Lymphatic vessels and nodes of the upper limb

The upper extremity has superficial and deep lymphatic vessels, which are directed to the ulnar and axillary lymph nodes. Surface lymphatic vessels are located near the subcutaneous veins of the upper limb and form three groups: lateral, medial and anterior. 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, the forearm and the shoulder, follow the lateral subcutaneous vein and flow into the axillary lymph nodes. Lymphatic vessels of the medial group (5-15) are formed in the skin and subcutaneous base of IV-V fingers and partly of the third finger, the medial side of the hand, forearm and shoulder. In the region of the elbow, the vessels of the medial group pass to the anteromedial surface of the limb and are directed to the ulnar and axillary lymph nodes. Lymphatic vessels of the middle group follow from the front (palmar) surface of the wrist and forearm, then along the intermediate vein of the forearm are directed toward the elbow, where some of them join the lateral group, and some - to the medial.

Deep lymph vessels that divert lymph from muscles, tendons, fasciae, articular capsules and ligaments, periosteum, nerves, accompany large arteries and veins of the upper limb.

Part of the superficial and deep lymphatic vessels of the upper limb, following from the hand and forearm, flow into the ulnar lymph nodes (nodi lymphatici cubitales, only 1-3). These nodes are located in the ulnar fossa superficially, on the fascia, near the medial saphenous vein, and also in the depth, under the fascia, near the deep vascular bundle. The vascular lymph nodes of these nodes are directed to the axillary lymph nodes (nodi lymphatici axillares, total 12-45), lying in the fat tissue of the axillary cavity. There are six separate 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, lying between the axillary vein and the medial wall of the cavity;
6. apical lymph nodes that are located near the axillary artery and vein under the clavicle, above the small pectoral muscle.

Individual groups of nodes are adjacent to the walls of the axilla, others are located near the neurovascular bundle. In the axillary lymph nodes, surface and deep lymphatic vessels of the upper limb, anterior, lateral and posterior walls of the thoracic cavity and the breast (breast) gland. 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. Vessels also follow the peri-chest and lateral cervical deep lymph nodes. The endometrial lymphatic vessels of the lateral, medial, posterior, inferior and central groups are directed to the apical axillary lymph nodes, which lie on the lymph drainage pathways from the upper limb to the veins of the lower region of the neck.

In the anterior wall of the axillary cavity, between the large and small pectoral muscles, there are non-permanent interstitial lymph nodes (nodi lymphatici interpectorales, total 1-5). In these nodes lymphatic vessels emerge from the adjacent muscles, lateral and lower axillary nodes, and also from the mammary gland. The lymphatic vessels of the interstitial nodes are sent to the apical axillary lymph nodes.

The lymphatic vessels of the apical axillary lymph nodes in the sternoclavicular triangle form one common subclavicular trunk (truncus subcldvius) 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 to the left - in the neck part of the thoracic duct.

Lymphatic vessels, as well as lymph nodes can be detected in a living person when filling them with radiopaque substances. Lymphography (lymphangiadenography), first developed and applied in our country by A. Zolotukhin, D. A. Zhdanov and M. G. Prives, is widely used and serves as a reliable diagnostic method for determining the number, shape, size of lymphatic vessels and nodes at various diseases, especially with tumors and their metastasis. Lymphangiadenography makes it possible to examine the 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.

With the help of this method, the reserve capacity of the lymphatic channel is revealed, the "opening" of already existing vessels or the emergence of new roundabout (collateral) ways of lymph flow with damage to or switching off of individual lymph vessels and nodes.

[1], [2], [3], [4], [5], [6], [7], [8]