The Lymphatic System

SHANDONG UNIVERSITY

Liu Zhiyu

Introduction of The Lymphatic System

The Lymphatic System

Heart

Artery

Capillaries

Vein

Cell Tissue fluid Lymphatic capillary Lymphatic vessel

Lymphatic node

Lymphatic trunk

Lymphatic duct

The Lymphatic System Composition Lymphatic vessel

Lymphatic capillary Lymphatic vessels two sets, superficial and deep Lymphatic trunks （ nine） Lymphatic ducts:

thoracic duct right lymphatic duck Lymphatic tissue

Lymphatic organ Lymphatic nodes

Spleen thymus Tonsil

The Lymphatic System

Lymphatic capillary Begin tissue The wall is composed of a si

ngle 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 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 (Small oval or bean-

shaped 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 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. 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.

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 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. Jugulodigastric ln.

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. Juguloomohyoid ln.

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. Supraclavicular lymph nodes Lie

along transverse cervical a. & v. Retrophrangeal ln.

Lying vertically behind the pharynx

Lymph nodes of upper limb

Cubital lymph node lies above medial epicondyle of humerus

Infraclavicular nodes Axillary lymph node

arranged in five groups

Axillary lymph nodes

Axillary lymph nodes vary in

size from a pin-head to a

large bean.

They are arranged in five

groups.

Axillary lymph nodes

Pectoral lymph nodes

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

Along medial side distal part axillary vein

Receives lymph from upper limb

Axillary lymph nodes

Subscapular lymph node

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

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

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

Lateral ln.

Pectoral ln.

Subscapular ln.

Central ln.

Apical ln.

Efferents form subclavian trunk, the right subclavian trunk joints the right lymphatic duct; left usually drains directly into thoracic duct

Subclavian trunk

Lymphatic drainage of thorax

The lymphatic drainage of thoracic wall

To axillary lymph nodes To parasternal lymph nodes (along

internal thoracic vessels) To intercostals lymph nodes from

deeper structures

lymph nodes of the thorax

Pulmonary ln. lie in the angles of bifurcation of branching lobar bronchi

Bronchopulmonary hilar ln. － lie in the hilus of the lung

Tracheobronchial ln. － situated above or below the bifurcation of trachea

Paratracheal ln. － along each side of the trachea

lymph nodes of the thorax Anterior mediastinal lymph

node 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 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

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

Travels upward, veering to the left at the level of T5

Thoracic duct

At the roof of the neck, it turns laterally and arches forwards and descends to enter the left venous angle

Just before termination, it receives the left jugular, subclavian and bronchomediastinal trunks

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

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. 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

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

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 Internal iliac lymph node

Surround internal iliac vessels Receive afferents from pelvic viscera,

perineum, buttock and back of thigh External iliac lymph nodes

Lie along external iliac artery Receive afferents from lower limb

and some parts of pelvic viscera Sacral lymph node Common iliac lymph node

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 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

Lumbar lymph nodes 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

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

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 Shape

The largest single mass of lymphoid tissue in the body

Reddish in color Location:

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 Two surfaces

Diaphragmatic: smooth, convex Visceral: concave, hilum of spleen

Two extremities Anterior － wider Posterior － rounder

Two border Superior － has 2-3 splenic notch, which

serve as a landmark on palpation when it is enlarge; normally it is not palpable

Inferior － rounder