Human Anatomy: Part 2 - K. A. Dyubenko, A. K. Kolomiytsev, Yu. B. Chaykovsky 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 upper and lower limbs

The Lymphatic vessels of the upper limb are divided into superficial and deep. The superficial lymphatic Vessels of the upper limb are located around the subcutaneous Veins. They form three groups of lymphatic vessels (lateral, medial, and intermediate) (Fig. 112 A) accompanying the veins that drain into the regional Lymph Nodes: the cubital lymph nodes, nodi lymphatici cubitales, and the axillary lymph nodes, nodi lymphatici axillares (Fig. 112 A).

The deep lymphatic vessels of the upper limb accompany the radial, ulnar, and brachial Arteries and drain into the cubital and axillary lymph nodes. The axillary nodes also receive lymphatic vessels from the paramammary lymph nodes, nodi lymphatici paramammani.

The main regional nodes of the upper limb are the axillary lymph nodes, nodi lymphatici axillares, which number on average 15–18 in the axillary fossa, though their number can sometimes range from 8 to 50 (D. A. Zhdanov). The axillary lymph nodes are subdivided into several groups: lateral nodes, adjacent to the axillary artery and vein; subscapular nodes, located at the Water/144.html">Origin of the circumflex scapular artery and vein; and central nodes, situated near the entrance to the cavum axillare. An important group of nodes is formed by the pectoral nodes, located along the lateral thoracic artery on the serratus anterior Muscle and the lateral wall of The thoracic cage, with several nodes lying directly beneath the clavicle (apical lymph nodes) (see Fig. 109).

Efferent lymphatic vessels emerge from the axillary lymph nodes, interconnect, and form the subclavian trunk (right and left), truncus subclavius dexter et sinister. The subclavian trunk joins the jugular trunk to form the Right lymphatic duct, ductus lymphaticus dexter, whereas on the left side it empties into the Thoracic duct, ductus thoracicus, where the latter enters the venous angle.

The lymphatic vessels of the lower limb are divided into superficial and deep. The superficial lymphatic vessels originate from the lymph capillary plexuses of the Skin and subcutaneous tissue. They accompany the subcutaneous veins and drain lymph from the superficial areas of the lower limb (Fig. 112 B). Along their path, they empty into the popliteal lymph nodes, nodi lymphatici popliteales, which also receive lymph from the deep vessels of the leg and FOOT.

The superficial lymph nodes of the lower limb also include the superficial inguinal lymph nodes, nodi lymphatici inguinales superficiales (4–20 according to D. A. Zhdanov), which lie on the Superficial layer of the fascia lata in the femoral triangle, around the saphenous opening, hiatus saphenus (Fig. 112 B). These lymph nodes drain lymph from the anterior abdominal wall, Perineum, anus, buttocks, and external genitalia.

The deep lymphatic vessels of the lower limb are formed by lymph capillaries of Muscles, synovial bursae and sheaths, joints, and periosteum. They drain lymph from areas situated deep to the fascia lata of the thigh, leg, and foot. The deep lymphatic vessels pass through the anterior and posterior tibial, popliteal, and inguinal lymph nodes. The superficial and deep lymphatic vessels of the lower limb anastomose with one another in the popliteal fossa and on the anterior and medial surfaces of the thigh.

Efferent lymphatic vessels arise from the deep inguinal lymph nodes, accompany the hip Blood Vessels, and pass along their course through the chains of the internal iliac lymph nodes, nodi lymphatici iliaci. They also drain lymph from the Organs and walls of the lesser pelvis.

Class="center">Collaterals in The Lymphatic system

Lymph drainage from organs is carried out through lymphatic chains into regional LYMPH NODES AND then into the lymphatic ducts via short pathways.

Throughout the lymphatic system along the course of the thoracic duct at various levels, There is a significant number of collateral pathways that ensure the movement of lymph toward the Venous system. According to D. A. Zhdanov (1952), a substantial portion of lymph drains into the thoracic duct via additional collateral pathways: transdiaphragmatic roots, and short and long collaterals.

In the thoracic cavity and the lower region of the neck in humans, there are collateral lymphatic pathways that connect the initial and terminal segments of the thoracic duct, the thoracic duct with the right lymphatic duct, and the lymphatic collectors of the right and left halves of the body. These collateral pathways pass through a complex system of regional lymph nodes: mediastinal, cervical, pretracheal, and plexuses of lymphatic vessels connecting these nodes.

According to E. I. Borziak (1985), in the lumbar region of the Abdominal cavity, collateral lymphatic pathways normally exist that empty into the thoracic duct, bypassing the lumbar lymph nodes. He identified three variants of lumbar collateral vessels: the paracaval lumbar collateral lymphatic vessel occurs in 50% of cases, through which lymph drains bypassing the right lumbar lymph nodes; the paraaortic lumbar collateral lymphatic vessel occurs in 23.3% of cases, through which lymph drains bypassing the left lumbar lymph nodes; and the intermediate lumbar lymphatic vessel occurs in 7.5% of cases, through which lymph drains bypassing the intermediate lymph nodes.

Lymphography is a radiographic examination method for various PARTS OF THE lymphatic system using contrast agents that are non-harmful to the Organism (radiopaque lymphography). Iodolipol, Lipiodol, Biligraphin (cardiotrast), and other substances are most frequently used. Recently, radioisotope lymphography has been performed. For this purpose, colloidal solutions of gold-198, indium-111, and human serum albumin are used.

Lymphography makes it possible to study the Structure and function of various parts of the lymphatic system in vivo under normal and pathological conditions. Radioisotope lymphography is based on the ability of reticuloendothelial Cells of lymph nodes to selectively absorb radioactive colloids. The condition of the lymph nodes is assessed using scanning.