Lymphatics Draining of the Thorax

Question 1

What is the function of the lymphatic system?

Answer 1

• Drains interstitial fluid
• Recycles blood plasma into cardiovascular system

Question 2

What is the path of lymph flow through a lymph node?

Answer 2

1. 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
2. The afferent vessels deliver lymph to the subcapsular space, a meshwork of reticular fibers, macrophages, and dendritic cells
3. Lymph next flows into the outer cortex, which contains B cells within germinal centers that resemble those of lymphoid nodules
4. Lymph then flows through lymph sinuses in the deep cortex, which is dominated by T cells
5. Lymph continues into the medullary sinus at the core of the lymph node. This region contains B cells and plasma cells
6. Efferent lymphatics leave the lymph node at the hilum. These vessels collect lymph from the medullary sinus and carry it toward the venous circulation.

Question 3

What are the 5 lymphatic trunks and what areas of the body do they drain?

Answer 3

• 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

Question 4

There is asymmetry of lymphatic drainage. What does the right lymphatic duct drain? What about the thoracic duct?

Answer 4

• Right lymphatic duct
  
  • ​Right upper arm
  • Right side of the head and thorax
• Thoracic duct
  
  • ​Lymph from the rest of the body

Question 5

Right lymphatic duct and thoracic duct drain at the _____________.

Answer 5

Angulus venosus

NOTE: The angulus venosus is the junction of the inferior and superior vena cava

Question 6

At which spinal level do the following structures pass through the diaphragm?

Vena Cava

Esophagus

Aortic hiatus

Answer 6

Vena Cava : T8

Esophagus: T10

Aortic hiatus: T12

Question 7

What are the primary lymphatic organs?

Answer 7

Thymus

Bone marrow

Question 8

Where do T lymphocytes mature?

Answer 8

In the thymus

Question 9

In which mediastinum is the thymus located?

Answer 9

Anterior mediastinum

Question 10

What is the nerve sumply of the thymus?

Answer 10

Parasympathetic: CN X

Sympathetic: Sympathetic trunk

Question 11

Blood supply to the thymus

Answer 11

internal thoracic artery

Question 12

Which nodes drain the thymus?

Answer 12

–Parasternal nodes

–Anterior mediastinal nodes

–Tracheobronchial nodes

Question 13

How do the parasternal, anterior mediastinal and tracheobronchial nodes drain from the thymus?

Answer 13

Right side: Node-> Right brochomediastinal trunk-> Right lymphatic duct

Left side: Node-> Left brochomediastinal trunk-> Thoracic duct

Question 14

Symptoms of thymoma

Answer 14

Persistent cough

Chest pain

Question 15

Thymoma

Answer 15

Tumor in the epithelial cells of the thymus gland

*Linked with myastenia gravis and other autoimmune disease

Question 16

What are the characteristics of superior vena cava syndrome?

Answer 16

• Edema of the face and arms
• Swolen collateral veins on nech and chest wall
• Shortness of breath, coughing, difficulty swallowing

Question 17

Lymph from the axillary lymph nodes drain into the ____________ trunks.

Answer 17

Subclavian

Question 18

Axillary lymph nodes drain lymph vessels from which areas of the body?

Answer 18

• Superficial regions of the thoracic wall
• Lateral breast
• Vessels of upper limb
• Superficial regions of abdomen above navel

Question 19

______________ lymph nodes receive efferent lymph vessels from all axillary nodes.

Answer 19

Apical

Question 20

Where does breast cancer develop?

Answer 20

In acini, lactiferous ducts and lobules of breast

Question 21

Which lymph nodes can drain the breast?

Answer 21

Axillary

Supraclavicular

Parasternal

Abdominal

Question 22

Lymphatics of the thoracic wall drain mainly into which nodes?

Answer 22

Parasternal nodes

Intercostal nodes

Diaphragmatic nodes

Question 23

Parasternal nodes travel along the internal thoracic artery and drain to ____________.

Answer 23

Bronchomediastinal trunks

Question 24

The upper thorax drains into __________, while the lower thorax drains into the _____________.

Answer 24

Bronchomediastinal trunks; thoracic duct

Question 25

Nodes located on different parts of the diaphragm drain to different structures. Where do the different nodes drain?

Answer 25

* **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**

Question 26

What parts of the body are drained by parasternal lymph nodes?

Answer 26

Breast, deep abdominal wall above umbilicus, anterior thoracic wall **REMEMBER:** Parasternal lymph nodes run along the internal thoracic artery

Question 27

Where are intercostal nodes found?

Answer 27

Posterior wall of the posterior mediastinum

Question 28

Where do intercostal nodes drain into?

Answer 28

**Upper nodes:** * **Bronchomediastinal trunks**, then to either the **thoracic duct** or the **right lymphatic duct** **​Lower nodes:** * **Thoracic duct or cisterna chyli**

Question 29

What parts of the body are drained by intercostal nodes?

Answer 29

Deep lymphatics of posterior and lateral chest

Question 30

Where are anterior mediastinal nodes located?

Answer 30

In front of the brachiocephalic veins

Question 31

What parts of the body do anterior mediastinal nodes drain and where do they drain to?

Answer 31

**Afferents**: Thymus, thyroid gland, and anterior part of the pericardium **Efferent:**Right or left bronchomediastinal trunk

Question 32

Where are posterior mediastinal nodes located?

Answer 32

Posterior to the pericardium

Question 33

Where do afferents of posterior mediastinal nodes come from? Where do the efferents go?

Answer 33

**Afferents:** Esophogus and posterior part of the pericardium **Efferents:** Thoracic duct

Question 34

Enlargement of the posterior mediastinal nodes may indent the \_\_\_\_\_\_\_\_\_\_\_.

Answer 34

Esophagus

Question 35

Chylothorax

Answer 35

A type of pleural effusion caused by the **rupture of the thoracic duct** leading to the leakage of lymph into the **posterior mediastinum**

Question 36

Pancoast Tumor/Syndrome

Answer 36

Tumor of the apex of the lung that affects the root of the neck

Question 37

Where does lymph fluid from the visceral pleura drain?

Answer 37

Into the **subpleural lymphatic plexus** and into the **bronchopulmonary nodes** at the hilum of the lung

Question 38

What are the lymph nodes of the trachea and lungs and where are they located?

Answer 38

**Pulmonary group-** Inside the lung tissue **Bronchopulmonary group-** At the hilum **Tracheobronchial group**- Alongside primary bronchi **Paratracheal group**- On either side of the trachea

Question 39

What are respiratory symptoms of lung cancer?

Answer 39

Coughing, coughing up blood, wheezing, or shortness of breath

Question 40

What are systemic symptoms of lung cancer?

Answer 40

Weight loss, weakness, fever, or clubing of fingernails

Question 41

The lymphatics of the heart drain into which lymph nodes?

Answer 41

**Right side:** Right tracheobronchial nodes and brachiocephalic nodes **Left side:** Left tracheobronchial nodes and brachiocephalic nodes

Question 42

Lymph from the esophagus drains into the ________ and the \_\_\_\_\_\_\_\_\_\_\_\_.

Answer 42

Posterior mediastinal nodes; Posterior intercostal nodes \*Lymph then drains into the thoracic duct

Question 43

What are the symptoms of esophageal cancer?

Answer 43

* 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

Question 44

Compression of structures due to esophageal cancer can lead to what symptoms?

Answer 44

Upper airway obstruction Superior vena cava syndrome

Question 45

A ______________ is a left-sided supraclavicular lymph node.

Answer 45

Virchow's node **NOTE:** Virchow's node receives lymph from lymph vessels int he avdomial cavity

Question 47

An enlarged, hard Virchow's node can indicate what?

Answer 47

**Abdominal cancer**, specifically gastric cancer that has spread through the lymph vessels