The Lymphatic System

1. 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 drainageof 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. • 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 nodesLie along transverse cervical a. & v. • Retrophrangeal ln. • Lying vertically behind the pharynx

14. Lymph nodes of upper limb • Cubital lymph nodelies 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 • 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 • 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