Transcript Axillary lymph node

The Lymphatic
System
SHANDONG UNIVERSITY
Liu Zhiyu
Introduction of The Lymphatic
System
The Lymphatic System
Heart
Vein
Artery
Lymphatic duct
Lymphatic trunk
Capillaries
Lymphatic node
Cell
Tissue fluid
Lymphatic capillary
Lymphatic vessel
The Lymphatic System
Composition
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Lymphatic vessel
 Lymphatic capillary
 Lymphatic vessels
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two sets, superficial and deep
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Lymphatic trunks （nine）
Lymphatic ducts:
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Lymphatic tissue
Lymphatic organ
Lymphatic nodes
 Spleen
 thymus
 Tonsil
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thoracic duct
right lymphatic duck
The Lymphatic System
Lymphatic capillary
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Begin tissue
The wall is composed of a
single layer of overlapping
endothelial cells
They are numerous and
form complex networks
The brain, spinal cord, bone
marrow, parenchyma of
spleen and eyeball lack
lymphatic capillaries
The Lymphatic System
Lymphatic vessel
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Have valves that give them a beaded
appearance
Two sets: superficial (lie in the
superficial fascia ) and deep (run with
blood vessels and nerves)
Passes through at least one lymph
node and often several
The Lymphatic System
Right lymphatic duck
Thoracic duct
The Lymphatic System
lymph node
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(Small oval or beanshaped bodes
Afferent vessels enter the
node on its convex
surface, and afferent
vessels leave the node at
its concave surface－the
hilum
Arranged in groups, along
the blood vessels
Regional nodes
The lymphatic drainage of head
Lymph nodes of head
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Located at junction of head and neck
Consist of
 Occipital lymph nodes
 Mastoid lymph nodes
 Parotid lymph nodes
★ Submandibular lymph nodes
lies near the submandibular gland,
receive lymphatic vessels from the
face, nose and mouth
 submental lymph nodes
 Drain into deep cervical lymph
nodes
Lymph nodes of the neck
Anterior cervical ln.
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Superficial anterior cervical
lymph nodes
Deep anterior cervical lymph
nodes
Lateral cervical ln.
★ Superficial lateral cervical
ln. lie along the external
jugular vein
★ Deep lateral cervical ln.
extend along the internal
jugular vein
Lymph nodes of the neck
★ Deep lateral cervical ln.
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Extend along the internal jugular vein from
the base of skull to the root of neck
Divided into superior deep lateral cervical
ln. and inferior deep lateral cervical ln.
Receive lymphatic vessels from head,
neck, tongue, larynx, cervical parts of
esophagus and trachea, thyroid gland,
upper parts of the thoracic wall and breast
Efferent vessels form the jugular trunk
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Left jugular trunk joins the thoracic duct
Right jugular trunk joints the right
lymphatic duct
Lymph nodes of the neck
Superior deep lateral cervical ln.
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Jugulodigastric ln.
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Lies at the junction of posterior belly of
digastric and internal jugular vein
Drain the nasopharynx, palatine tonsil and
root of tougue
Inferior deep lateral cervical ln.
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Juguloomohyoid ln.
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Lies at the junction of the intermediate tendon
of omohyoid and internal jugular vein
Drain the apex of tongue
Lymph nodes of the neck
Inferior deep lateral
cervical ln.
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Supraclavicular lymph nodes Lie
along transverse cervical a. & v.
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Retrophrangeal ln.
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Lying vertically behind the pharynx
Lymph nodes of upper limb
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Cubital lymph node
lies above medial epicondyle
of humerus
Infraclavicular nodes
Axillary lymph node
arranged in five groups
Axillary lymph nodes
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Axillary lymph nodes vary in
size from a pin-head to a large
bean.
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They are arranged in five
groups.
Axillary lymph nodes
Pectoral lymph nodes
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Lying along the lower
border of pectoralis
minor behind the
pectoralis major
Receive lymph vessels
from the lateral
quadrants of the breast
and superficial vessels
from the anterolateral
abdominal wall above
the level of the umbilicus
Axillary lymph nodes
Lateral lymph
nodes
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Along medial side
distal part axillary vein
Receives lymph from
upper limb
Axillary lymph nodes
Subscapular lymph
node
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Lying along
subscapular vessels, in
front of the
subscapularis
Receive superficial
lymph vessels from the
back, down as far as the
level of the iliac crests
Efferents above three
groups pass to central
lymph node
Axillary lymph nodes
Central lymph node
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Lying in the center of
the axilla in the
axillary fat
Receive lymph from
the above three
nodes
Efferents pass to
apical lymph node
Axillary lymph nodes
Apical lymph node
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Lying at the apex of
the axilla at the lateral
border of the fist rib
Receive lymph the
efferent lymph
vessels from all the
other axillary nodes
The efferents of the
apical nodes form the
subclavian trunk
Axillary lymph nodes
Efferents form subclavian trunk,
the right subclavian trunk joints
the right lymphatic duct; left
Apical ln.
usually drains directly into
thoracic duct
Subclavian trunk
Central ln.
Pectoral ln.
Lateral ln.
Subscapular ln.
Lymphatic drainage of thorax
The lymphatic drainage of
thoracic wall
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To axillary lymph nodes
To parasternal lymph nodes (along
internal thoracic vessels)
To intercostals lymph nodes from
deeper structures
lymph nodes of the thorax
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Pulmonary ln.
lie in the angles of bifurcation of
branching lobar bronchi
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Bronchopulmonary hilar ln.
－lie in the hilus of the lung
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Tracheobronchial ln.
－situated above or below the
bifurcation of trachea
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Paratracheal ln.
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－along each side of the trachea
lymph nodes of the thorax
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Anterior mediastinal lymph
node
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Lies anterior to the large blood vessels
of thoracic cavity and pericardium
The efferents unite with those of
paratracheal lymph nodes and
parasternal lymph nodes to form the
right and left bronchomediastinal
trunks
The left bronchomediastinal trunk
terminates in thoracic duct, and right in
the right lymphtic duct
Posterior mediastinal lymph
nodes
lie along the esophagus and
thoracic aorta
Thoracic duct
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Begins in front of lower border of T12 as
a dilated sac, the cisterna chyli , which
formed by joining of left and right lumbar
trunks and intestinal trunk
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Enter thoracic cavity by passing through
the aortic hiatus of the diaphragm and
ascends along on the front of the
vertebral column, between thoracic aorta
and azygos vein
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Travels upward, veering to the left at the
level of T5
Thoracic duct
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At the roof of the neck, it turns laterally
and arches forwards and descends to
enter the left venous angle
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Just before termination, it receives the
left jugular, subclavian and
bronchomediastinal trunks
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Drains lymph from lower limbs, pelvic
cavity, abdominal cavity, left side of
thorax, and left side of the head, neck
and left upper limb
Right lymphatic duct
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Formed by union of right jugular, subclavian,
and bronchomediastinal trunks
Ends by entering the right venous angle
Receives lymph from right half of head,
neck, thorax and right upper limb
Lymph nodes of lower limb
Popliteal ln.
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Embedded in the fatty connective
tissue of popliteal fossa
Receive superficial lymphatic vessels
from posterolateral part of calf, and
from deep lymphatic vessels
accompanying anterior and posterior
tibial a.
Efferents pass to the deep inguinal ln.
Lymph nodes of lower limb
Superficial inguinal lymph
nodes
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Superior group:
 Lies just distal to the inguinal ligament
 Receive lymph vessels from anterior
abdominal wall below umbilicus, gluteal
region, perineal region, external genital
organs
Inferior group:
 Lies vertical along the terminal great
saphenous v.
 Receives all superficial lymph vessels of
lower limb, except for those from the
posterolateral part of calf
 Efferent vessels drain into the deep
inguinal ln. or external iliac ln.
Lymph nodes of lower limb
Deep inguinal lymph
nodes
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Lie medial to the femoral
v.
Receive deep lymph
vessels of lower limb,
perineal region, and
efferent vessels from the
superficial inguinal ln.
Drain into the external
iliac ln.
Lymphangiogram showing the inguinal
lymph vessels and nodes.
Lymph nodes of pelvis
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Internal iliac lymph node
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External iliac lymph nodes
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Surround internal iliac vessels
Receive afferents from pelvic viscera,
perineum, buttock and back of thigh
Lie along external iliac artery
Receive afferents from lower limb and
some parts of pelvic viscera
Sacral lymph node
Common iliac lymph node
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Lie along common iliac artery
Receive afferents from all the above
nodes
Efferent pass to lumbar lymph node
Lymph nodes of abdomen
Lymphatic drainage of abdominal wall
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To axillary lymph node from region above
umbilicus
To superficial inguinal lymph node from
region below umbilicus
To lumbar lymph node from post wall of
abdomen
Lymph nodes of abdomen
Lymphatic drainage of
abdominal viscera
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Lumbar lymph nodes
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Lie on posterior abdominal wall,
along the abdominal aorta and
inferior vena cava
Receive lymph from kidneys,
suprarenal glands, testes,
ovaries, fundus of uterus, ovary,
and common iliac nodes
Right and left lumbar trunks
formed by efferent vessel
Paired viscera－drain to the
lumbar lymph nodes
Lymph nodes of abdomen
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Right and left gastric ln. lie along
the same vessels and finally to the
celiac ln.
Right and left gastroomental ln.
lie along the same vessels, the
former drain into subpyloric ln., the
latter drain into splenic ln.
Suprapyloric and subpyloric ln.
receive lymphatics from pyloric part
and finally to the celiac ln.
Splenic ln. receive lymphatics
from fundus and left third of
stomach, and finally to the celiac ln.
Celiac lymph nodes
－situated around the celiac
trunk
Lymph nodes of abdomen
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Superior mesenteric
lymph node
－situated around
superior mesenteric a.
Inferior mesenteric
lymph node －situated
around inferior
mesenteric a.
Intestinal trunk
－formed by efferent
vessel of celiac,
superior and inferior
lymph nodes
Spleen
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Shape
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The largest single mass of lymphoid
tissue in the body
Reddish in color
Location:
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lies in the left hypochondriac region
(between stomach and diaphragm)
deep to the 9th to 11th rib
its long axis corresponds roughly to
the 10th rib
Its lower pole extends forward only
as far as the midline and cannot be
palpated on clinical examination
Spleen
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Two surfaces
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Two extremities
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Diaphragmatic: smooth, convex
Visceral: concave, hilum of spleen
Anterior－wider
Posterior－rounder
Two border
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Superior－has 2-3 splenic notch, which
serve as a landmark on palpation when it is
enlarge; normally it is not palpable
Inferior－rounder