Human Anatomy. Part 2 - K. A. Diubenko, A. K. Kolomiitsev, Yu. B. Chaikovsky 2008

Special Part
Lymphatic system (systema lymphaticum [systema lymphoideum]) - General Overview
Lymphatic vessels and regional nodes of specific body regions and organs - Lymphatic vessels and nodes of the thoracic wall and thoracic cavity

The Lymphatic vessels and nodes of the thoracic cavity are located in the anterior and posterior Mediastinum along the path of the Trachea, Bronchi, and pulmonary vessels. The lymphatic Vessels of the thoracic cavity drain into the right and left bronchomediastinal lymphatic trunks, which subsequently empty into the Thoracic duct (on the left) and the Right lymphatic duct (on the right).

The regional Lymph Nodes of the thoracic wall and thoracic Organs are subdivided into parietal and visceral groups.

The parietal lymph nodes include the following:

1. Parasternal (paramammary) lymph nodes (nodi lymphatici paramammarii), located along the lateral margin of the pectoralis major Muscle (Fig. 107). They drain lymph from the mammary gland. The lymphatic vessels of the Skin of the breast are arranged in concentric circles relative to the center of the mammary areola (Fig. 108). From the vessels that form a convexity toward the glandular primordium, branching extensions (0.15 mm in length) arise and end blindly. One of these extensions penetrates deeply, seemingly underlying the glandular primordium. In the area of the mammary gland primordium, a clear connection can be traced between the superficial and deep lymphatic networks (Fig. 108). The vessels of the superficial network at the periphery of the gland primordium drain into the vessels of the deep network and also exhibit a circular arrangement.

Of great practical significance are the pathways that drain lymph from the mammary gland (according to D. A. Zhdanov).

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Fig. 108. Lymphatic vessels in the skin area of the fetal mammary gland. Oc. 8; Obj. 4. The lymphatic vessels are arranged in concentric circles toward the center, and a clear connection between the superficial and deep lymphatic networks is visible. (Preparation by O. I. Svyridov)

Fig. 109. Diagram of the lymph nodes of the neck and mediastinum (after D. A. Zhdanov)

The lymphatic vessels of the mammary gland through which malignant tumor metastases spread are directed primarily in a lateral direction. This is the main lateral lymphatic pathway from the breast. The vessels of this pathway reach the axilla and drain mainly into the pectoral lymph nodes of the axillary group located on the lateral thoracic wall and on the serratus anterior muscle near the lateral thoracic artery. However, some vessels of the main lateral pathway extend further to the external axillary, subscapular, or central axillary lymph nodes. The most treacherous lymphatic vessels of the mammary gland are the transmuscular vessels. They pierce the pectoralis major muscle, pass through or pierce the pectoralis minor muscle, and reach the superior thoracic and apical axillary nodes.

Fig. 110. Lymphatic vessels of the Inferior surface of the Liver, anterior surface of The Stomach, right suprarenal gland, and Kidneys (after G. M. Yosyfov)

In malignant tumors of the mammary gland, metastases may accumulate within these nodes. In clinical oncological practice, to prevent recurrence of this disease, the entire mammary gland and all axillary lymph nodes along with the adipose tissue are removed, as well as the pectoralis Major and minor Muscles.

2. Parasternal lymph nodes (nodi lymphatici parasternales), located along the course of the internal thoracic artery (Fig. 107). They drain lymph from the anterior chest wall and the medial Regions of the mammary gland.

3. Intercostal lymph nodes (nodi lymphatici intercostales), located along the intercostal vessels. They drain lymph from the lateral chest walls and the parietal Pleura.

4. Superior diaphragmatic lymph nodes (nodi lymphatici phrenici superiores), located on the Diaphragm to the left of the INFERIOR VENA CAVA, at the site where the musculophrenic artery and phrenic nerves enter the diaphragm. They drain lymph from the diaphragm, pleura, Pericardium, and the diaphragmatic surface of the liver.

The visceral regional nodes include the following:

1. Paratracheal lymph nodes (nodi lymphatici paratracheales), located at the tracheal bifurcation.

2. Tracheobronchial lymph nodes (nodi lymphatici tracheobronchiales). The paratracheal and tracheobronchial nodes drain lymph from the trachea, bronchi, Lungs, and Esophagus (Fig. 109).

3. Bronchopulmonary lymph nodes (nodi lymphatici bronchopulmonales), located around the ROOT of the lung (Fig. 109). They drain lymph from the superficial lymphatic networks of the bronchi, lungs, and anterior regions of the diaphragm.

4. Anterior mediastinal lymph nodes (nodi lymphatici mediastinales anteriores), which drain lymph from the anterior chest wall, Heart, pericardium, liver, and anterior regions of the diaphragm.

Fig. 111. Lymphatic vessels and nodes of the Abdominal cavity in a 7–8-month-old infant (after G. M. Yosyfov)

5. Posterior mediastinal lymph nodes (nodi lymphatici mediastinales posteriores), which drain lymph from the thoracic spine, esophagus, posterior regions of the diaphragm, and partially from the liver.