paratracheal+mediastinal+hilar
(ABDOMEN) celiac, superior and inferior mesenteric
+PARAaortic
(ILIAC) External and internal
What lymph nodes are palpable?
submandibular, cervical, supraclavicular, axilary, epitrochlear, superficial inguinal, periumbilical, popliteal
Axillary lymph nodes. Anterior (pectoral) lymph nodes? area drained
Mammary and pectoral regions
Skin region located above the umbilicus
Axillary lymph nodes. Central lymph nodes? drained area
Lymph from the anterior, posterior, and lateral axillary lymph nodes
Drain into the apical lymph nodes
Axillary lymph nodes. Anterior and central PATHOLOGY?
Localized infection in the drainage area (e.g., mastitis)
Breast cancer or metastasis
Axillary lymph nodes. Posterior (subscapular) lymph nodes? drained area
Upper back and posterior neck
Axillary lymph nodes. Posterior (subscapular) lymph nodes? pathology
Localized infection of the upper extremities/chest wall
Axillary lymph nodes. Lateral (brachial) lymph nodes? drained area
Majority of the upper limb
Axillary lymph nodes. Lateral (brachial) lymph nodes? pathology
Localized infections of the upper extremities
Axillary lymph nodes. Apical (subclavicular aka infraclavicular) lymph nodes? Drained area
Lymph from the central lymph node group
Upper outer quadrant of the breast
Drain into the right lymphatic duct and thoracic duct
Axillary lymph nodes. Apical (subclavicular aka infraclavicular) lymph nodes? Pathology
Localized infection in the drainage area (e.g., mastitis)
Breast cancer or metastasis
