Lymphatic drainage of the head, neck,
chest cavity, abdomen and pelvis.
Semmelweis University,
Faculty of Medicine, 1st year 2nd semester
Dr. Kocsis Katalin
Department of Human Morphology and Developmental Biology
2014.05.06.

MECHANISM OF LYMPH PRODUCTION
fluid filtrated to the
extracellular space from the
capillaries

function of lymphatic circulation
• transport of extracellularis fluid
• filtration of lymph
• absorption and transport of fats
• immune defence
1. overproduction
2. low osmotic pressure
3. lymph vessel obstruction
lymph volume is increased by:
oedema = lymph volume is increased in the tissues
lymphatic circulation is sustained by
1. tissue pressure
2. contraction of lymph vessels
3. skeletal muscle function
4. negative pressure in the veins
LYMPH = clear water (blood plasm)
components of lymph
1. water
2. 2-5 % protein
3. electrolytes
4. glucose, amino acids
5. fatty acids, triglicerids
6. lymphocytes
no lymph vessels
1. CNS
2. bone and cartilage
3. placenta
4. spleen parenchyma

RIGHT AND LEFT ANGULUS VENOSUS
v. jugularis interna
v. jugularis interna
ductus thoracicus
ductus thoracicus
v. brachiocephalica
v. subclavia
v. azygos
ductus
lymphaticus dexter

LYMPH VESSEL LONGITUDINAL SECTION
Valve(V)

THE LYMPH FLOWS THROUGH SOME (2-3) LYMPH
NODES BEFORE ENTERING THE SYSTEMIC
CIRCULATION
afferent lymph vessels
efferent lymph vessel
Femoralis lymph nodes
vas efferens artery
vein
vasa
afferentes
follicle
medullary sinus
sinus intermedius

EXAMINATION OF LYMPHATIC VESSELS
Injection of vital dye
LYMPHOGRAPHY:
injection of contrast material

Lymphangiography

retroperitoneal lmyph vessels
RETROPERITONEAL LYMPH NODES
nodi
lymphatici
lumbales
nodi
lymphatici
aortici

MAIN LYMPH VESSELS
aorta
ductus thoracicus
truncus
lumbalis
truncus intestinalis
cisterna chyli
truncus
lymphaticus
dexter
truncus jugularis
truncus subclavius
truncus
bronchomediastinalis
dexter
ductus thoracicus

UPPER LIMB LYMPH VESSELS
nodi lymphatici
axillares laterales

Lymphatic vessels of the upper limb and wall of the upper trunk
Superficial and deep lymphatic vessels - the superficial ones are superficial to the
fascias, running with the superficial veins, the deep ones run with the vessels.
lymph nodes:
n.l. cubitales: forearm
n.l. axillares - superficial group:
n.l. axillares laterales: arm
n.l. axillares pectorales: thoracic wall, mammary gland
n.l. axillares subscapulares: nucha, shoulder, back
n.l. axillares - deep group:
n.l. axillares centrales: arm
n.l. axillares apicales: arm, mammary gland
drainage: through the n.l. supraclaviculares to the truncus subclavius

LYMPH NODES OF THE FOSSA AXILLARIS
1.
2.
3.
4.
5.
1. Nodi lymphatici axillares laterales
2. Nodi lymphatici pectorales
3. Nodi lymphatici subscapulares
4. Nodi lymphatici centrales
5. Nodi lymphatici apicales

LYMPHATIC DRAINAGE OF THE MAMMARY GLAND

Lymphatic drainage of the mammary gland
superficial and deep lymphatic vessels drained to
n.l. pectorales (from the lateral part) and n.l. intercostales (from the lower part)
– from there to the n.l. axillares centrales and n.l. axillares apicales
– from there to the n.l. supraclaviculares and the
– truncus subclavius
n.l. parasternales (from the medial part)
– to the n.l. mediastinales and the
– truncus bronchomediastinalis

Axillary lymph nodes (dissection room preparation)

LYMPHATIC DRAINAGE OF THE SUPERFICIAL
LAYER OF HEAD
nodi lymphatici occipitales
nodi lymphatici retroauriculares
nodi lymphatici parotidei superficiales
nodi lymphatici submentales
nodi lymphatici submandibulares
nodi lymphatici cervicales profundi

Head lymphatic drainage
Regional (primary) lymph nodes:
1. n.l. submentales: lower lip, chin, lower 1.-2. teeth, tongue apex, sublingual region
2. n.l. submandibulares: forehead middle part, nose surface, lower eyelid, bucca,
upper lip, skin on the mandibule, nasal cavity anterior part, tongue middle part,
upper teeth, palate, 3-7. lower teeth, floor of oral cavity
3. n.l. parotidei superficiales et profundi: skin before the ear, forehead, upper eyelid,
auricule, external ear, glandula parotis
4. n.l. retroauriculares/mastoidei: skin behind the eaer, dorsal surface of the
auricule, meatus acusticus externus, tympanic cavity
5. n.l. occipitales: nuchal region
6. n.l. retropharyngei: pharynx upper part, tympanic cavity, auditory tube, soft palate,
posterior part of nasal cevity, deep part of orbit
7. n.l. praelaryngei: larynx, pharynx lower part, esophagus upper part
8. n.l. para- et praetracheales: larynx, trachea, bronchi, esophagus
9. n.l. cervicales anteriores: neck anterior part
10. n.l. cervicales superficiales: neck skin superficial part, auricule, regio
parotideomasseterica
Secondary (partly primary) lymph nodes:
I. n.l. cervicales profundi superiores: isthmus faucium, tonsilla palatina, pharynx,
radix linguae, 8. teeth, collects the lymph from 1-7 lymph nodes
II. n.l. cervicales profundi inferiores collects the lymph from 7-10 lymph nodes

LYMPHATIC
DRAINAGE OF THE
HEAD AND NECK
Deep lymph nodes are pale,
the superficial ones are dark

LYMPHATIC
DRAINAGE OF
THE HEAD AND
NECK

Neck lymphatic drainage
Primary lymph nodes:
n.l. cervicales superficiales: neck superficial part, ear, regio parotideomasseterica
n.l. cervicales anteriores: neck anterior part
n.l. cervicales prof.: larynx, thyroid gland, trachea, esophagus
n.l. praelaryngei: larynx
n.l. para- et praetracheales: larynx, trachea, bronchi, esophagus
Secondary and tertiary lymph nodes:
n.l. cervicales profundi sup. et inf. (lymph nodes around trachea can drain to
posterior mediastinal lymph nodes)

LYMPHATIC DRAINAGE OF THE
LUNG AND THORACIC WALL
nodi lymphatici
pulmonales
ductus
thoracicus
nodi
lymphatici
mediastinales
posteriores
nodi lymphatici
bronchopulmonales
nodi lymphatici
parasternales
nodi lymphatici
tracheobronchiales
Truncus
broncho-
mediastinalis
sinister
truncus
broncho-
mediastinalis
dexter
nodi lymphatici
tracheobronchiales
nodi lymphatici
bronchopulmonales
nodi lymphatici
pulmonales
= parietal subserous = visceral subserous = pericanalicular

Thorax lymphatic drainage
Parietal subserous lymphatic vessels (from parietal pleura and pericardium) run to
intercostal lymphatic vessels, and from here to the n.l. parasternal (from anterior),
and to the n.l. mediastinales post. (from posterior)
Truncus bronchomediastinalis 3 trunks:
- truncus parasternalis:
n.l. parasternales - chest skin, skin of abdomen until the level of umbilicus, intercostal
spaces, parietal pleura, diaphragm, epigastrium peritoneum, liver
- truncus mediastinalis anterior:
n.l. mediastinales ant. - n.l. phrenici - mediastinum ant., thymus, pericardium. heart,
liver
- tr. bronchomediastinalis:
n.l. mediast. post. - mediastinum post., lungs, esophagus, diaphragm, liver
n.l. tracheales - larynx (subglottic cavity), trachea, lungs, esophagus middle part
n.l. tracheobronchiales - bronchi, lungs, pleura visceralis, heart

MEDIASTINUM LYMPHATIC DRAINAGE
szív
nodi lymphatici
mediastinales
anteriores
nodi lymphatici
phrenici ductus
thoracicus
angulus venosus sinister
truncus
bronchomediastinalis sinister
nodi lymphatici
parasternales
intercostal
lymph vessels
nodi lymphatici
phrenici
nodi lymphatici
mediastinales
posteriores
nodi lymphatici tracheales

LUNG
LYMPHATIC
DRAINAGE

Lung lymphatic drainage
From the peripheral part of lobes subpleural (visceral subserous), draining to
interlobar lymphatic vessels. From the deep part of lobes peribronchial
(pericanalicular) plexus. The vessels run toward the lung hilum.
Primary lymph nodes:
n.l. pulmonales
n.l. bronchopulmonales
n.l. tracheobronchiales sup. et inf.
n.l. tracheales
Secondary lymph nodes:
n.l. mediast. post.

LYMPH NODES AROUND THE HEART

LYMPHATIC
DRAINAGE IN THE
ABDOMINAL CAVITY
(LIVER, PANCREAS)

LYMPH NODES IN THE ABDOMINAL CAVITY,
CISTERNA CHYLI

LYMPHATIC DRAINAGE OF
THE STOMACH,
DUODENUM AND
PANCREAS
from the head of pancreas
lymph transported toward:
1. nodi ly. mesen. sup.
2. nodi ly. pylorici
3. nodi ly. suprapancreatici
4. nodi ly. lumbales
nodi lymphatici
gastrici sinistri
nodi lymphatici
pancreolienales +
suprapancreatici
nodi lymphatici
lienales
nodi lymphatici
mesenterici superiores
nodi lymphatici
gastrici dextri
nodi lymphatici
pylorici
nodi lymphatici
gastroepiploici sinistri
nodi lymphatici
gastrici sinistri
nodi lymphatici
gastroepiploici dextri
nodi lymphatici
pylorici
nodi lymphatici
gastrici dextri és
hepatici

Stomach lymphatic drainage
Submucosal and subserosal plexuses. The lymphatic vessels run in the lesser and
greater curvature, with the supplying arteries.
Primary lymph nodes:
n.l. gastrici sinistri (fundus, lesser curvature), n.l. gastrici dextri and n.l.
pylorici/hepatici (lesser curvature)
n.l. pancreaticolienales (upper part), n.l. gastroepiploici (greater curvature)
further drainage:
n.l. coeliaci, then to the truncus intestinalis and cisterna chyli
The n.l. coeliaci and the n.l. gastrici sinistri are in connection a with n.l.
mediastinales through the diaphragm.
Duodenum, pancreas, spleen lymphatic drainage
n.l. pancreaticoduodenales to the n.l. coeliaci
n.l. pancreaticolienales

LYMPHATIC DRAINAGE OF LIVER
superficial, subcapsular and deep lymph vessels

Liver, gall bladder lymphatic drainage
In the liver the superficial and deep lymphatic plexuses are in connection.
Superficial subserosal (visceral subserosal) lymphatic vessels form groups.
On the diaphragmatic surface 4 groups: anterior, middle, left and right, drained partly
to the thorax, partly to the n.l. hepatici.
Deep lymphatic vessels (visceral perivascular and pericanalicular) begins with
intralobular and interlobular plexuses:
interlobular lymphatic vessels run with v. portae to the porta hepatis and to the n.l.
hepatici, later to the n.l. coeliaci
intralobular lymphatic vessels run with v. hepatica to the diaphragm to the n.l.
cardiaci, or with the vena cava inferior to n.l. mediast. post.
Gall bladder submucosal (deep) and subserosal (superficial) plexuses run to n.l.
hepatici

Mesenterial lymph nodes

L
LYMPHATIC DRAINAGE OF SMALL INTESTINE
L = lacteal

LYMPH VESSELS of small intestine wall
tunica submucosa
Perifollicular lymph vessels
lamina propria
tunica subserosa

Intestines lymphatic drainage
3 lymphatic vessel plexus: submucosal, muscular and subserosal
small intestine
the submucosal plexus transports the chylus (absorbed fat)
n.l. mesenterii
appendix vermiformis
mesoappendix lymph nodes, to the n.l. ileocolici.
large intestine
n.l. colici (mesocolon transversum, mesosigmoideum and the posterior body wall)
secunder lymph nodes are
n.l. coeliaci (from here to the truncus intestinalis, cisterna chylibe)

LYMPHATIC
DRAINAGE
OF THE
GASTROINTESTINAL
TRACT

RETROPERITONEUM
LYMPH NODES

Lymphatic drainage of the retroperitoneum
n.l. lumbales - gonads, kidneys, adrenal glands, abdominal wall
their vas efferens form the truncus lumbalis
Lymphatic drainage of the pelvis
The lymphatic drainage is mainly beside the supplying arteries
lymph nodes:
n.l. subaortici
n.l. lumbales (aortici laterales, paraaortici)
n.l. iliaci communes, externi, interni
n.l. interiliaci
n.l. sacrales
n.l. glutei sup. et inf.
n.l. parauterini, n.l. pararectales
n.l. inguinales spf. et prof.
These lymph nodes are drained toward the truncus lumbalis

LYMPH NODES OF THE PELVIS
nodi lymphatici
iliaci interni
nodi lymphatici aortici
nodi lymphatici
iliaci externi
nodi lymphatici
sacrales laterales nodi lymphatici
sacrales laterales
nodi lymphatici
iliaci communes

RECTUM LYMPH DRAINAGE
1
along a. rectalis superior
along a. rectalis media
along a. rectalis inferior
to inguinal lymph nodes

Rectum
3 directions:
- upper part: toward n.l. sacrales
- middle part: toward n.l. iliaci int.
- lower part: toward n.l. inguinales superficiales
Urinary bladder: n.l. prae- et postvesicales, n.l. vesicales laterales. from the upper
part to the n.l. iliaci communes, from the lower parft to the n.l. iliaci int.
Prostate lymph vessels are in connection with the lymph vessels of the bladder. (the
metastasis from the prostatic carcinoma is hematogen)
Testis lymph vessels beside the a. testicularis to the n.l. lumbales
Ovary lymph vessels beside the a. ovarica to the n.l. lumbales
Uterus
fundus, corpus 3 directions:
beside the lig. ovarii proprium and lig. suspensorium ovarii to the n.l. lumbales
through the lig. teres uteri (through the canalis inguinalis) to the n.l. inguinales
superficiales- and to the n.l. interiliaci
cervix uteri is connected with each pelvic lymph node
Vagina lymph vessels are drained to n.l. iliaci, n.l. interiliaci
Outer genital organs superficial structures (scrotum skin, labium major, minor),
perineum superficial structures are drained to n.l. inguinales superficiales

MALE PELVIS ORGANS LYMPHATIC DRAINAGE
nodi lymphatici
sacrales laterales
nodi lymphatici
sacrales mediani
ureter
nodi lymphatici
iliaci externi
nodi lymphatici
iliaci communes
nodi lymphatici
iliaci interni
…………..

MALE PELVIS ORGANS LYMPHATIC DRAINAGE

MALE PELVIS
ORGANS
LYMPHATIC
DRAINAGE

MALE PELVIS
ORGANS
LYMPHATIC
DRAINAGE

1.
2.
3.
4.
UTERUS
1. Nodi lymphatici sacrales
2. Nodi lymphatici iliaci interni
3. Nodi lymphatici aortici
4. Nodi lymphatici inguinales mediales
Nodi lymphatici
inguinales mediales
Nodi lymphatici
aortici
Nodi lymphatici
iliaci interni
Nodi lymphatici sacrales
FEMALE PELVIS ORGANS LYMPHATIC DRAINAGE

FEMALE PELVIS ORGANS
LYMPHATIC DRAINAGE

FEMALE PELVIS
ORGANS
LYMPHATIC
DRAINAGE

FEMALE PELVIS ORGANS
LYMPHATIC DRAINAGE

LOWER LIMB LYMPH VESSELS
fossa poplitea lymph nodes lymph vessels on the medial thigh nodi lymphatici femorales
canalis femoralis
posterior view
nodi lymphatici
iliacae externae

Lymphatic drainage of the lower limb
Superficial and deep lymphatic vessels - the superficial ones are superficial to
the fascias, running with the superficial veins, the deep ones run with the
vessels.
Superficial lymphatic vessels run to:
n.l. poplitei
n.l. inguinales superficiales (vertical group)
Deep lymphatic vessels run to:
n.l. tibiales ant.
n.l. poplitei
secundaer lymph nodes:
n.l. ing. profundi, then lacuna lymphatica (Rosenmüller lymph node)

Diseases of lymphatic vessels
• Oedema
• Lymphangitis
• Obstruction (carcinoma metastasis, worms, etc.)
• Malignant diseases of lymph nodes (e.g. lymphoma, Hodgkin
disease).

CAUSES OF LYMPHOEDEMA
1. Malignant tumor
2. Obstruction of lymph vessels
3. Hypoplasia (stenosis of lymph vessels)

LYMPHOEDEMA OF THREE LIMBS

Filariasis (elephantiasis)
http://www.lookfordiagnosis.com/mesh_info.php?term=Elephantiasis,
%20Filarial&lang=1

ELEPHANTIASIS

http://www.picturesdepot.com/medical/14004/elephantiasis.ht
ml
http://students.cis.uab.edu/sajayi11/
Elephantiasis.html
http://crunkish.com/ten-most-disfiguring-diseases/

References
•Anderson, J. E.: Grant’s Atlas of Anatomy, Williams & Wilkins,
Baltimore, London, 1984.
•Hollinshead, W.H.: Textbook of Anatomy, Harper & Row,
Hagerstwon, 1983.
• Vigh, B., Szisztémás Anatómia, Alliter,
Budapest, 2005.
•A Humánmorfológiai és Fejlődésbiológiai Intézet Honlapja
Gray’s Anatomy
Stirczer Gabriella: Krónikus lymphoedema (prevencio és kezelés)
LAM 2004;14:562-9.
Johannes W. Rohen, Chihiro Yokochi, Elke Lütjen-Drecoll: Color atlas of anatomy
Kiss Ferenc, Szentágotai János: Az ember anatómiájának atlasza
Keith L. Moore: Clinically oriented anatomy
Péter Mózes: Radiológia