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Anatomy of Lymphatics

  • Tatsuo SatoEmail author
Chapter

Abstract

To facilitate a clearer understanding of the topographical arrangement of lymphatics, pictorial demonstrations based on actual cadaveric dissections of four segments of the digestive tract (esophagus, stomach, colon, and rectum) are provided.
  1. 1.

    The lymphatics of the esophagus: Due to the pressure of the aortic arch from the left, asymmetrical development of the ascending lymphatics along the trachea and esophagus is observed. The typical right ascending lymphatic chain reaches the lower neck and follows upstream along the inferior thyroid artery to reach the right venous angle. Several branches are given off from this chain at various levels to finally reach the venous angle. As the left ascending chain is generally poorly developed, most of the lymphatics of the left tracheobronchial nodes move rightward to join the right chain. The left chain is located close to and anterior to the left recurrent laryngeal nerve. The lymphatic chain of the lower thoracic esophagus connects with the lymph vessels of the left gastric nodes via the superior diaphragmatic nodes close to the esophagus.

     
  2. 2.

    The lymphatics of the stomach: In general, lymphatics accompany the typical arteries and finally connect to the coeliac nodes at the origin of the coeliac trunk. However, in the case of the right gastroepiploic artery, lymph vessels do not accompany the artery, but rather they run along the vein and drain into the superior mesenteric nodes. Furthermore, atypical lymphatics are observed: (a) those which descend along the posterior gastric artery to join the splenic lymphatics, and (b) those which run along the cardioesophageal branch of the left inferior phrenic artery, and then descend along this artery, to finally drain into the lateral aortic nodes.

     
  3. 3.

    The lymphatics of the colon: The lymphatics of the right hemicolon accompany the colic branches of the superior mesenteric artery and then gather around this artery. Before reaching the superior mesenteric artery, lymph vessels cross the superior mesenteric vein. The lymphatics of the left hemicolon also run along the inferior mesenteric artery and gather at the lateroaortic nodes. Some lymph vessels cross in front of the abdominal aorta and reach the interaorticocaval nodes.

     
  4. 4.

    The lymphatics of the rectum: In addition to the classically recognized superior group, the lateral (middle) group of the lymphatics are demonstrated. In order to reach the subaortic nodes, lymphatics from the rectum first reach the nodes of the interiliac area with or without accompanying the middle rectal artery. The iliac lymph vessels surround and run alongside the iliac blood vessels. Before reaching the interiliac area, the lymphatics cross over or under the cord of the umbilical artery. Some lymph vessels from the posterior wall of the rectum run backwards and pierce the fascial membrane between the right and left hypogastric nerves before reaching the subaortic nodes. The subaortic nodes are of great importance as they perform the role of a terminal station of the pelvic lymphatics as well as the starting station of the para-aortic lymphatics.

     
  5. 5.

    The para-aortic nodes (lumbar nodes): Para-aortic nodes surround not only the abdominal aorta, but also the inferior vena cava. The para-aortic lymphatics originate from the subaortic nodes and from the lateral aortic and lateral caval nodes at the level of the lower ends of the aorta and inferior vena cava. These lymphatics are also well developed behind the two great blood vessels. Up to the level of the renal blood vessels, the lymphatics surrounding the inferior vena cava gather around the interaorticocaval nodes. The lymph vessels from the uppermost interaorticocaval and lateral aortic nodes converge behind the aorta to form the thoracic duct.

     

Keywords

Esophageal lymphatics Gastric lymphatics Lymphatics of the large intestine Para-aortic lymph nodes Topographical anatomy 

Abbreviations

aa

Arch of aorta

ac

Ascending colon

acc

Accessory nerve

ai

Angular incisure

alg

Accessory left gastric artery

an

Anterior group node of deep lateral cervical nodes

ap

Appendix vermiformis

apa

Appendicular artery

av

Anterior vagus trunk

az

Azygos vein

aza

Arch of azygos vein

bc

Brachiocephalic trunk

bca

Brachiocephalic angle node

bd

Common bile duct

bt

Bifurcation of trachea

cae

Caecum

cc

Common carotid artery

cd

Cardia

ceb

Cardioesophageal branch

ch

Common hepatic artery

ci

Common iliac artery

civ

Common iliac vein

co

Coeliac node

cp

Caudate process

ct

Coeliac trunk

di

Diaphragm

du

Duodenum

eb

Esophageal branch

ec

External carotid artery

ei

External iliac artery

eiv

External iliac vein

epc

Epicolic node

es

Esophagus

gb

Gallbladder

gct

Gastrocolic trunk

gd

Gastrodudenal artery

hb

Hepatic branch (anterior vagus)

hp

Hepatic artery proper

ica

Ileocolic artery

iil

Interiliac node

ii

Internal iliac artery

ij

Internal jejunal vein

ile

Ileum

im

Intermediate node

ima

Inferior mesenteric artery

imv

Inferior mesenteric vein

ipv

Left inferior phrenic vein

ita

Internal thoracic artery

itb

Inferior tracheobronchial node

ith

Inferior thyroid artery

ivc

Inferior vena cava

jd

Jugulodigastric node

jo

Jugulo-omohyoid node

la

Lateral aortic node

lb

Left bronchus

lbc

Left brachiocephalic vein

lc

Lateral caval node

lca

Left colic artery

lg

Left gastric artery

lga

Ligamentum arteriosum

lgo

Left gastro-omental artery

lgv

Left gastric vein

li

Liver

lia

Ligamentum arteriosum

lip

Left inferior phrenic artery

lk

Left kidney

ll

Left lung

ln

Lateral group node of deep lateral cervical nodes

lrv

Left renal vein

lt

Lumbar trunk

lv

Left vagus nerve

lva

Levator ani

mca

Middle colic artery

mra

Middle rectal artery

of

Omental foramen node

ov

Ovarian vein

pa

Pre-aortic

pb

Pubic bone

pc

Paracolic node

pd

Pancreaticoduodenal node

pe

Peritoneum

pg

Posterior gastric artery

ph

Phrenic nerve

pl

Pleura

poc

Postcaval node

pr

Principal node

prm

Promontorium

ps

Pelvic splanchnic nerve

pso

Psoas major

pu

Pubis

pua

Pulmonary artery

pv

Portal vein

py

Pylorus

rb

Right bronchus

rbc

Right brachiocephalic vein

rc

Recurrent laryngeal nerve

rca

Right colic artery

rg

Right gastric artery

rgo

Right gastro-omental artery

rgov

Right gastro-omental vein

rk

Right kidney

rl

Right lung

rrv

Right renal vein

S1

First sacral vertebra

Sa

Subaortic node

sc

Subclavian artery

scv

Subclavian vein

sg

Short gastric artery

sh

Superior hypogastric plexus

si

Sigmoid colon

sia

Sigmoid artery

sl

Superior laryngeal nerve

sm

Submandibular gland

sp

Spleen

spa

Splenic artery

spv

Splenic vein

sr

Suprarenal gland

sra

Superior rectal artery

srpd

Superior retropancreaticoduodenal node (Rouvière)

srv

Suprarenal vein

st

Stomach

sth

Superior thyroid artery

sva

Superior vesical artery

svc

Superior vena cava

syt

Sympathetic trunk

ta

Testicular artery

tc

Thyroid cartilage

td

Thoracic duct

th

Thyroid gland

tr

Trachea

tv

Testicular vein

ua

Uterine artery

ub

Urinary bladder

ur

Ureter

ut

Uterus

utt

Uterine tube

va

Venous angle

vc

Vertebral column

vg

Vagus nerve

vgn

Vagina

Notes

Acknowledgments

I’m deeply indebted to all of my colleagues, and, in particular, Prof. K. Sato, Prof. H. Sakamoto, Dr. H. Deki, and Dr. M. Ito, for their expert dissection skills to make such remarkable figures possible. I also wish to thank Mr. M. Kohga for his excellent artistic skills to create meaningful precise schemes.

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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Tokyo Medical and Dental UniversityTokyoJapan

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