1. Lymphatic drainage of the head, neck, chest cavity, abdomen and pelvis.
Semmelweis University,
Faculty of Medicine, 1st year 2nd semester
Dr. Kocsis Katalin
Department of Human Morphology and Developmental Biology

2. fluid filtrated to the extracellular space from the capillaries
MECHANISM OF LYMPH PRODUCTION
fluid filtrated to the extracellular space from the capillaries

3. lymphatic circulation is sustained by lymph volume is increased by:
LYMPH = clear water (blood plasm)
components of lymph
water
2-5 % protein
electrolytes
glucose, amino acids
fatty acids, triglicerids
lymphocytes
function of lymphatic circulation
transport of extracellularis fluid
filtration of lymph
absorption and transport of fats
immune defence
no lymph vessels
CNS
bone and cartilage
placenta
spleen parenchyma
lymphatic circulation is sustained by
tissue pressure
contraction of lymph vessels
skeletal muscle function
negative pressure in the veins
1. overproduction
2. low osmotic pressure
3. lymph vessel obstruction
lymph volume is increased by:
oedema = lymph volume is increased in the tissues

5. ductus lymphaticus dexter
RIGHT AND LEFT ANGULUS VENOSUS
v. jugularis interna
v. jugularis interna
ductus thoracicus
ductus
lymphaticus dexter
v. subclavia
v. brachiocephalica
ductus thoracicus
v. azygos

6. LYMPH VESSEL LONGITUDINAL SECTION
Valve(V)

7. THE LYMPH FLOWS THROUGH SOME (2-3) LYMPH NODES BEFORE ENTERING THE SYSTEMIC CIRCULATION
sinus intermedius
vasa
afferentes
efferent lymph vessel
follicle
medullary sinus
artery
vas efferens
vein
afferent lymph vessels
Femoralis lymph nodes

8. injection of contrast material
EXAMINATION OF LYMPHATIC VESSELS
LYMPHOGRAPHY:
injection of contrast material
Injection of vital dye

9. Lymphangiography

10. retroperitoneal lmyph vessels
RETROPERITONEAL LYMPH NODES
nodi
lymphatici
aortici
nodi
lymphatici
lumbales
retroperitoneal lmyph vessels

11. bronchomediastinalis
MAIN LYMPH VESSELS
truncus
bronchomediastinalis
dexter
truncus
lymphaticus
dexter
truncus jugularis
truncus subclavius
aorta
ductus thoracicus
cisterna chyli
truncus
lumbalis
truncus intestinalis
ductus thoracicus

12. UPPER LIMB LYMPH VESSELS
nodi lymphatici
axillares laterales

13. Lymphatic vessels of the upper limb and wall of the upper trunk
Superficial and deep lymphatic vessels - the superficial ones are superficial to the fascias, running with the superficial veins, the deep ones run with the vessels.
lymph nodes:
n.l. cubitales: forearm
n.l. axillares - superficial group:
n.l. axillares laterales: arm
n.l. axillares pectorales: thoracic wall, mammary gland
n.l. axillares subscapulares: nucha, shoulder, back
n.l. axillares - deep group:
n.l. axillares centrales: arm
n.l. axillares apicales: arm, mammary gland
drainage: through the n.l. supraclaviculares to the truncus subclavius

14. 5. 1. 4. 3. 2. LYMPH NODES OF THE FOSSA AXILLARIS
Nodi lymphatici axillares laterales
Nodi lymphatici pectorales
Nodi lymphatici subscapulares
Nodi lymphatici centrales
Nodi lymphatici apicales

16. LYMPHATIC DRAINAGE OF THE MAMMARY GLAND

17. Lymphatic drainage of the mammary gland
superficial and deep lymphatic vessels drained to
n.l. pectorales (from the lateral part) and n.l. intercostales (from the lower part)
– from there to the n.l. axillares centrales and n.l. axillares apicales
– from there to the n.l. supraclaviculares and the
– truncus subclavius
n.l. parasternales (from the medial part)
– to the n.l. mediastinales and the
– truncus bronchomediastinalis

18. Axillary lymph nodes (dissection room preparation)

19. LYMPHATIC DRAINAGE OF THE SUPERFICIAL LAYER OF HEAD
nodi lymphatici occipitales
nodi lymphatici retroauriculares
nodi lymphatici parotidei superficiales
nodi lymphatici submentales
nodi lymphatici submandibulares
nodi lymphatici cervicales profundi

20. Head lymphatic drainage
Regional (primary) lymph nodes:
1. n.l. submentales: lower lip, chin, lower teeth, tongue apex, sublingual region
2. n.l. submandibulares: forehead middle part, nose surface, lower eyelid, bucca, upper lip, skin on the mandibule, nasal cavity anterior part, tongue middle part, upper teeth, palate, 3-7. lower teeth, floor of oral cavity
3. n.l. parotidei superficiales et profundi: skin before the ear, forehead, upper eyelid, auricule, external ear, glandula parotis
4. n.l. retroauriculares/mastoidei: skin behind the eaer, dorsal surface of the auricule, meatus acusticus externus, tympanic cavity
5. n.l. occipitales: nuchal region
6. n.l. retropharyngei: pharynx upper part, tympanic cavity, auditory tube, soft palate, posterior part of nasal cevity, deep part of orbit
7. n.l. praelaryngei: larynx, pharynx lower part, esophagus upper part
8. n.l. para- et praetracheales: larynx, trachea, bronchi, esophagus
9. n.l. cervicales anteriores: neck anterior part
10. n.l. cervicales superficiales: neck skin superficial part, auricule, regio parotideomasseterica
Secondary (partly primary) lymph nodes:
I. n.l. cervicales profundi superiores: isthmus faucium, tonsilla palatina, pharynx, radix linguae, 8. teeth, collects the lymph from 1-7 lymph nodes
II. n.l. cervicales profundi inferiores collects the lymph from 7-10 lymph nodes

21. LYMPHATIC DRAINAGE OF THE HEAD AND NECK
Deep lymph nodes are pale, the superficial ones are dark

22. LYMPHATIC DRAINAGE OF THE HEAD AND NECK

23. Neck lymphatic drainage
Primary lymph nodes:
n.l. cervicales superficiales: neck superficial part, ear, regio parotideomasseterica
n.l. cervicales anteriores: neck anterior part
n.l. cervicales prof.: larynx, thyroid gland, trachea, esophagus
n.l. praelaryngei: larynx
n.l. para- et praetracheales: larynx, trachea, bronchi, esophagus
Secondary and tertiary lymph nodes:
n.l. cervicales profundi sup. et inf. (lymph nodes around trachea can drain to posterior mediastinal lymph nodes)

25. LYMPHATIC DRAINAGE OF THE
LUNG AND THORACIC WALL
nodi lymphatici
pulmonales
ductus
thoracicus
nodi
lymphatici
mediastinales
posteriores
bronchopulmonales
parasternales
tracheobronchiales
truncus
broncho-
mediastinalis
dexter
Truncus
broncho-
mediastinalis
sinister
nodi lymphatici
tracheobronchiales
nodi lymphatici
pulmonales
nodi lymphatici
bronchopulmonales
= parietal subserous
= visceral subserous
= pericanalicular

26. Thorax lymphatic drainage
Parietal subserous lymphatic vessels (from parietal pleura and pericardium) run to intercostal lymphatic vessels, and from here to the n.l. parasternal (from anterior), and to the n.l. mediastinales post. (from posterior)
Truncus bronchomediastinalis 3 trunks:
- truncus parasternalis:
n.l. parasternales - chest skin, skin of abdomen until the level of umbilicus, intercostal spaces, parietal pleura, diaphragm, epigastrium peritoneum, liver
- truncus mediastinalis anterior:
n.l. mediastinales ant. - n.l. phrenici - mediastinum ant., thymus, pericardium. heart, liver
- tr. bronchomediastinalis:
n.l. mediast. post. - mediastinum post., lungs, esophagus, diaphragm, liver
n.l. tracheales - larynx (subglottic cavity), trachea, lungs, esophagus middle part
n.l. tracheobronchiales - bronchi, lungs, pleura visceralis, heart

27. MEDIASTINUM LYMPHATIC DRAINAGE
szív
nodi lymphatici
mediastinales
anteriores
phrenici
ductus
thoracicus
angulus venosus sinister
truncus
bronchomediastinalis sinister
parasternales
intercostal lymph vessels
posteriores
nodi lymphatici tracheales
v.c.s.
v.bc.s.

28. LUNG LYMPHATIC DRAINAGE

30. Lung lymphatic drainage
From the peripheral part of lobes subpleural (visceral subserous), draining to interlobar lymphatic vessels. From the deep part of lobes peribronchial (pericanalicular) plexus. The vessels run toward the lung hilum.
Primary lymph nodes:
n.l. pulmonales
n.l. bronchopulmonales
n.l. tracheobronchiales sup. et inf.
n.l. tracheales
Secondary lymph nodes:
n.l. mediast. post.

31. LYMPH NODES AROUND THE HEART

32. LYMPHATIC DRAINAGE IN THE ABDOMINAL CAVITY (LIVER, PANCREAS)

33. LYMPH NODES IN THE ABDOMINAL CAVITY, CISTERNA CHYLI

34. LYMPHATIC DRAINAGE OF THE STOMACH, DUODENUM AND PANCREAS
nodi lymphatici
gastrici sinistri
nodi lymphatici
lienales
nodi lymphatici
gastrici dextri
nodi lymphatici
pylorici
nodi lymphatici
pancreolienales +
suprapancreatici
nodi lymphatici
gastrici sinistri
nodi lymphatici
mesenterici superiores
nodi lymphatici
gastrici dextri és
hepatici
from the head of pancreas lymph transported toward:
nodi ly. mesen. sup.
nodi ly. pylorici
nodi ly. suprapancreatici
nodi ly. lumbales
nodi lymphatici
gastroepiploici sinistri
nodi lymphatici
pylorici
nodi lymphatici
gastroepiploici dextri

35. Stomach lymphatic drainage
Submucosal and subserosal plexuses. The lymphatic vessels run in the lesser and greater curvature, with the supplying arteries.
Primary lymph nodes:
n.l. gastrici sinistri (fundus, lesser curvature), n.l. gastrici dextri and n.l. pylorici/hepatici (lesser curvature)
n.l. pancreaticolienales (upper part), n.l. gastroepiploici (greater curvature)
further drainage:
n.l. coeliaci, then to the truncus intestinalis and cisterna chyli
The n.l. coeliaci and the n.l. gastrici sinistri are in connection a with n.l. mediastinales through the diaphragm.
Duodenum, pancreas, spleen lymphatic drainage
n.l. pancreaticoduodenales to the n.l. coeliaci
n.l. pancreaticolienales

36. LYMPHATIC DRAINAGE OF LIVER
superficial, subcapsular and deep lymph vessels

37. Liver, gall bladder lymphatic drainage
In the liver the superficial and deep lymphatic plexuses are in connection.
Superficial subserosal (visceral subserosal) lymphatic vessels form groups.
On the diaphragmatic surface 4 groups: anterior, middle, left and right, drained partly to the thorax, partly to the n.l. hepatici.
Deep lymphatic vessels (visceral perivascular and pericanalicular) begins with intralobular and interlobular plexuses:
interlobular lymphatic vessels run with v. portae to the porta hepatis and to the n.l. hepatici, later to the n.l. coeliaci
intralobular lymphatic vessels run with v. hepatica to the diaphragm to the n.l. cardiaci, or with the vena cava inferior to n.l. mediast. post.
Gall bladder submucosal (deep) and subserosal (superficial) plexuses run to n.l. hepatici

38. Mesenterial lymph nodes

39. LYMPHATIC DRAINAGE OF SMALL INTESTINE
L = lacteal

40. LYMPH VESSELS of small intestine wall
Perifollicular lymph vessels
tunica submucosa
lamina propria
tunica subserosa

41. Intestines lymphatic drainage
3 lymphatic vessel plexus: submucosal, muscular and subserosal
small intestine
the submucosal plexus transports the chylus (absorbed fat)
n.l. mesenterii
appendix vermiformis
mesoappendix lymph nodes, to the n.l. ileocolici.
large intestine
n.l. colici (mesocolon transversum, mesosigmoideum and the posterior body wall)
secunder lymph nodes are
n.l. coeliaci (from here to the truncus intestinalis, cisterna chylibe)

42. LYMPHATIC DRAINAGE
OF THE GASTROINTESTINAL TRACT

43. RETROPERITONEUM LYMPH NODES

44. Lymphatic drainage of the retroperitoneum
n.l. lumbales - gonads, kidneys, adrenal glands, abdominal wall
their vas efferens form the truncus lumbalis
Lymphatic drainage of the pelvis
The lymphatic drainage is mainly beside the supplying arteries
lymph nodes:
n.l. subaortici
n.l. lumbales (aortici laterales, paraaortici)
n.l. iliaci communes, externi, interni
n.l. interiliaci
n.l. sacrales
n.l. glutei sup. et inf.
n.l. parauterini, n.l. pararectales
n.l. inguinales spf. et prof.
These lymph nodes are drained toward the truncus lumbalis

45. LYMPH NODES OF THE PELVIS
nodi lymphatici aortici
nodi lymphatici
iliaci interni
nodi lymphatici
iliaci communes
nodi lymphatici
iliaci externi
nodi lymphatici
sacrales laterales
nodi lymphatici
sacrales laterales

46. RECTUM LYMPH DRAINAGE 1 Colon sigmoideum along a. rectalis superior
along a. rectalis media
along a. rectalis inferior
to inguinal lymph nodes

47. Rectum
3 directions:
- upper part: toward n.l. sacrales
- middle part: toward n.l. iliaci int.
- lower part: toward n.l. inguinales superficiales
Urinary bladder: n.l. prae- et postvesicales, n.l. vesicales laterales. from the upper part to the n.l. iliaci communes, from the lower parft to the n.l. iliaci int.
Prostate lymph vessels are in connection with the lymph vessels of the bladder. (the metastasis from the prostatic carcinoma is hematogen)
Testis lymph vessels beside the a. testicularis to the n.l. lumbales
Ovary lymph vessels beside the a. ovarica to the n.l. lumbales
Uterus
fundus, corpus 3 directions:
beside the lig. ovarii proprium and lig. suspensorium ovarii to the n.l. lumbales
through the lig. teres uteri (through the canalis inguinalis) to the n.l. inguinales superficiales- and to the n.l. interiliaci
cervix uteri is connected with each pelvic lymph node
Vagina lymph vessels are drained to n.l. iliaci, n.l. interiliaci
Outer genital organs superficial structures (scrotum skin, labium major, minor), perineum superficial structures are drained to n.l. inguinales superficiales

48. MALE PELVIS ORGANS LYMPHATIC DRAINAGE
nodi lymphatici
sacrales laterales
sacrales mediani
ureter
iliaci externi
iliaci communes
iliaci interni
…………..

49. MALE PELVIS ORGANS LYMPHATIC DRAINAGE

50. MALE PELVIS ORGANS LYMPHATIC DRAINAGE

51. MALE PELVIS ORGANS LYMPHATIC DRAINAGE

52. FEMALE PELVIS ORGANS LYMPHATIC DRAINAGE1. 2. 3. 4.
Nodi lymphatici
aortici
UTERUS
Nodi lymphatici sacrales
Nodi lymphatici iliaci interni
Nodi lymphatici aortici
Nodi lymphatici inguinales mediales
Nodi lymphatici
iliaci interni
Nodi lymphatici
inguinales mediales
Nodi lymphatici sacrales

53. FEMALE PELVIS ORGANS LYMPHATIC DRAINAGE

54. FEMALE PELVIS ORGANS LYMPHATIC DRAINAGE

55. FEMALE PELVIS ORGANS LYMPHATIC DRAINAGE

56. LOWER LIMB LYMPH VESSELS
nodi lymphatici
iliacae externae
canalis femoralis
posterior view
fossa poplitea lymph nodes
lymph vessels on the medial thigh
nodi lymphatici femorales

57. Lymphatic drainage of the lower limb
Superficial and deep lymphatic vessels - the superficial ones are superficial to the fascias, running with the superficial veins, the deep ones run with the vessels.
Superficial lymphatic vessels run to:
n.l. poplitei
n.l. inguinales superficiales (vertical group)
Deep lymphatic vessels run to:
n.l. tibiales ant.
secundaer lymph nodes:
n.l. ing. profundi, then lacuna lymphatica (Rosenmüller lymph node)

58. Diseases of lymphatic vessels
Oedema
Lymphangitis
Obstruction (carcinoma metastasis, worms, etc.)
Malignant diseases of lymph nodes (e.g. lymphoma, Hodgkin disease).

59. CAUSES OF LYMPHOEDEMA Malignant tumor Obstruction of lymph vessels
Hypoplasia (stenosis of lymph vessels)

60. LYMPHOEDEMA OF THREE LIMBS
                                             

61. Filariasis (elephantiasis)

62. ELEPHANTIASIS

64. References
Anderson, J. E.: Grant’s Atlas of Anatomy, Williams & Wilkins, Baltimore, London, 1984.
Hollinshead, W.H.: Textbook of Anatomy, Harper & Row, Hagerstwon, 1983.
Vigh, B., Szisztémás Anatómia, Alliter, Budapest, 2005.
A Humánmorfológiai és Fejlődésbiológiai Intézet Honlapja
Gray’s Anatomy
Stirczer Gabriella: Krónikus lymphoedema (prevencio és kezelés)
LAM 2004;14:562-9.
Johannes W. Rohen, Chihiro Yokochi, Elke Lütjen-Drecoll: Color atlas of anatomy
Kiss Ferenc, Szentágotai János: Az ember anatómiájának atlasza
Keith L. Moore: Clinically oriented anatomy
Péter Mózes: Radiológia