Lymphatic vessels and nodes of the thoracic cavity

In the chest cavity, parietal (parietal) lymph nodes located on the respective walls (anterior, posterior and posterior) and visceral (internal) located in the thoracic cavity on the lymph flow path from its internal organs are isolated.

The parietal (parietal) lymph nodes are the parodragrinal lymph nodes (nodi lymphatici parasternales), no 2-20 on each side. They are located on the inner (posterior) surface of the anterior thoracic wall to the right and left of the sternum and adhere to the internal thoracic arteries and veins; In rare cases, individual nodes are located on the posterior surface of the sternum. Lymphatic vessels flow into the pericordinal lymph nodes not only from the tissues of the anterior thoracic wall, pleura and pericardium, the lower epigastric and upper diaphragmatic lymph nodes, as well as from the diaphragmatic surface of the liver (penetrate the diaphragm) and from the mammary gland. The endometrial lymphatic vessels of the right perioral lymph nodes flow into the right jugular trunk and into the prevenous lymph nodes located in the upper mediastinum. Vessels of the left parietal nodes go to the pre-aortic lymph nodes, and also flow directly into the thoracic duct and into the left jugular trunk.

In the intercostal spaces on each side of the spine, near the posterior intercostal vessels, the posterior intercostal lymph nodes are located (nodi lymphatici intercostales, only 1-7). Lymph vessels from the posterior wall of the thoracic cavity are directed to these nodes. The lymphatic vessels that carry the intercostal nodes flow into the thoracic duct, and from the upper nodes into the deep lateral cervical (internal jugular) lymph nodes located near the internal jugular vein.

The upper diaphragmatic lymph nodes (nodi lymphatici phrenici superiores) lie on the diaphragm, to the left of the inferior vena cava and around the pericardium, at the sites of entry into the diaphragm of the right and left diaphragmatic nerves and the muscular-diaphragmatic arteries. Depending on the position with respect to the pericardium in this group, unstable lateral pericardial, prepericardial and post-pericardial lymph nodes are distinguished. Paired lateral pericardial nodes (nodi lymphatici pericardiales laterales, 1-4 on the right and 1-2 on the left) occur more often (in 50% of cases) near the right diaphragmatic nerve than near the left (10%). Prepericardial lymph nodes (nodi lymphatici prepericardiales, total 1-7) are located behind the xiphoid process, as well as near the muscular-diaphragmatic arteries near the site of their entry into the diaphragm. Under the pericardium, near the inferior vena cava and in front of the esophagus, there are post-pericardial lymph nodes (1-9). Lymphatic vessels from the diaphragm, pericardium, pleura and diaphragmatic surface of the liver are guided to the diaphragm nodes (perforate the diaphragm). The vascular lymphatic vessels of the upper diaphragmatic lymph nodes flow mainly into the peritoneal, posterior mediastinal, lower tracheobronchial and bronchopulmonary lymph nodes.

To the visceral (internal) lymph nodes are the anterior and posterior mediastinal, tracheobronchial and bronchopulmonary lymph nodes. The anterior mediastinal lymph nodes (nodi lymphatici mediastinales) are located in the superior mediastinum (in the upper part of the anterior mediastinum), on the anterior surface of the superior vena cava and the brachiocephalic veins, the arch of the aorta and the arteries leaving it, up from the base of the heart. According to the situation, these nodes (according to Ruvier-Zhdanov) are divided into pre-cava (prevenous) lymph nodes (1-11), which lie in front of the upper hollow and right brachiocephalic veins; preorortocarotid (3-18) located on the anterior surface of the left brachiocephalic vein and brachiocephalic trunk.

Lymphatic vessels of the heart, pericardium, thymus and enduring lymph vessels of bronchopulmonary and tracheobronchial lymph nodes flow into the anterior mediastinal lymph nodes. From the lymph nodes located in the upper and anterior parts of the mediastinum, several fairly large lymphatic vessels emerge that go upward to the neck area - to the right and left venous corners. The lymphatic vessels of the prevenous lymph nodes form a small diameter, the short right lymphatic duct (truncus lymphaticus dexter), which occurs in Va cases, as well as in the right lymphatic duct or in the right jugular trunk and near-bronchial lymph nodes. The lymphatic vessels of the pre-aortocarotid nodes flow into the thoracic duct, the left jugular trunk, and also go to the left lateral (internal) jugular lymph nodes. Thus, the lymph from the lymph nodes of the anterior (superior) mediastinum can flow to the side of both the right and left venous angles.

The posterior mediastinal lymph nodes (nodi lymphatici mediastinales posteriores, total 1-15) are located in the cellulose near the thoracic part of the aorta and near the esophagus, they receive lymph from the organs of the posterior mediastinum. Lymph nodes that lie near the esophagus (anterior to it) and on the sides are near the esophagus, as well as between the aorta and the esophagus - interaorthottive (1-8), occur in about 60% of cases. Behind the aorta and to the side of it, the near-aortic lymph nodes are found even less frequently - in less than 30% of cases. The vascular lymph nodes of these nodes flow directly into the thoracic duct, as well as into the lower tracheobronchial and, rarely, into the left extraorganic bronchopulmonary lymph nodes.

On the lymphatic vessels of the lung lie bronchopulmonary lymph nodes, only 4-25. Intraorganic bronchopulmonary nodes are located in each lung at the sites of branching of the main bronchi into lobar and lobar segments, and the extraorganic (root) are grouped around the main bronchus, near the pulmonary arteries and veins. The vascular lymphatic vessels of the right and left bronchopulmonary nodes are directed to the lower and upper tracheobronchial lymph nodes. Sometimes they fall directly into the thoracic duct, as well as into the prevenotic nodes (right) and preorortocarotid (on the left).

The lower tracheobronchial (bifurcation) lymph nodes (nodi lymphatici tracheobronchiales inferiores, total 1-14) lie under the bifurcation of the trachea, and the upper tracheobronchial (right and left) lymph nodes (nodi limphatici tracheobronchiales superiores dextri, 3-30, et sinistri, 3-24 ) are located on the lateral surface of the trachea and in the tracheobronchial corner formed by the lateral surface of the trachea and the upper semicircle of the main bronchus of the corresponding side. To these lymph nodes the outgoing lymph vessels of bronchopulmonary nodes are directed, as well as other visceral and parietal nodes of the thoracic cavity. The vascular lymphatic vessels of the right upper tracheobronchial nodes participate in the formation of the right bronchoconstrictorial trunk and the right lymphatic duct. There are also ways of outflow of lymph from the right upper tracheobronchial lymph nodes towards the left venous angle. The lymphatic vessels of the left upper tracheobronchial lymph nodes flow into the thoracic duct.

[1], [2], [3], [4]