Lymphatics of the Thorax: Rahmat

Question 1

What are the functions of the lymphatic system?

Answer 1

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

Question 2

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

Answer 2

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

Question 3

What are lymphatic trunks formed by?

Answer 3

the union of the largest collecting vessels

Question 4

The lumbar lymphatic trunk drains what?

Answer 4

lower limbs, kidney, pelvis, abdominal wall

Question 5

The intestinal lymphatic trunk drains what?

Answer 5

stomach, intestines, spleen, pancreas, liver

Question 6

The bronchomediastinal lymphatic trunk drains what?

Answer 6

thoracic wall, lungs, heart

Question 7

The subclavian lymphatic trunk drains what?

Answer 7

upper limbs

Question 8

The jugular lymphatic trunk drains what?

Answer 8

head and neck

Question 9

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

Answer 9

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

Question 10

Where does the thoracic duct drain into?

Answer 10

left subclavian vein

Question 11

Where does the right lymphatic and thoracic duct drain?

Answer 11

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

Question 12

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

Answer 12

inferior vena cava: T8

esophagus: T10

aortic hiatus: T12

Question 13

What are the primary lymphatic organs?

Answer 13

• bone marrow

- thymus

Question 14

Where in the mediastinum is the thymus located?

Answer 14

anterior mediastinum

Question 15

Where do T lymphocytes mature?

Answer 15

in the thymus

-thymus decreases in size after puberty

Question 16

What nerves supplies the thymus?

Answer 16

Parasympathetic: CN X
Sympathetic: sympathetic trunk

Question 17

What arteries supply the thymus?

Answer 17

internal thoracic artery branches

Question 18

What veins drain the thymus?

Answer 18

internal thoracic veins: tributaries

Question 19

What nodes are found in the thymus?

Answer 19

• parasternal nodes
• anterior mediastinal nodes
• tracheobronchial nodes

Question 20

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

Answer 20

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

left side–> left bronchomediastinal trunk–> thoracic duct

Question 21

What is thymoma and what are symptoms of it?

Answer 21

tumor in epithelial cells of the thymus gland

linked with myasthenia gravis and other autoimmune diseases

symptoms include persistent cough and chest pain

Question 22

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

Answer 22

-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

Question 23

Axillary lymph nodes drain lymph vessels FROM where?

Answer 23

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

Question 24

Axillary lymph nodes drain lymph vessels TO where?

Answer 24

subclavian trunks

Question 25

What do apical lymph nodes receive efferent lymph vessels from?

Answer 25

all axillary nodes

Question 26

What are the early warning signs of breast cancer?

Answer 26

- visible lump - nipple change (inversion) - color or texture change - dimpled or depressed skin - bloody discharge

Question 27

Breast cancer develops where?

Answer 27

develops in acini, lactiferous ducts and lobules of breast

Question 28

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

Answer 28

- axillary lymph nodes - supraclavicular nodes - parasternal lymph nodes - abdominal lymph nodes

Question 29

What factors are included in staging the tumor?

Answer 29

- size of primary tumor - exact size of primary tumor - number and sites of lymph node spread - organs which tumor may have spread

Question 30

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

Answer 30

- 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

Question 31

Lymphatic vessels of the thoracic wall drain mainly to?

Answer 31

-parasternal nodes -intercostal nodes diaphragmatic nodes

Question 32

Intercostal nodes at the upper thorax drain into what?

Answer 32

bronchomediastinal trunk

Question 33

Intercostal nodes at the lower thorax drain into what?

Answer 33

thoracic duct

Question 34

Diaphragmatic nodes interconnect with what nodes?

Answer 34

- parasternal nodes - brachiocephalic nodes - lateral aortic/lumbar nodes - esophageal nodes

Question 35

The anterior group of the diaphragmatic nodes drain into what?

Answer 35

parasternal nodes then to bronchomediastinal trunk

Question 36

The lateral group of the diaphragmatic nodes drain into what?

Answer 36

parasternal nodes and/or posterior intercostal nodes

Question 37

The posterior group of the diaphragmatic nodes drain into what?

Answer 37

thoracic duct and cisterna chyli

Question 38

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

Answer 38

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

Question 39

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

Answer 39

intercostal nodes

Question 40

Where are anterior mediastinal nodes located?

Answer 40

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

Question 41

Where are posterior mediastinal nodes located?

Answer 41

- lie posterior to the pericardium - may indent the esophagus when enlarged - afferents from esophagus and posterior part of pericardium - efferents to thoracic duct

Question 42

What is chylothorax?

Answer 42

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

Question 43

What is the pancoast tumor/syndrome?

Answer 43

- tumor of the apex of lung | - affects root of the neck

Question 44

Where does lymph fluid from the visceral pleura drain into?

Answer 44

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

Question 45

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

Answer 45

1. pulmonary group 2. bronchopulmonary group 3. tracheobronchial group 4. paratracheal group

Question 46

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

Answer 46

right side--> right bronchomediastinal trunk --> right lymphatic duct left side--> left bronchomediastinal trunk--> thoracic duct

Question 47

What are the respiratory symptoms of lung cancer?

Answer 47

- cough - coughing up blood - wheezing - SOB

Question 48

What are the systemic symptoms of lung cancer?

Answer 48

- weight loss - weakness - fever - clubbing of the fingernails

Question 49

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

Answer 49

- chest pain - bone pain - superior vena cava obstruction - difficulty swallowing and breathing

Question 50

Where do the lymphatics of the heart drain into?

Answer 50

-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

Question 51

Where do the lymphatics of the esophagus drain into?

Answer 51

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

Question 52

What are the symptoms of esophageal cancer?

Answer 52

- 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

Question 53

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

Answer 53

upper airway obstruction and superior vena cava syndrome

Question 54

What is the Virchow's node?

Answer 54

-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

Question 55

The angulus venosus is the junction of which veins?

Answer 55

Internal jugular & Subclavian

Question 56

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

Answer 56

Superior vena cava syndrome

Question 57

A tumor in the apex of the lung is called?

Answer 57

Pancoast tumor

Question 58

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

Answer 58

Bronchopulmonary group

Question 59

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

Answer 59

intercostal nodes

Question 60

Lymph from the heart drains into which lymph nodes?

Answer 60

tracheobronchial nodes

Question 61

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

Answer 61

anterior mediastinal nodes

Question 62

The aortic hiatus is located at which vertebral level?

Answer 62

T12

Question 63

Which structures travel through the aortic hiatus?

Answer 63

azygos vein thoracic duct descending aorta NOT esophagus

Question 64

Which lymph nodes are located along the internal thoracic vessels?

Answer 64

parasternal nodes