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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

  thoracicoesophagus 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 II
    drains along Rt. gastroepiploic vessel to
    subpyloric nodes then into aortic nodes

   Area III
    drains along short gastric, splenic
    vessels, superior pancreatic nodes then into
    aortic nodes
Lt. gastric nodes

                               cisterna chyli
  Rt. Gastric nodes                                      III
      aortic nodes                                   I   splenic nodes



superior pancreatic nodes




            Subpyloric nodes
                                                II
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
Lymphatic drainage of major organs
clinical relevance

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


       Spread   of infection

       Spread   of malignant tumours (lymphatic
       spread)
         Stagingof 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:
              Paratracheal
              Superior tracheobronchial
              Inferior tracheobroncial
              Bronchopulmonary
              Pulmonary
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
                                             CONTD
    trunk.                                   …
-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      Upper vagina, cervix, lower uterine corpus
   Lateral Sacral
   Superior Gluteal
   Inferior Gluteal
   Obturator
   Vescical
   Rectal
   Parauterine

Inguinal            Vulva, lower vagina; (rare: uterus, fallopian tubes, ovaries)
   Superficial
   Deep
Lumbar lymphatic
                    trunks




                 Paraaortic nodes

                 Common iliac nodes

                  Sacral nodes
 Lymphatics      Internal iliac nodes
   of the
Female Pelvis      External iliac nodes

                   Obturator nodes

                      Inguinal nodes




                 Parametrial nodes
Lymphatic drainage of major organs

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Lymphatic drainage of major organs

  • 1. Lymphatic Drainage of Major Organs
  • 3. 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.
  • 4. lymphatic drainage of the oesophagus  cervical oesophagus drains into deep cervical nodes  thoracicoesophagus drains into posterior mediastinal nodes  abdominal oesophagus drains into preaortic and coeliac nodes
  • 5. lymphatic drainage of the stomach  Area I superior 2/3 rd drains along Lt. and Rt. gastric vessels to aortic nodes  Area II drains along Rt. gastroepiploic vessel to subpyloric nodes then into aortic nodes  Area III drains along short gastric, splenic vessels, superior pancreatic nodes then into aortic nodes
  • 6. Lt. gastric nodes cisterna chyli Rt. Gastric nodes III aortic nodes I splenic nodes superior pancreatic nodes Subpyloric nodes II
  • 7. lymphatic drainage of the small intestine  drains into superior mesenteric nodes
  • 8. 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
  • 9. epicolic nodes paracolic nodes intermediate nodes central group of nodes
  • 10. 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
  • 11. lymphatic drainage of the anal canal  upper canal drains into internal iliac nodes  lower part drains into superficial inguinal nodes
  • 13. clinical relevance  Drainage area of particular group of lymph nodes  Primary site of pathology  Spread of infection  Spread of malignant tumours (lymphatic spread)  Stagingof disease ( TNM classification )  Treatment  Prognosis
  • 15. Lymphatic Drainage  50 tracheobronchial lymph nodes : Some of the largest lymph nodes in the body. Include: Paratracheal Superior tracheobronchial Inferior tracheobroncial Bronchopulmonary Pulmonary
  • 16. 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.
  • 17. 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.
  • 18. Diaphragmatic nodes: -Lie on upper surface of diaphragm. -Receive lymph from diaphragm, pericardium, upper surface of liver. -Drain to parasternal and posterior mediastinal nodes.
  • 19. Posterior mediastinal nodes: Lie along esophagus and descending thoracic aorta.  Brachiocephalic nodes: Lie along brachiocephalic veins.
  • 20. Lymph Trunks Bronchiomediastinal lymph trunks receive lymph from: -Posterior mediastinal nodes -Brachiocephalic nodes -Tracheobronchial nodes -Parasternal nodes
  • 21. 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 CONTD trunk. …
  • 22. -Receives lymph from left subclavian lymph trunk. -Empties into venous system at junction of: Left internal jugular vein. Left subclavian vein.
  • 23. 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.
  • 24. Lymphatic Drainage of Liver, Spleen & Gall Bladder
  • 25. 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
  • 26. Biliary Duct  Cystic LN, node of omental foramen, hepatic LN’s
  • 28. Lymphatic Drainage of Male Genital Tract
  • 29. Lymph Drainage of the Scrotum  Lymph from the skin and fascia, including the tunica vaginalis, drains into the superficial inguinal lymph nodes .
  • 30. Lymphatic Drainage of The Testes  para-aortic lymph nodes.
  • 31. 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
  • 32. 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.
  • 33. Lymphatic Drainage of Female Genital Tract
  • 34. 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 Upper vagina, cervix, lower uterine corpus Lateral Sacral Superior Gluteal Inferior Gluteal Obturator Vescical Rectal Parauterine Inguinal Vulva, lower vagina; (rare: uterus, fallopian tubes, ovaries) Superficial Deep
  • 35. Lumbar lymphatic trunks Paraaortic nodes Common iliac nodes Sacral nodes Lymphatics Internal iliac nodes of the Female Pelvis External iliac nodes Obturator nodes Inguinal nodes Parametrial nodes