LYMPHATIC SYSTEM A.Lymph vessels

Lymph capillariesLymph vessels proper- veinsTerminal lymph ducts Thoracic ductRight Lymphatic duct

B. Lymphoid tissue

Primary lymphatic follicle Lymph nodesHaemolymph nodes-SpleenThymus

Lymphatic System

Lymphoid Tissues

THORACIC DUCT

LONGEST LYMPH TRUNK

Drains whole body except

Rt side of H&NRt.ULRt.Chest wallRt.Lung &PleuraRt.surface of Heart &PCRt.dome of diaphragmRt.surface of liver

Length: 40-45CMS

Caliber: 0.5 cmsExtent: Beginning – T12 Termination- C7Appearance: BeadedValves: Several

Pressure related one constant at

termination

Course:

Cervical

Thoracic

Abdominal

RELATIONS: Abdominal part

Aortic Opening-T12

Anterior: Median arcuate ligament

Posterior:T12

Right: Azygos vein

Left: Aorta

Rt.

Lt

At Aortic Opening

Posterior:T12

Right: Azygos vein

Left: Aorta

Azygos Aorta

Thoracic duct

Aortic opening

Post. Mediastinum

Sup.Mediastinum

RELATIONS:PosteriorMediastinumAnterior:

Rt. Pleural recess

Oesophagus Diaphragm

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)

Posterior Mediastinum Contd…..

RELATIONS:

SuperiorMediastinum

Anterior:

•Lt lung & pleura

Arch of aorta (Lower)

•Lt.Subclavian A (Upper)

•Thymus

Sup.Mediastinum Contd….

Posterior:

•T1-T4 Vertebrae

•Longus cervicis

Right:

•oesophagus

Left:

Lt.Lung & Pleura

(Mediastinal surface)

SuperiorMediastinum contd…

RELATIONS:

CervicalAnterior: 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 ANATOMY1.Lymphangiography2. Injury during oesophageal surgery

0.2-3.0%3. Rupture of thoracic duct – Fracture of thoracic vertebrae – chylothorax -

Progressive immune and nutritional deficit4.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