LYMPHATIC SYSTEM

• Lymph vessels
Lymph capillaries
Lymph vessels proper- veins
Terminal lymph ducts
Thoracic duct
Right Lymphatic duct

B. Lymphoid tissue
Primary lymphatic follicle
Lymph nodes
Haemolymph nodes-Spleen
Thymus
Lymphatic System
Lymphoid Tissues
 THORACIC DUCT
LONGEST LYMPH TRUNK

Drains whole body except

Rt side of H&N
Rt.UL
Rt.Chest wall
Rt.Lung &Pleura
Rt.surface of Heart &PC
Rt.dome of diaphragm
Rt.surface of liver
Length: 40-45CMS

Caliber: 0.5 cms

Extent:
Beginning – T12
Termination- C7
Appearance: Beaded
Valves: Several
Pressure related
one constant at
termination
Course:

Cervical

Thoracic

Abdominal
RELATIONS:
Abdominal part
Aortic Opening-T12
Anterior: Median
arcuate ligament
Posterior:T12
Rt Lt
Right: Azygos vein
.
Left: Aorta
At Aortic Opening

Posterior:T12

Right: Azygos vein Azygos Aorta

Left: Aorta
Thoracic duct

Aortic opening

Post. Mediastinum

Sup.Mediastinum
RELATIONS:
PosteriorMediastinum
Anterior:
Rt. Pleural recess

Oesophagus

Diaphragm
Posterior Mediastinum contd…

Posterior:
•T5 - T 12
Vertebrae
•Post.Intercostal
vessels (Rt)
•Azygos &
Hemiazygos
communications
Posterior Mediastinum Contd…..

Right-
Right:
•Azygos V
•Splanchnic
nerves (Rt)
•Sympathetic
trunk (Rt)
•Lung and Pleura
(Rt)
Posterior Mediastinum Contd…..

Left:
•Thoracic aorta
•Hemiazygos Vs
•Splanchnic nerves (Lt)
RELATIONS:
SuperiorMediastinum
Anterior:
•Lt lung & pleura
Arch of aorta
(Lower)
•Lt.Subclavian A
(Upper)
•Thymus
Sup.Mediastinum Contd….

Posterior:
•T1-T4 Vertebrae
•Longus cervicis
 SuperiorMediastinum contd…

Right:

•oesophagus
Left:

Lt.Lung & Pleura

(Mediastinal surface)
RELATIONS:
Cervical
Anterior:
Carotid sheath
Cervical

PosteriorMedial
•Vertebral A (Lt)
•Vertebral V (Lt)
•Inf. Cervical
ganglion (Lt)
•C7 TP(Lt)
Posterior Lateral:
•Subclavian A – 1st part
(Lt)
•Thyrocervical trunk
(Lt)
& its branches
•Scalenus anterior (Lt)
& fascia
•Phrenic N (Lt)
Relations:
Cervical
Subclavian A.&V
Vertebral A.
Thyrocervical
Trunk
TD crossing
Subclavian A.
Thoracic duct Termination
 Variations in
termination
And in course

Division in neck

Division in thorax
 Factors responsible for
propulsion of lymph through
Thoracic duct
•Pressure changes in thorax
•Aortic pulsations
•Valves
•Muscle contraction- Cisterna chyli
•Raised abdominal pressure
Tributaries
Lt. Jugular lymph trunk
Lt Subclavian lymph trunk
Lt. Bronchomediastinal
lymph trunk
Efferents from
Post.intercostal L.nodes
Upper 5 spaces on Lt
Lower 6 ICS – Pair of
descending lymph trunks
Pair of Ascending Lumbar
lymph trunks
 DEVELOPMENT OF THORACIC DUCT
Primitive Right and left
lymphatic ducts

1.Lower Vertical

2.Intermediate oblique

3.Upper part
 APPLIED ANATOMY
1.Lymphangiography
2. Injury during oesophageal surgery
0.2-3.0%
3. Rupture of thoracic duct –
Fracture of thoracic vertebrae – chylothorax
-Progressive immune and nutritional deficit
4.Thoracic duct obstruction – Filarial parasite-
collection of chylous fluid in pleura,
peritoneum,scrotal sac or chyluria
5. Inadvertent incision or transection of duct
during thoracoscopic surgery