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CSF3 Exam 2 > Lymphatics of the Thorax: Rahmat > Flashcards

Lymphatics of the Thorax: Rahmat Flashcards

1
Q

What are the functions of the lymphatic system?

A
  1. drains interstitial fluid
  2. recycles blood plasma into cardiovascular system
  3. filtration
  4. transportation: fatty acids, hormones, steroids, vitamins
  5. Natural defense of the body: phagocytosis, cytotoxic reactions, antibody production
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2
Q

How does the lymphatic system recycle blood plasma into the cardiovascular system?

A

the excess water and solutes that filter out of the capillary are picked up by the lymph vessels and returned to the circulation

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3
Q

What are lymphatic trunks formed by?

A

the union of the largest collecting vessels

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4
Q

The lumbar lymphatic trunk drains what?

A

lower limbs, kidney, pelvis, abdominal wall

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5
Q

The intestinal lymphatic trunk drains what?

A

stomach, intestines, spleen, pancreas, liver

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6
Q

The bronchomediastinal lymphatic trunk drains what?

A

thoracic wall, lungs, heart

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7
Q

The subclavian lymphatic trunk drains what?

A

upper limbs

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8
Q

The jugular lymphatic trunk drains what?

A

head and neck

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9
Q

How is the lymphatic drainage asymmetric in terms of the right and left lymphatic duct?

A

right lymphatic duct: drains lymph from the right upper arm and right side of the head and thorax

thoracic duct: receives lymph from the rest of the body

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10
Q

Where does the thoracic duct drain into?

A

left subclavian vein

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11
Q

Where does the right lymphatic and thoracic duct drain?

A

at the angulus venosus located at the junction of the IJV and SCV

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12
Q

At what thoracic level does the inferior vena cava, esophagus, and aortic hiatus pass through the diaphragm?

A

inferior vena cava: T8

esophagus: T10

aortic hiatus: T12

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13
Q

What are the primary lymphatic organs?

A
  • bone marrow

- thymus

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14
Q

Where in the mediastinum is the thymus located?

A

anterior mediastinum

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15
Q

Where do T lymphocytes mature?

A

in the thymus

-thymus decreases in size after puberty

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16
Q

What nerves supplies the thymus?

A

Parasympathetic: CN X
Sympathetic: sympathetic trunk

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17
Q

What arteries supply the thymus?

A

internal thoracic artery branches

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18
Q

What veins drain the thymus?

A

internal thoracic veins: tributaries

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19
Q

What nodes are found in the thymus?

A
  • parasternal nodes
  • anterior mediastinal nodes
  • tracheobronchial nodes
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20
Q

Where do the parasternal, anterior mediastinal, and tracheobronchial nodes drain?

A

right side–> right bronchomediastinal trunk–> right lymphatic duct

left side–> left bronchomediastinal trunk–> thoracic duct

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21
Q

What is thymoma and what are symptoms of it?

A

tumor in epithelial cells of the thymus gland

linked with myasthenia gravis and other autoimmune diseases

symptoms include persistent cough and chest pain

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22
Q

What is the superior vena cava syndrome? What is it caused by and what are characteristics of it?

A

-caused by obstruction of the superior vena cava (usually cancer)

Symptoms:

  • edema (swelling due to excess fluid) of the face and arms
  • development of swollen collateral veins on neck and chest wall
  • shortness of breath, coughing, difficulty swallowing
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23
Q

Axillary lymph nodes drain lymph vessels FROM where?

A
  • superficial regions of the thoracic wall
  • lateral breast
  • vessels of upper limb
  • superficial regions of the abdomen above the navel
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24
Q

Axillary lymph nodes drain lymph vessels TO where?

A

subclavian trunks

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25
Q

What do apical lymph nodes receive efferent lymph vessels from?

A

all axillary nodes

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26
Q

What are the early warning signs of breast cancer?

A
  • visible lump
  • nipple change (inversion)
  • color or texture change
  • dimpled or depressed skin
  • bloody discharge
27
Q

Breast cancer develops where?

A

develops in acini, lactiferous ducts and lobules of breast

28
Q

The lymphatic drainage of breast is complex. Where are does lymph from breast drain into?

A
  • axillary lymph nodes
  • supraclavicular nodes
  • parasternal lymph nodes
  • abdominal lymph nodes
29
Q

What factors are included in staging the tumor?

A
  • size of primary tumor
  • exact size of primary tumor
  • number and sites of lymph node spread
  • organs which tumor may have spread
30
Q

What is the importance of sentinel lymph nodes in the breast?

A
  • sentinel nodes are the first few lymph nodes into which a tumor drains
  • dye is injected near tumor to locate the position of the sentinel lymph node
  • surgeon looks for stained lymph node
  • biopsy of the sentinel lymph node to check for presence of cancer cells
  • if cancer is found, additional lymph nodes are removed
31
Q

Lymphatic vessels of the thoracic wall drain mainly to?

A

-parasternal nodes
-intercostal nodes
diaphragmatic nodes

32
Q

Intercostal nodes at the upper thorax drain into what?

A

bronchomediastinal trunk

33
Q

Intercostal nodes at the lower thorax drain into what?

A

thoracic duct

34
Q

Diaphragmatic nodes interconnect with what nodes?

A
  • parasternal nodes
  • brachiocephalic nodes
  • lateral aortic/lumbar nodes
  • esophageal nodes
35
Q

The anterior group of the diaphragmatic nodes drain into what?

A

parasternal nodes then to bronchomediastinal trunk

36
Q

The lateral group of the diaphragmatic nodes drain into what?

A

parasternal nodes and/or posterior intercostal nodes

37
Q

The posterior group of the diaphragmatic nodes drain into what?

A

thoracic duct and cisterna chyli

38
Q

What are the 4 or 5 pairs of lymph nodes along the internal thoracic artery that drain directly into the bronchomediastinal trunk?

A

parasternal lymph nodes

the ultimate final destination is the right lymphatic duct and the thoracic duct

drains the breast, abdominal wall above the umbilicus, and anterior thoracic wall

39
Q

What are the lymph nodes on the posterior wall of the posterior mediastinum that drain the lymphatics of the posterior and lateral chest called?

A

intercostal nodes

40
Q

Where are anterior mediastinal nodes located?

A
  • in the superior mediastinum
  • anterior to the brachiocephalic vein
  • drain into the right and left bronchomediastinal trunks (efferents)
  • afferents from thymus
41
Q

Where are posterior mediastinal nodes located?

A
  • lie posterior to the pericardium
  • may indent the esophagus when enlarged
  • afferents from esophagus and posterior part of pericardium
  • efferents to thoracic duct
42
Q

What is chylothorax?

A

caused by rupture of the thoracic duct leading to leakage of lymph into the posterior mediastinum

43
Q

What is the pancoast tumor/syndrome?

A
  • tumor of the apex of lung

- affects root of the neck

44
Q

Where does lymph fluid from the visceral pleura drain into?

A

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

45
Q

What are the four groups of lymph nodes of the trachea and lungs?

A
  1. pulmonary group
  2. bronchopulmonary group
  3. tracheobronchial group
  4. paratracheal group
46
Q

Where do the lymph nodes of the trachea and lungs ultimately drain into?

A

right side–> right bronchomediastinal trunk –> right lymphatic duct

left side–> left bronchomediastinal trunk–> thoracic duct

47
Q

What are the respiratory symptoms of lung cancer?

A
  • cough
  • coughing up blood
  • wheezing
  • SOB
48
Q

What are the systemic symptoms of lung cancer?

A
  • weight loss
  • weakness
  • fever
  • clubbing of the fingernails
49
Q

What are the symptoms of lung cancer due to cancer mass pressing on adjacent structures?

A
  • chest pain
  • bone pain
  • superior vena cava obstruction
  • difficulty swallowing and breathing
50
Q

Where do the lymphatics of the heart drain into?

A

-right side drains into right tracheobronchial nodes and brachiocephalic nodes
that then drain into the right bronchomediastinal trunk which empties into the right lymphatic duct

-left side drains into left tracheobronchial nodes and brachiocephalic nodes which then drain into the left bronchomediastinal trunk which empties into the thoracic duct

51
Q

Where do the lymphatics of the esophagus drain into?

A

posterior mediastinal nodes and posterior intercostal nodes then into the thoracic duct

52
Q

What are the symptoms of esophageal cancer?

A
  • difficulty in swallowing (often first with solid foods, then softer foods and liquids)
  • weight loss due to reduced appetite 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
53
Q

When esophageal cancer tumor starts compressing structures it can lead to what?

A

upper airway obstruction and superior vena cava syndrome

54
Q

What is the Virchow’s node?

A

-an enlarged, hard node that strongly indicates abdominal cancer, specifically gastric cancer, that has spread through the lymph vessels

  • in the left supraclavicular fossa
  • gets lymph from lymph vessels in the abdominal cavity
55
Q

The angulus venosus is the junction of which veins?

A

Internal jugular & Subclavian

56
Q

The presence of swollen collateral veins on the neck and chest wall is directly caused by which condition?

A

Superior vena cava syndrome

57
Q

A tumor in the apex of the lung is called?

A

Pancoast tumor

58
Q

Which lymph nodes are found in the hilum of the lung?

A

Bronchopulmonary group

59
Q

Which lymph nodes are located near the head of the ribs?

A

intercostal nodes

60
Q

Lymph from the heart drains into which lymph nodes?

A

tracheobronchial nodes

61
Q

Which lymph nodes are located in front of the brachiocephalic veins?

A

anterior mediastinal nodes

62
Q

The aortic hiatus is located at which vertebral level?

A

T12

63
Q

Which structures travel through the aortic hiatus?

A

azygos vein
thoracic duct
descending aorta

NOT esophagus

64
Q

Which lymph nodes are located along the internal thoracic vessels?

A

parasternal nodes

CSF3 Exam 2 (14 decks)

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