Lymphatics of the Chest Wall

Question 1

What is lymph?

Answer 1

Lymph is essentially plasma (extracellular fluid) which has leaked from the capillary beds due to high hydrostatic pressures.

Question 2

How does plasma leak from capillary beds?

Answer 2

High hydrostatic pressure.

Question 3

What does the lymphatic system do?

Answer 3

Returns lymph to the circulatory process.

Question 4

What secondary function does the lymphatic system have?

Answer 4

Role in immunity and cancer spread.

Question 5

What organs have lymphatic drainage?

Answer 5

All organs and tissues except cartilage, the eyes, inner ear, brain and spinal cord.

Question 6

Why is the lymphatic system important in pathology?

Answer 6

Because it provides a potential route for metastasis of cancer cells.

Question 7

Where are the locations of the major groups of lymph nodes?

Answer 7

Root of the upper limb (axillary)
Root of the lower limb (superficial/deep inguinal)
Bifurcation of the trachea in the thorax (tracheobronchial)
Around the roots of arteries n the abdomen and pelvis (lumbar / pelvic)
As superficial/deep groups in the head and neck (cervical)

Question 8

Where are the axillary lymph nodes located?

Answer 8

Root of the upper limb.

Question 9

Where are the superficial and deep inguinal lymph nodes located?

Answer 9

Root of the lower limb.

Question 10

Where are the tracheobronchial lymph nodes located?

Answer 10

Bifurcation of the trachea in the thorax.

Question 11

Where are the lumbar/pelvic lymph nodes located?

Answer 11

Around the roots of arteries in the abdomen and pelvis.

Question 12

Where are the superficial and deep cervical lymph nodes located?

Answer 12

Located as superficial and deep groups in the head and neck.

Question 13

What arises from each of the major groups of lymph nodes?

Answer 13

Efferent lymphatic vessels which lead to the thoracic duct or to the right lymphatic duct which, in turn, can carry the lymphatic fluid back to the venous circulation.

Question 14

What do the thoracic duct and right lymphatic duct do?

Answer 14

Return lymphatic fluid back to the venous circulation.

Question 15

Where are lymph nodes usually clustered?

Answer 15

Around large veins.

Question 16

What do the axillary lymph nodes lie in relation to?

Answer 16

Axillary vein and its branches in the axilla.

Question 17

What groups do the axillary lymph nodes include?

Answer 17

Anterior (pectoral)
Apical
Central
Lateral

Question 18

What is the breast composed of?

Answer 18

Glandular

Adipose

Question 19

Why does the breast need an effective lymphatic drainage system?

Answer 19

Glandular and adipose composition.

Question 20

What can the lymphatic system of the breast lead to pathologically?

Answer 20

Metastatic cancer of the breast.

Question 21

Where does most of the breast, particularly from the lateral breast quadrants drain too?

Answer 21

Drains to the anterior (pectoral) group of axillary lymph nodes.

Question 22

Where does the remainder of lymph drain too?

Answer 22

Parasternal nodes
Opposite breast (medial quadrants)
Abdominal nodes (lower quadrants)

Question 23

What quadrants does lymph drain to in the opposite breast?

Answer 23

Medial quadrants.

Question 24

What quadrants does lymph drain to in the abdominal nodes?

Answer 24

Lower quadrants.

Question 25

Where is the base (glandular part) of the breast located?

Answer 25

Located between Ribs 2-6 and between the lateral border of the sternum and midaxillary line.

Question 26

What is the glandular part of the breast divided into?

Answer 26

16-20 lobes and smaller lobules, surrounded by extensive adipose (fat) tissue.

Question 27

Where does the axillary tail extend?

Answer 27

Extends superolaterally to penetrate the floor of the axilla, lying in close proximity to the axillary lymph nodes.