Lymphatics Draining of the Thorax Flashcards
What is the function of the lymphatic system?
- Drains interstitial fluid
- Recycles blood plasma into cardiovascular system
What is the path of lymph flow through a lymph node?
- Afferent lymphatics carry lymph to the lymph node from peripheral tissues. The afferent lymphatics penetrate the capsule of the lymph node on the side opposite the hilum
- The afferent vessels deliver lymph to the subcapsular space, a meshwork of reticular fibers, macrophages, and dendritic cells
- Lymph next flows into the outer cortex, which contains B cells within germinal centers that resemble those of lymphoid nodules
- Lymph then flows through lymph sinuses in the deep cortex, which is dominated by T cells
- Lymph continues into the medullary sinus at the core of the lymph node. This region contains B cells and plasma cells
- Efferent lymphatics leave the lymph node at the hilum. These vessels collect lymph from the medullary sinus and carry it toward the venous circulation.
What are the 5 lymphatic trunks and what areas of the body do they drain?
-
Lumbar
- Drain lower limbs, kidney, pelvis, abdominal wall
-
Intestinal
- Drain stomach, intestines, spleen, pancreas, liver
-
Bronchomediastinal
- Drain thoracic wall, lungs, heart
-
Subclavian
- Drain upper limbs
-
Jugular
- Drain head and neck
There is asymmetry of lymphatic drainage. What does the right lymphatic duct drain? What about the thoracic duct?
-
Right lymphatic duct
- Right upper arm
- Right side of the head and thorax
-
Thoracic duct
- Lymph from the rest of the body
Right lymphatic duct and thoracic duct drain at the _____________.
Angulus venosus
NOTE: The angulus venosus is the junction of the inferior and superior vena cava
At which spinal level do the following structures pass through the diaphragm?
Vena Cava
Esophagus
Aortic hiatus
Vena Cava : T8
Esophagus: T10
Aortic hiatus: T12
What are the primary lymphatic organs?
Thymus
Bone marrow
Where do T lymphocytes mature?
In the thymus
In which mediastinum is the thymus located?
Anterior mediastinum
What is the nerve sumply of the thymus?
Parasympathetic: CN X
Sympathetic: Sympathetic trunk
Blood supply to the thymus
internal thoracic artery
Which nodes drain the thymus?
–Parasternal nodes
–Anterior mediastinal nodes
–Tracheobronchial nodes
How do the parasternal, anterior mediastinal and tracheobronchial nodes drain from the thymus?
Right side: Node-> Right brochomediastinal trunk-> Right lymphatic duct
Left side: Node-> Left brochomediastinal trunk-> Thoracic duct
Symptoms of thymoma
Persistent cough
Chest pain
Thymoma
Tumor in the epithelial cells of the thymus gland
*Linked with myastenia gravis and other autoimmune disease
What are the characteristics of superior vena cava syndrome?
- Edema of the face and arms
- Swolen collateral veins on nech and chest wall
- Shortness of breath, coughing, difficulty swallowing
Lymph from the axillary lymph nodes drain into the ____________ trunks.
Subclavian
Axillary lymph nodes drain lymph vessels from which areas of the body?
- Superficial regions of the thoracic wall
- Lateral breast
- Vessels of upper limb
- Superficial regions of abdomen above navel
______________ lymph nodes receive efferent lymph vessels from all axillary nodes.
Apical
Where does breast cancer develop?
In acini, lactiferous ducts and lobules of breast
Which lymph nodes can drain the breast?
Axillary
Supraclavicular
Parasternal
Abdominal
Lymphatics of the thoracic wall drain mainly into which nodes?
Parasternal nodes
Intercostal nodes
Diaphragmatic nodes
Parasternal nodes travel along the internal thoracic artery and drain to ____________.
Bronchomediastinal trunks
The upper thorax drains into __________, while the lower thorax drains into the _____________.
Bronchomediastinal trunks; thoracic duct
Nodes located on different parts of the diaphragm drain to different structures. Where do the different nodes drain?
-
Anterior group
- Drain into parasternal nodes then to the brochomediastal trunk
-
Lateral group
- Drain into parasternal nodes and/or posterior intercostal nodes
-
Posterior group
- Drain into thoracic duct and cisterna chyli
What parts of the body are drained by parasternal lymph nodes?
Breast, deep abdominal wall above umbilicus, anterior thoracic wall
REMEMBER: Parasternal lymph nodes run along the internal thoracic artery
Where are intercostal nodes found?
Posterior wall of the posterior mediastinum
Where do intercostal nodes drain into?
Upper nodes:
- Bronchomediastinal trunks, then to either the thoracic duct or the right lymphatic duct
Lower nodes:
- Thoracic duct or cisterna chyli
What parts of the body are drained by intercostal nodes?
Deep lymphatics of posterior and lateral chest
Where are anterior mediastinal nodes located?
In front of the brachiocephalic veins
What parts of the body do anterior mediastinal nodes drain and where do they drain to?
Afferents: Thymus, thyroid gland, and anterior part of the pericardium
Efferent:Right or left bronchomediastinal trunk
Where are posterior mediastinal nodes located?
Posterior to the pericardium
Where do afferents of posterior mediastinal nodes come from? Where do the efferents go?
Afferents: Esophogus and posterior part of the pericardium
Efferents: Thoracic duct
Enlargement of the posterior mediastinal nodes may indent the ___________.
Esophagus
Chylothorax
A type of pleural effusion caused by the rupture of the thoracic duct leading to the leakage of lymph into the posterior mediastinum
Pancoast Tumor/Syndrome
Tumor of the apex of the lung that affects the root of the neck
Where does lymph fluid from the visceral pleura drain?
Into the subpleural lymphatic plexus and into the bronchopulmonary nodes at the hilum of the lung
What are the lymph nodes of the trachea and lungs and where are they located?
Pulmonary group- Inside the lung tissue
Bronchopulmonary group- At the hilum
Tracheobronchial group- Alongside primary bronchi
Paratracheal group- On either side of the trachea
What are respiratory symptoms of lung cancer?
Coughing, coughing up blood, wheezing, or shortness of breath
What are systemic symptoms of lung cancer?
Weight loss, weakness, fever, or clubing of fingernails
The lymphatics of the heart drain into which lymph nodes?
Right side: Right tracheobronchial nodes and brachiocephalic nodes
Left side: Left tracheobronchial nodes and brachiocephalic nodes
Lymph from the esophagus drains into the ________ and the ____________.
Posterior mediastinal nodes; Posterior intercostal nodes
*Lymph then drains into the thoracic duct
What are the symptoms of esophageal cancer?
- Difficulty swallowing
- Weight loss due to reduced appetitie and undernutrition
- Pain behind the breastbone or in the region around the stomach
- Unusually raspy or hoarse-sounding cough
- Nausea, vomiting and regurgitation of food
- Vomiting of blood
Compression of structures due to esophageal cancer can lead to what symptoms?
Upper airway obstruction
Superior vena cava syndrome
A ______________ is a left-sided supraclavicular lymph node.
Virchow’s node
NOTE: Virchow’s node receives lymph from lymph vessels int he avdomial cavity
An enlarged, hard Virchow’s node can indicate what?
Abdominal cancer, specifically gastric cancer that has spread through the lymph vessels
