Lymphatic System Flashcards
Skin of the thoracic wall
– Superficial lymphatic vessels (superficial
to deep fascia): ant. & post. wall
• → Ant. & post. axillary lymph nodes
– Superior to umbilicus & iliac crest
• → Axillary nodes
– Inferior to umbilicus
• → Inguinal lymph nodes
Thoracic wall intercostal spaces
Anteriorly – parasternal nodes
Posteriorly – posterior intercostal nodes
Thoracic wall periphery of diaphragm
Diaphragmatic nodes
Parietal pleura
Parasternal, posterior intercostal &
diaphragmatic
Posterior intercostal terminal drainage
– Thoracic duct & right lymphatic duct
(direct)
– Deep cervical nodes
Diaphragmatic terminal drainage
Parasternal, post. & sup. mediastinal
nodes
Superior mediastinal
AKA brachicephalic
Afferent: thymus, thyroid & pericardium
Efferent: + tracheobronchial = right & left bronchomediastinal trunks
Posterior mediastinal
Afferent: oesophagus, post. pericardium & diaphragm
Efferent: thoracic duct (some – tracheobronchial)
Tracheobronchial
Afferent: lungs, bronchi, trachea & heart
Efferent: right & left bronchomediastinal trunks
Tracheobronchial nodes (5 groups)
– Paratracheal – Superior tracheobronchial – Inferior tracheobronchial – Bronchopulmonary – Pulmonary (intra)
Lung tissue
Visceral pleura
Superficial lymphatic plexus to bronchopulmonary to superior and inferior tracheobronchial
Deep to root of lung
Deep lymphatic plexus to pulmonary to bronchopulmonary to superior and inferior tracheobronchial
Inferior tracheobronchial
R and L bronchomediastinal trunks
Superior tracheobronchial
R lymphatic duct and thoracic duct
Anterior pericardium
Superior mediastinal to tracheobronchial to R and L bronchomediastinal trunks
Posterior pericardium
Posterior mediastinal to thoracic duct
Myocardium & subendocardial connective tissue
Subepicardial lymphatic plexus to coronary groove to coronary trunks
L coronary trunk
Ascend between pulmonary trunk and L atrium
Drains LV, LA, small portion RV
Inferior tracheobronchial
R coronary trunk
Ascending anterior to asc aorta
Drains RV, RA
Superior mediastinal
Oesophagus
Paraoesophageal
Upper 1/3: Deep cervical
Middle 1/3: Inferior tracheobronchial & posterior
mediastinal lymph nodes to R and L bronchomediastinal
Lower 1/3: Superior gastric
Diaphragm thoracic surface
Anterior and posterior diaphragmatic nodes to superior phrenic lymph nodes, parasternal lymph nodes, posterior mediastinal lymph nodes
Diaphragm abdominal surface
Anterior diaphragmatic to anterior diaphragmatic lymph nodes, inferior phrenic lymph nodes, superior lumbar lymph nodes
Axilla (6 groups)
– Pectoral/anterior group – Subscapular/posterior group – Lateral group – Central group – Apical/infraclavicular group – Deltopectoral group
Pectoral
AKA anterior
• 3 – 5 nodes – Med. wall of axilla – Around: lat. thoracic vein & inf. border of pectoralis minor • Afferent: – Ant. thoracic wall (most of breast) – Upper, anterior abdominal wall • Efferent: – Central nodes
Subscapular
AKA posterior
• 6 – 7 nodes – Post. axillary fold – Subscapular blood vessels • Afferent: – Post. aspect of thoracic wall (back) – Scapular region (shoulder) – Neck • Efferent: – Central nodes
Central
• 3 – 4 large nodes – Deep to pectoralis minor (near axilla base) – 2 nd part of axillary artery • Afferent: – Pectoral (ant), subscapular (post) & humeral (lat) • Efferent: – Apical/Infraclavicular lymph nodes
Apical
• Located: – Med. side of axillary vein – 1st part of axillary artery • Afferent: – Pectoral, subscapular, humeral & central – Lymphatics: proximal cephalic vein • Efferent: – Unite → Subclavian lymphatic trunk
Lateral
• 4 – 6 nodes – Lat. wall of axilla – Med. & post. to axillary vein • Afferent: – Medial aspect of the arm – Most of lymphatics from upper limb • Efferent: – Central nodes
Mammary tissue
• Subareolar plexus – Pectoral nodes • Medial border – Parasternal nodes • Inferomedial quadrant – Subperitoneal and pelvis • 75% via axillary tail – Pectoral nodes • Lateral border – Parasternal nodes – Posterior intercostal nodes • Deep breast tissue – Apical nodes
Hand drainage
NB!
Occipital
1 – 3 nodes ; back of head; apex of post. triangle
Afferents: occipital region of scalp
Efferents: sup. deep cervical nodes
Posterior auricular/mastoid
2 nodes; post. to ear on mastoid process
Afferents: post. surface of auricle, post. part
of scalp & post. wall of external acoustic meatus
Efferents: sup. deep cervical nodes
Preauricular
1 – 3 nodes; ant. to trachus of ear
Afferents: lat. surface of auricula & skin of
adjacent temporal region
Efferents: sup. deep cervical glands
Parotid
2 groups: inside the gland & ant. to gland
Afferents: root of nose, eyelids, frontotemporal
region, ant. wall external acoustic meatus, conjunctiva
Efferents: sup. deep cervical nodes
Buccal
1/more nodes; on buccinator @ ant. border of
masseter (relation: facial vein)
Afferents: cheek & lower eyelid
Efferents: submandibular nodes
Submandibular
3 – 6 nodes; below deep fascia & on submandibular
salivary gland
Afferents: middle of forehead, nose & paranasal sinuses,
cheek, palate, gingiva, upper lip & ant. 2/3 of tongue
Efferents: sup. deep cervical nodes
Submental
Between ant. bellies of digastric in submental
triangle
Afferents: apex of tongue, floor of mouth,
gingiva (lower incisors), chin, middle section of lower
lip
Efferents: submandibular nodes
Superficial cervical
Along: ant, jugular vein & external jugular vein
Afferents: infrahyoid region, larynx, trachea, thyroid,
cervical part of oesophagus, lower part of ear and
parotid region
Efferents: submandibular nodes
Pretracheal
Front of trachea
Afferents: lower larynx, thyroid gland, upper trachea
Efferents: lowest of sup. deep cervical nodes &
inf. deep cervical nodes
Paratracheal
Few; alongside recurrent laryngeal nerves on
lat,. aspects of trachea & oesophagus
Afferents: thyroid gland, cervical portion trachea
Efferents: lowest of sup. deep cervical nodes & inf.
deep cervical nodes
Prelaryngeal
On the middle cricothyroid ligament
Afferents: lower larynx, thyroid gland, upper trachea
Efferents: sup. deep cervical nodes
Infrahyoid
Located: between levels of hyoid bone and thyroid
cartilage
Afferents: thyroid gland, larynx
Efferents: sup. deep cervical nodes
Retropharyngeal
1 – 3 nodes; in buccopharyngeal fascia
Afferents: nasal cavities, nasal part of pharynx, auditory
tubes
Efferents: sup. deep cervical nodes
Face
Submental
Afferents: Medial part of lower lip
and chin
Efferents: Submandibular nodes
Submandibular Afferents: Medial corner of the orbit, most of the external nose, medial part of the cheek, upper lip, lateral part of the lower lip Efferents: superior deep cervical nodes
Preauricular and parotid
Afferents: Lateral part of face, eyelids,
part of the external nose, lateral part of
the cheek
Efferents: superior deep cervical nodes
Scalp
Occipital
Afferents: Occipital area
Efferents: Superior deep cervical nodes
Postauricular/mastoid
Afferents: Post. To vertex of head
Efferents: Superior deep cervical node
Preauricular/parotid
Afferents: Ant. to vertex of head
Efferents: Superior deep cervical nodes
Submandibular
Afferents: Part of the forehead
Efferents: superior deep cervical nodes
Eyelids and conjuctiva
Parotid
Afferents: Eyelids (lateral ¾)
Efferents: Superior deep cervical nodes
Submandibular
Afferents: Medial corner of eye (medial ¼)
Efferents: Superior deep cervical nodes
Nose
Parotid
Afferents: Root of the nose
Efferents: Superior deep cervical nodes
Submandibular
Afferents: Surface of nose, ant. nasal cavities:
Efferents: Superior deep cervical nodes
Retropharyngeal
Afferents: Air sinuses, adenoids
Efferents: Superior deep cervical nodes
Lips
Submandibular
Afferents: Upper lip, lateral parts of lower lip
Efferents: Superior deep cervical nodes
Submental
Afferents: Medial part of lower lip
Efferents: Submandibular nodes
Teeth
Submandibular
Afferents: post. gums & teeth (lower)
Efferents: superior deep cervical nodes
Submental
Afferents: ant. gums & teeth (lower)
Efferents: submandibular nodes
Jugulodigastric
Afferents: ant. & post. gums & teeth (upper)
Efferents: inferior deep cervical nodes
Tongue
Jugulodigastric
Afferents: Posterior third of tongue
Efferents: Inferior deep cervical nodes
Juguloomohyoid
Afferents: Medial part of anterior 2/3 of tongue
Efferents: Jugular trunks
Submandibular
Afferents: Lateral parts of anterior 2/3 of tongue
Efferents: Superior deep cervical nodes
Submental
Afferents: Apex and frenulum
Efferents: jugulo-omohyoid node
Paratracheal
Afferents: Superior to vocal folds
Efferents: Inferior deep cervical nodes
Thyroid
Prelaryngeal nodes
Afferents: Sup. lymphatic vessels from thyroid
Efferents: Superior deep cervical nodes
Inferior deep cervical nodes
Afferents: Ant. lymphatic vessels from thyroid
Efferents: Inferior deep cervical nodes
Pretracheal and Paratracheal nodes
Afferents: Lateral lymphatic vessels from thyroid
Efferents: right & left jugular trunks
Brachiocephalic nodes or thoracic duct
Afferents: Some lymphatic vessels
Larynx
Superior deep cervical nodes
Afferents: Superior to vocal folds
Efferents: Inferior deep cervical nodes
Pretracheal OR paratracheal nodes
Afferents: Inferior to vocal folds
Efferents: Inferior deep cervical nodes
Tonsils and adenoids
Jugulo-digastric nodes
Afferents: Tonsils
Efferents: right & left jugular trunks
Retropharyngeal nodes
Afferents: Adenoids
Efferents: inferior deep cervical nodes
Deep lymphatic drainage of abdominal wall
Accompany deep veins of abdominal wall
Lumbar lymph nodes
Abdominal aorta
External iliac lymph nodes
External iliac artery
Common iliac lymph nodes
Common iliac artery
Preaortic LN
Celiac nodes
Afferent: organs (foregut), superior & inferior mesenteric nodes
Efferents: cisterna chyli
Superior mesenteric nodes
Afferents: organs (midgut), inferior mesenteric nodes
Efferents: celiac nodes
Inferior mesenteric nodes
Afferents: organs (hindgut)
Efferents: superior mesenteric nodes
Para aortic
Afferents: body wall, kidneys, suprarenal
glands, testes or ovaries
Oesophagus
Left gastric lymph nodes
Afferents: abdominal part of oesophagus
Efferents: celiac lymph nodes
Stomach
Gastric lymph nodes
Afferents: sup. 2/3 of stomach
Efferents: celiac lymph nodes
Gastro-omental lymph nodes
Afferents: ant. & post. surface of stomach
Efferents: celiac lymph nodes
Pancreaticosplenic lymph nodes
Afferents: fundus, superior part of body of stomach
Efferents: celiac lymph nodes
Pyloric lymph nodes
Afferents: right 2/3 of inferior 1/3 stomach
Efferents: celiac lymph nodes
Pancreaticoduodenal lymph nodes
Afferents: left 1/3 of greater curvature
Efferents: pyloric OR celiac lymph nodes
Duodenum
Pacreaticosplenic lymph nodes
Afferents: anterior surface of duodenum
Efferents: celiac lymph nodes
Pyloric lymph nodes
Afferents: anterior surface of duodenum
Efferents: superior mesenteric lymph nodes
Superior mesenteric lymph nodes
Afferents: posterior surface of duodenum
Efferents: celiac lymph nodes
Jejenum and ileum
Juxta-intestinal lymph nodes
Located close to intestinal wall
Afferents: jejunum & ileum
Efferents: mesenteric lymph nodes
Mesenteric lymph nodes
Scattered along the arterial arcades
Afferents: Jejunum & ileum
Efferents: superior central nodes
Superior central lymph nodes
Located along proximal part of SMA
Afferents: anterior surface of duodenum
Efferents: superior mesenteric lymph nodes
Caecum and appendix
Ileocolic lymph nodes
Located along ileocolic artery
Afferents: cecum & appendix
Efferents: superior mesenteric nodes
Mesoappendix lymph nodes
Ascending colon & prox. 2/3 of transverse colon
NB!!!
Distal 1/3 of transverse colon & descending colon & sigmoid colon
NB!!!
Pancreas
Pancreaticosplenic lymph nodes
Along splenic artery
Afferents: most of body of pancreas and tail
Efferents: superior mesenteric nodes
Pyloric lymph nodes Along gastroduocenal artery Afferents: some of body of pancreas and the head Efferents: superior mesenteric nodes
Liver and gallbladder
Hepatic nodes Superficial lymphatics: ant. aspects of diaphragmatic & visceral surfaces Deep lymphatics: portal triad vessels Gallbladder (via cystic nodes) Efferents: celiac nodes
Phrenic nodes
Superficial lymphatics: post. aspects of diaphragmatic
& visceral surfaces (drain to bare area of liver)
Efferents: posterior mediastinal lymph nodes
Spleen
Splenic hilar nodes to pancreaticosplenic nodes
Kidneys, suprarenal glands and ureters
Lymphatic plexuses in kidney = 3
Substance of kidney
Under fibrous capsule of kidney
Perirenal fat
Lumbar nodes
Afferents: 4/5 lymphatic trunks leave renal hilum, lymph
from suprarenal glands, superior part of ureters
Efferents: Lumbar trunks → cisterna chyli
Common iliac nodes
Afferents: middle part of ureters
Efferents: lumbar nodes
Common iliac, external iliac or internal iliac nodes
Afferents: inferior part of ureters
Efferents: lumbar nodes
Pelvis
External iliac lymph nodes Location: above pelvic brim, along external iliac vessels Afferents: inguinal lymph nodes, pelvic viscera (sup. parts of middle to ant. pelvic organs) Efferents: common iliac nodes
Internal iliac lymph nodes
Location: clustered: ant. & post. divisions
of internal iliac arteries & origins of
gluteal arteries
Afferents: inf. pelvic viscera, deep perineum,
gluteal region
Efferents: common iliac nodes
Sacral iliac lymph nodes
Location: concavity of sacrum, adjacent to
median sacral vessels
Afferents: posteroinferior pelvic viscera
Efferents: internal or common iliac nodes
Common iliac lymph nodes Location: superior to pelvis Afferents: external, internal & sacral nodes, neck of bladder, inferior vagina Efferents: lumbar nodes
Bladder
External iliac nodes
Afferents: superolateral aspects of bladder
Efferents: common iliac nodes
Internal iliac nodes
Afferents: fundus and neck of bladder
Efferents: common iliac nodes
Common iliac nodes
Afferents: neck of bladder (some)
Efferents: lumbar nodes
Rectum
Pararectal nodes
Directly on muscle layer of rectum
Afferents: superior ½ of rectum
Efferents: inf. mesenteric nodes
Sacral nodes
Afferents: inferior ½ of rectum
Efferents: internal iliac nodes (some vessels
may drain directly into internal iliac nodes
Anal canal
Internal iliac nodes
Afferents: superior to pectinate line
Efferents: common iliac nodes → lumbar
Superficial inguinal nodes
Afferents: inferior to pectinate line
Efferents: external iliac nodes OR deep inguinal
nodes → lumbar
Male intrapelvic organs
Internal iliac nodes
Afferents: majority of prostate, proximal urethra, inferior
part of seminal glands,
Efferents: common iliac nodes → lumbar
Sacral nodes
Afferents: some of prostate
Efferents: internal iliac nodes
External iliac nodes
Afferents: proximal urethra(some), ductus deferens,
ejaculatory ducts, superior part of seminal glands
Efferents: common iliac nodes → lumbar
Deep inguinal nodes
Afferents: distal urethra
Efferents: external iliac nodes
Female intrapelvis nodes
Internal iliac nodes
Afferents: cervix of uterus, superior & middle parts of vagina,
proximal urethra
Efferents: common iliac nodes → lumbar
Sacral nodes
Afferents: cervix of uterus, inferior part of vagina (or CIN)
Efferents: internal iliac nodes
External iliac nodes
Afferents: body & cervix of uterus, superior part of vagina
Efferents: common iliac nodes → lumbar
Superficial inguinal nodes
Afferents: external orifice of vagina, fundus (uterus)
Efferents: external iliac nodes or deep inguinal nodes
Deep inguinal nodes
Afferents: distal urethra
Efferents: external iliac nodes
Lumbar nodes
Afferents: ovaries & uterine tubes,
fundus of uterus
Efferents: cisterna chyli
Male external genitalia organs
Internal iliac nodes
Afferents: cavernous bodies of penis
Efferents: common iliac nodes
Superficial inguinal nodes
Afferents: skin of penis, scrotum
Efferents: external iliac nodes OR deep inguinal
External iliac nodes
Afferents: glans of penis
Efferents: external iliac nodes
Lumbar nodes
Afferents: testis & epididymis
Efferents: cisterna chyli
Deep inguinal nodes
Afferents: glans of penis,
Efferents: external iliac nodes
Female external genitalia organs
Superficial inguinal nodes
Afferents: vulva
Efferents: external iliac nodes OR deep inguinal
Deep inguinal nodes
Afferents: glans clitoris & labia
Efferents: external iliac nodes
Inguinal nodes
– Superficial group of nodes
• Subdivided in 2
• Horizontal chain (superior) – inferior inguinal
ligament
• Vertical (inferior) chain – along great saphenous
vein
– Deep group of nodes
Popliteal nodes
• 5 – 6 nodes; surrounding popliteal vessels
in popliteal fossa
• Superficial (in subcutaneous tissue) and
deep nodes (surround vessels)
• Afferents:
– Superficial vessels (small saphenous vein)
– Deep areas of leg and foot
• Efferents:
– Deep inguinal nodes → external iliac nodes
Deep inguinal nodes
• Vary in number between 1 – 3 • Lie medial to femoral vein • Nodes located as follows: – Great saphenous vein join femoral vein – In femoral sheath – Lateral part of femoral ring • Afferents: – Deep lymphatics associated with femoral vessels – Glans penis or clitoris (perineum) – Connection: superficial inguinal nodes
Superficial inguinal nodes
• ± 10 nodes; in superficial fascia • Afferents: – Gluteal region – Lower abdominal wall – Perineum & external genitalia – Superficial regions of lower limbs • Efferents: – External iliac nodes (interconnect – deep inguinal nodes) • Common iliac nodes → lumbar nodes → lumbar trunks → cisterna chyli
Foot
• Subcutaneous plexuses – Superficial & deep lymphatic vessels • Superficial lymphatic vessels – Medial superficial lymphatic vessels – Lateral superficial lymphatic vessels • Deep lymphatic vessels
