Lymphatic vessels and nodes of the upper extremity

The upper limb has superficial and deep lymphatic vessels that flow to the ulnar and axillary lymph nodes. The superficial lymphatic vessels are located near the subcutaneous veins of the upper limb and form three groups: lateral, medial and anterior. The lymphatic vessels of the lateral group (5-10) are formed in the skin and subcutaneous base of the I-III fingers, the lateral edge of the hand, forearm and shoulder, follow along the lateral saphenous vein and flow into the axillary lymph nodes. The lymphatic vessels of the medial group (5-15) are formed in the skin and subcutaneous base of the IV-V fingers and partially the III finger, the medial side of the hand, forearm and shoulder. In the elbow area, the vessels of the medial group pass to the anteromedial surface of the limb and flow to the ulnar and axillary lymph nodes. The lymphatic vessels of the middle group follow from the anterior (palmar) surface of the wrist and forearm, then along the intermediate vein of the forearm they are directed towards the elbow, where some of them join the lateral group, and some join the medial.

Deep lymphatic vessels that drain lymph from muscles, tendons, fascia, joint capsules and ligaments, periosteum, nerves accompany the large arteries and veins of the upper limb.

Some of the superficial and deep lymphatic vessels of the upper limb, following from the hand and forearm, flow into the cubital lymph nodes (nodi lymphatici cubitales, 1-3 in total). These nodes are located in the cubital fossa superficially, on the fascia, near the medial saphenous vein, and also deep, under the fascia, near the deep vascular bundle. The efferent lymphatic vessels of these nodes go to the axillary lymph nodes (nodi lymphatici axillares, 12-45 in total), located in the fatty tissue of the axillary cavity. These are six independent groups:

1. lateral (1-8);
2. medial, or thoracic (1-9);
3. subscapular, or posterior (1-11);
4. lower (1-7);
5. central (2-12) groups located between the axillary vein and the medial wall of the cavity;
6. apical lymph nodes, which are located near the axillary artery and vein under the collarbone, above the pectoralis minor muscle.

Some groups of nodes are adjacent to the walls of the axillary cavity, while others are located near the vascular-nerve bundle. The superficial and deep lymphatic vessels of the upper limb, the anterior, lateral, and posterior walls of the thoracic cavity, and the mammary (breast) gland flow into the axillary lymph nodes. From the mammary gland, the lymphatic vessels are directed mainly to the medial (thoracic) axillary nodes, as well as to the central and apical axillary lymph nodes. The vessels also go to the parasternal and lateral cervical deep lymph nodes. The efferent lymphatic vessels of the lateral, medial, posterior, lower, and central groups are directed to the apical axillary lymph nodes, which lie on the paths of lymph flow from the upper limb to the veins of the lower neck.

In the anterior wall of the axillary cavity, between the pectoralis major and minor muscles, there are variable interpectoral lymph nodes (nodi lymphatici interpectorales, 1-5 in total). Lymphatic vessels from adjacent muscles, lateral and lower axillary nodes, and from the mammary gland flow into these nodes. The efferent lymphatic vessels of the interpectoral nodes are directed to the apical axillary lymph nodes.

The efferent lymphatic vessels of the apical axillary lymph nodes in the region of the sternoclavicular triangle form one common subclavian trunk (truncus subclavius) or two or three large vessels that accompany the subclavian vein and flow into the venous angle in the lower parts of the neck or into the subclavian vein on the right, and on the left - into the cervical part of the thoracic duct.

Lymphatic vessels and lymph nodes can be detected in a living person when they are filled with a radiopaque substance. Lymphography (lymphangioadenography), first developed and applied in our country by A.S. Zolotukhin, D.A. Zhdanov and M.G. Prives, has become widespread and serves as a reliable diagnostic method for determining the number, shape, size of lymphatic vessels and nodes in various diseases, especially in tumors and their metastasis. Lymphangioadenography allows examining lymph nodes, large lymphatic vessels, the thoracic duct that are inaccessible to other methods, and also to observe the tumor process in dynamics during treatment.

This method helps to identify the reserve capacity of the lymphatic channel, the “opening” of existing vessels, or the appearance of new collateral lymph flow pathways when individual lymphatic vessels and nodes are damaged or blocked.

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