Lymph Nodes & Superficial Lymphatic Vessels Of - DOC

							Lymph Nodes & Superficial
  Lymphatic Vessels Of
       Upper Limb

              LEARNING OBJECTIVES
•   What is a lymph node.

•   Identify the groups of lymph nodes.

•   Describe groups and area of drainage of each group of lymph nodes.

•    Discuss the commencement, course and termination of superficial lymphatic
    vessels.

•   Discuss the clinical conditions related to lymphatic channels of upper limb.
•

        LYMPHOID SYSTEM
•   consists of all of the tissue aggregates and organs
    composed of lymphoid tissue which function
    together to produce our specific resistance to disease
    (immunity).
               THE LYMPH NODE

•   An oval structure, 1 to 25mm in diameter.
•   Enclosed by a capsule with an internal framework of
    trabeculae consisting of collagenous and reticular
    fibers.
•   Found primarily in the proximal area of the limbs, i.e.,
    axilla, inguinal and cervical nodes, as well as, the
    retroperitoneal area of the pelvis and abdomen and the
    surface of thoracic and abdominal organs.




          Lymph: Cervical lymph nodes
                   LYMPHOID SYSTEM
•   The lymphatic vessels are arranged into a superficial and a deep set.
•   On the surface of the body the superficial lymphatic vessels are placed
    immediately beneath the integument, accompanying the superficial veins; they
    join the deep lymphatic vessels in certain situations by perforating the deep fascia.
•   In the interior of the body they lie in the submucous areolar tissue, throughout the
    whole length of the digestive, respiratory, and genito-urinary tracts; and in the
    subserous tissue of the thoracic and abdominal walls


                  LYMPHATIC SYSTEM
       THE LYMPH GLANDS OF THE UPPER EXTREMITY
   •    The lymph glands of the upper extremity are divided into two sets, superficial
        and deep.


                     SUPERFICIAL LYMPH GLANDS
   •    Are few and of small size.
   •    One or two supratrochlear glands are placed above the medial epicondyle of
        the humerus, medial to the basilic vein.
   •    Their afferents drain the middle, ring, and little fingers, the medial portion of the
        hand, and the superficial area over the ulnar side of the forearm.


                     SUPERFICIAL LYMPH GLANDS
   •    these vessels are in free communication with the other lymphatic vessels of the
        forearm.
   •    Their efferents accompany the basilic vein and join the deeper vessels.
   •    One or two deltoideopectoral glands are found beside the cephalic vein,
        between the Pectoralis major and Deltoideus, immediately below the clavicle.
   •    They are situated in the course of the external collecting trunks of the arm.



                            DEEP LYMPH GLANDS
   •    Are chiefly grouped in the axilla, although a few
        may be found in the forearm, in the course of the
        radial, ulnar, and interosseous vessels, and in the
        arm along the medial side of the brachial artery.
LYMPHATIC CHANNELS
  • Tubular vessels transport back lymph to the
    blood ultimately replacing the volume lost from
    the blood during the formation of the interstitial
    fluid.
  • These channels are the lymphatic channels or
    simply called lymphatics
                   Axillary Group of Lymph Nodes

Generally divided into five groups.
Classification on basis of location:

   •   Humeral (Lateral) Node:
         – Posteromedial to the axillary vein.
         – Receive most of the lymphatic
            drainage from the upper limb.

   •   Pectoral (anterior) nodes
          – occur along inferior margin of
             pectoralis minor muscle along the
             course of lateral thoracic vessels.
          – Receive drainage from the
             abdominal wall, the chest, and the
             mammary gland.

   •   Subscapular (Posterior) Nodes
          – on the posterior axillary wall in
             association with the subscapular
             vessels drain the posterior axillary
             wall.
          – Receive lymphatics from the back, the shoulder, and the neck.


   •   Central Nodes:

          –   are embedded in axillary fat
          –    receive tributaries from humeral, subscapular, and pectoral groups
              of nodes.

   •   Apical Nodes :

          –   are the most superior group of nodes in the axilla
          –    drain all other groups of nodes in the region. In addition, they receive
              lymphatic vessels that accompany the cephalic vein as well as vessels
              that drain the superior region of the mammary gland.
  Axillary Lymph Nodes




Lymphatics of Upper Limb
                SUPERFICIAL LYMPHATICS

•   Lymphatics of the finger
    Drain into the plexus on the dorsum and palm of the hand.
•   Medial group of lymphatic vessels
    Accompanies the basilic vein; passes through the cubital or supratrochlear nodes;
    and ascends to enter the lateral axillary nodes , which drain first into the central
    axillary nodes and then into the apical axillary nodes.
•   Lateral group of lymphatic vessels
    Accompanies the cephalic vein and drains into the lateral axillary nodes and also
    into the deltopectoral (infraclavicular) node, which then drain into the apical
    nodes.




    The Lymphatic Vessels of the Upper
          Extremity
•   The lymphatic vessels of the upper extremity are
    divided into two sets, superficial and deep.
        SUPERFICIAL LYMPHATIC VESSELS
•   commence in the lymphatic plexus which everywhere pervades the skin;
•   the meshes of the plexus are much finer in the palm and on the flexor aspect of
    the digits than elsewhere.
•   The digital plexuses are drained by a pair of vessels which run on the sides of
    each digit, and incline backward to reach the dorsum of the hand.
•   From the dense plexus of the palm, vessels pass in different directions, viz.,
    upward toward the wrist, downward to join the digital vessels, medialward to join
    the vessels on the ulnar border of the hand, and lateralward to those on the thumb.


        SUPERFICIAL LYMPHATIC VESSELS
•   Several vessels from the central part of the plexus unite to form a trunk, which
    passes around the metacarpal bone of the index finger to join the vessels on the
    back of that digit and on the back of the thumb.
•   Running upward in front of and behind the wrist, the lymphatic vessels are
    collected into radial, median, and ulnar groups, which accompany respectively the
    cephalic, median, and basilic veins in the forearm.
•   A few of the ulnar lymphatics end in the supratrochlear glands, but the majority
    pass directly to the lateral group of axillary glands.
•   Some of the radial vessels are collected into a trunk which ascends with the
    cephalic vein to the deltoideopectoral glands; the efferents from this group pass
    either to the subclavicular axillary glands or to the inferior cervical glands.
          DEEP LYMPHATIC VESSELS
•   Accompany the deep bloodvessels.
•   In the forearm, they consist of four sets, corresponding with the radial, ulnar,
    volar, and dorsal interosseous arteries.
•   They communicate at intervals with the superficial lymphatics, and some of them
    end in the glands which are occasionally found beside the arteries.
•   In their course upward, a few end in the glands which lie upon the brachial artery;
    but most of them pass to the lateral group of axillary glands.




      Lymph glands of popliteal fossa
         LYMPHATIC DRAINAGE OF BREAST

•   Removes lymphatic fluid from the lateral quadrants into the axillary nodes and the
    medial quadrants into the parasternal (internal thoracic) nodes.
•   Drains primarily (75%) to the axillary nodes, more specifically to the pectoral
    (anterior) nodes (including drainage of the nipple).
•   Follows the perforating vessels through the pectoralis major muscle and the
    thoracic wall to enter the parasternal (internal thoracic) nodes , which lie along the
    internal thoracic artery.
•   Also drains to the apical nodes and may connect to lymphatics draining the
    opposite breast and to lymphatics draining the anterior abdominal wall.
•   Is of great importance in view of the frequent development of cancer and
    subsequent dissemination of cancer cells through the lymphatic stream.


                  Lymphatic Drainage of Breast




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