1. SHANDONG UNIVERSITY Liu Zhiyu
The Lymphatic System
SHANDONG UNIVERSITY
Liu Zhiyu

2. Introduction of The Lymphatic System

3. The Lymphatic System Heart Vein Lymphatic duct Artery Lymphatic trunk
Capillaries
Lymphatic node
Cell
Tissue fluid
Lymphatic capillary
Lymphatic vessel

4. 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

5. The Lymphatic System Lymphatic capillary 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

6. 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

7. The Lymphatic System
Right lymphatic duck
Thoracic duct

8. 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

9. 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

10. Lymph nodes of the neck Anterior cervical ln. Lateral 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

11. 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

12. 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

13. 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

14. Lymph nodes of upper limb
Cubital lymph node lies above medial epicondyle of humerus
Infraclavicular nodes
Axillary lymph node arranged in five groups

15. Axillary lymph nodes
Axillary lymph nodes vary in size from a pin-head to a large bean.
They are arranged in five groups.

16. 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

17. Axillary lymph nodes Lateral lymph nodes
Along medial side distal part axillary vein
Receives lymph from upper limb

18. 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

19. 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

20. 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

21. Axillary lymph nodes
Efferents form subclavian trunk, the right subclavian trunk joints the right lymphatic duct; left usually drains directly into thoracic duct
Apical ln.
Subclavian trunk
Central ln.
Pectoral ln.
Lateral ln.
Subscapular ln.

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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.

29. 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.

30. 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.

31. Lymphangiogram showing the inguinal lymph vessels and nodes.

32. 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

33. 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

34. 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

35. 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

36. 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

37. Spleen Shape Location:
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

38. Spleen Two surfaces Two extremities Two border
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