Lymphatics of the Thorax: Rahmat Flashcards
What are the functions of the lymphatic system?
- drains interstitial fluid
- recycles blood plasma into cardiovascular system
- filtration
- transportation: fatty acids, hormones, steroids, vitamins
- Natural defense of the body: phagocytosis, cytotoxic reactions, antibody production
How does the lymphatic system recycle blood plasma into the cardiovascular system?
the excess water and solutes that filter out of the capillary are picked up by the lymph vessels and returned to the circulation
What are lymphatic trunks formed by?
the union of the largest collecting vessels
The lumbar lymphatic trunk drains what?
lower limbs, kidney, pelvis, abdominal wall
The intestinal lymphatic trunk drains what?
stomach, intestines, spleen, pancreas, liver
The bronchomediastinal lymphatic trunk drains what?
thoracic wall, lungs, heart
The subclavian lymphatic trunk drains what?
upper limbs
The jugular lymphatic trunk drains what?
head and neck
How is the lymphatic drainage asymmetric in terms of the right and left lymphatic duct?
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
Where does the thoracic duct drain into?
left subclavian vein
Where does the right lymphatic and thoracic duct drain?
at the angulus venosus located at the junction of the IJV and SCV
At what thoracic level does the inferior vena cava, esophagus, and aortic hiatus pass through the diaphragm?
inferior vena cava: T8
esophagus: T10
aortic hiatus: T12
What are the primary lymphatic organs?
- bone marrow
- thymus
Where in the mediastinum is the thymus located?
anterior mediastinum
Where do T lymphocytes mature?
in the thymus
-thymus decreases in size after puberty
What nerves supplies the thymus?
Parasympathetic: CN X
Sympathetic: sympathetic trunk
What arteries supply the thymus?
internal thoracic artery branches
What veins drain the thymus?
internal thoracic veins: tributaries
What nodes are found in the thymus?
- parasternal nodes
- anterior mediastinal nodes
- tracheobronchial nodes
Where do the parasternal, anterior mediastinal, and tracheobronchial nodes drain?
right side–> right bronchomediastinal trunk–> right lymphatic duct
left side–> left bronchomediastinal trunk–> thoracic duct
What is thymoma and what are symptoms of it?
tumor in epithelial cells of the thymus gland
linked with myasthenia gravis and other autoimmune diseases
symptoms include persistent cough and chest pain
What is the superior vena cava syndrome? What is it caused by and what are characteristics of it?
-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
Axillary lymph nodes drain lymph vessels FROM where?
- superficial regions of the thoracic wall
- lateral breast
- vessels of upper limb
- superficial regions of the abdomen above the navel
Axillary lymph nodes drain lymph vessels TO where?
subclavian trunks
What do apical lymph nodes receive efferent lymph vessels from?
all axillary nodes
What are the early warning signs of breast cancer?
- visible lump
- nipple change (inversion)
- color or texture change
- dimpled or depressed skin
- bloody discharge
Breast cancer develops where?
develops in acini, lactiferous ducts and lobules of breast
The lymphatic drainage of breast is complex. Where are does lymph from breast drain into?
- axillary lymph nodes
- supraclavicular nodes
- parasternal lymph nodes
- abdominal lymph nodes
What factors are included in staging the tumor?
- size of primary tumor
- exact size of primary tumor
- number and sites of lymph node spread
- organs which tumor may have spread
What is the importance of sentinel lymph nodes in the breast?
- 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
Lymphatic vessels of the thoracic wall drain mainly to?
-parasternal nodes
-intercostal nodes
diaphragmatic nodes
Intercostal nodes at the upper thorax drain into what?
bronchomediastinal trunk
Intercostal nodes at the lower thorax drain into what?
thoracic duct
Diaphragmatic nodes interconnect with what nodes?
- parasternal nodes
- brachiocephalic nodes
- lateral aortic/lumbar nodes
- esophageal nodes
The anterior group of the diaphragmatic nodes drain into what?
parasternal nodes then to bronchomediastinal trunk
The lateral group of the diaphragmatic nodes drain into what?
parasternal nodes and/or posterior intercostal nodes
The posterior group of the diaphragmatic nodes drain into what?
thoracic duct and cisterna chyli
What are the 4 or 5 pairs of lymph nodes along the internal thoracic artery that drain directly into the bronchomediastinal trunk?
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
What are the lymph nodes on the posterior wall of the posterior mediastinum that drain the lymphatics of the posterior and lateral chest called?
intercostal nodes
Where are anterior mediastinal nodes located?
- in the superior mediastinum
- anterior to the brachiocephalic vein
- drain into the right and left bronchomediastinal trunks (efferents)
- afferents from thymus
Where are posterior mediastinal nodes located?
- lie posterior to the pericardium
- may indent the esophagus when enlarged
- afferents from esophagus and posterior part of pericardium
- efferents to thoracic duct
What is chylothorax?
caused by rupture of the thoracic duct leading to leakage of lymph into the posterior mediastinum
What is the pancoast tumor/syndrome?
- tumor of the apex of lung
- affects 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 four groups of lymph nodes of the trachea and lungs?
- pulmonary group
- bronchopulmonary group
- tracheobronchial group
- paratracheal group
Where do the lymph nodes of the trachea and lungs ultimately drain into?
right side–> right bronchomediastinal trunk –> right lymphatic duct
left side–> left bronchomediastinal trunk–> thoracic duct
What are the respiratory symptoms of lung cancer?
- cough
- coughing up blood
- wheezing
- SOB
What are the systemic symptoms of lung cancer?
- weight loss
- weakness
- fever
- clubbing of the fingernails
What are the symptoms of lung cancer due to cancer mass pressing on adjacent structures?
- chest pain
- bone pain
- superior vena cava obstruction
- difficulty swallowing and breathing
Where do the lymphatics of the heart drain into?
-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
Where do the lymphatics of the esophagus drain into?
posterior mediastinal nodes and posterior intercostal nodes then into the thoracic duct
What are the symptoms of esophageal cancer?
- 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
When esophageal cancer tumor starts compressing structures it can lead to what?
upper airway obstruction and superior vena cava syndrome
What is the Virchow’s node?
-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
The angulus venosus is the junction of which veins?
Internal jugular & Subclavian
The presence of swollen collateral veins on the neck and chest wall is directly caused by which condition?
Superior vena cava syndrome
A tumor in the apex of the lung is called?
Pancoast tumor
Which lymph nodes are found in the hilum of the lung?
Bronchopulmonary group
Which lymph nodes are located near the head of the ribs?
intercostal nodes
Lymph from the heart drains into which lymph nodes?
tracheobronchial nodes
Which lymph nodes are located in front of the brachiocephalic veins?
anterior mediastinal nodes
The aortic hiatus is located at which vertebral level?
T12
Which structures travel through the aortic hiatus?
azygos vein
thoracic duct
descending aorta
NOT esophagus
Which lymph nodes are located along the internal thoracic vessels?
parasternal nodes
