Lymphatic Drainage of Major Organs

LYMPHATIC DRAINAGE OF GIT

lymphatic drainage

lymphatic capillaries in the interstitial space, organized into lymphatic vessels and lymph nodes [located along the course of the blood vessels and are named accordingly. e.g. left gastric nodes, splenic nodes, paraaortic nodes, coeliac nodes etc.]

All lymph of GIT drains into the cisterna chyli, thoracic duct, finally drains into the left subclavian vein.

lymphatic drainage of the oesophagus

cervical oesophagus drains into deep cervical nodes

thoracic oesophagus drains into posterior mediastinal nodes

abdominal oesophagus drains into preaortic and coeliac nodes

lymphatic drainage of the stomach

Area I superior 2/3 rd drains along Lt. and Rt. gastric vessels to aortic nodes

Area IIdrains along Rt. gastroepiploic vessel to subpyloric nodes then into aortic nodes

Area IIIdrains along short gastric, splenic vessels, superior pancreatic nodes then into aortic nodes

Subpyloric nodes

Rt. Gastric nodes

Lt. a

nd R

t. g

astroe

pipl

oic

node

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splenic nodes

superior pancreatic nodes

Lt. gastric nodes

aortic nodes

I

II

IIIcisterna chyli

lymphatic drainage of the small intestine

drains into superior mesenteric nodes

lymphatic drainage of the large intestine

drains into the central nodes located at the origin of the superior and inferior mesenteric arteries

through epicolic, paracolic, intermediate nodes

epicolic nodes

paracolic nodes

intermediate nodes

central group of nodes

lymphatic drainage of the rectum

drain into pararectal nodes nodes along vessels supplying the rectum and

then into para-aortic nodes at the origin of the IMA

drainage is mainly upwards upper half

along superior rectal vessels to inferior mesenteric nodes

lower half along middle rectal vessels to internal iliac nodes

lymphatic drainage of the anal canal

upper canal drains into internal iliac nodes

lower part drains into superficial inguinal nodes

clinical relevance

Drainage area of particular group of lymph nodes Primary site of pathology

Spread of infection

Spread of malignant tumours (lymphatic spread)

Staging of disease ( TNM classification ) Treatment Prognosis

Lymphatic Drainage of Mediastinum

Lymphatic Drainage

50 tracheobronchial lymph nodes :Some of the largest lymph nodes in

the body.Include:

ParatrachealSuperior tracheobronchialInferior tracheobroncialBronchopulmonaryPulmonary

Lymph Drainage of Thoracic Cavity Parasternal nodes:

- Lie behind sternum along course of internal thoracic artery.- Receive lymph from thoracic wall, upper anterior abdominal wall, and diaphragm.- Also receive significant amount of lymph from mammary gland.-Drain into parasternal lymph channel.

Posterior intercostal nodes:

-Lie in posterior intercostal space between heads of ribs.

-Receive lymph from thoracic wall and paravertebral regions.-Drain into thoracic duct:

From left and lower right.-Drain into right lymphatic duct:

From upper right.

Diaphragmatic nodes:-Lie on upper surface of diaphragm.

-Receive lymph from diaphragm, pericardium, upper surface of liver.

-Drain to parasternal and posterior mediastinal nodes.

Posterior mediastinal nodes:Lie along esophagus and descending

thoracic aorta.

Brachiocephalic nodes:Lie along brachiocephalic veins.

Lymph Trunks

Bronchiomediastinal lymph trunks receive lymph from:

-Posterior mediastinal nodes-Brachiocephalic nodes-Tracheobronchial nodes-Parasternal nodes

Thoracic Duct

-Begins in abdomen on right side of midline.

-Receives most of lymph from body below diaphragm.

-Drains left side of thoracic cavity and part of right.

-Receives lymph from left internal jugular lymph trunk. CONTD

…

-Receives lymph from left subclavian lymph trunk.

-Empties into venous system at junction of:

Left internal jugular vein.Left subclavian vein.

Right Lymphatic Duct:

-Drains upper right thoracic cavity, right upper extremity, and right side of head and neck.

-Empties into venous system at junction of:

Right internal jugular vein.Right subclavian vein.

Lymphatic Drainage of Liver, Spleen & Gall Bladder

Liver

Superficial and most deep lymph vessels converge at the porta and end in the hepatic lymph nodes (eg. Cystic LN near GB neck or LN of omental foramen)

Hepatic LN’s drain into coeliac LN’s around the coeliac trunk, then thoracic duct

Some deep lymph vessels follow hepatic veins to IVC foramen in diaphragm and end in middle phrenic LN’s

Biliary Duct

Cystic LN, node of omental foramen, hepatic LN’s

Spleen

Pancreaticosplenic LN’s

Lymphatic Drainage of Male Genital Tract

Lymph Drainage of the Scrotum Lymph from the

skin and fascia, including the tunica vaginalis, drains into the superficial inguinal lymph nodes .

Lymphatic Drainage of The Testes

para-aortic lymph nodes.

Lymphatics of The Prostate

Lymph vessels terminate in internal iliac and sacral lymph nodes

Some vessels from posterior surface pass with lymph vessels from bladder to external iliac LN’s

Lymphatics of The Penis

The skin of the penis is drained into the medial group of superficial inguinal nodes.

The deep structures of the penis are drained into the internal iliac nodes.

Lymphatic Drainage of Female Genital Tract

Nodes Primary Afferent Connections

Aortic/Paraaortic Ovary, fallopian tubes, upper uterine corpus; drainage from common iliac nodes

Common Iliac Drainage from external and internal iliac nodes

External Iliac Upper vagina, cervix, upper uterine corpus; drainage from inguinal nodes

Internal Iliac Lateral Sacral Superior Gluteal Inferior Gluteal Obturator Vescical Rectal Parauterine

Upper vagina, cervix, lower uterine corpus

Inguinal Superficial Deep

Vulva, lower vagina; (rare: uterus, fallopian tubes, ovaries)

Lymphaticsof the

Female Pelvis

Lumbar lymphatictrunks

Paraaortic nodes

Common iliac nodes

Sacral nodes

Internal iliac nodes

External iliac nodes

Obturator nodes

Inguinal nodes

Parametrial nodes