ANATOMY OF THE

LYMPHATIC SYSTEM
Done by
Res / Ahmed Alaa Elsebaey
 Introduction
 Definition :
The lymphatic system is a network of vessels
and organs that regulates the amount of fluid in the
human body and defends it against infections. 

 The lymphatic system is a system of specialized

vessels and organs whose main function is to return
the lymph from the tissues back into the
bloodstream. 
 Lymphatic system is considered as a part of
both the circulatory and immune
systems. The functions of the lymphatic system
complement the bloodstream functions, as it
regulates the balance of fluids in the body and
filters the pathogens from the blood. 
 Function
 Regulate the amount of fluid in the human
body
 Immune surveillance
 Transport of large molecules that can’t pass
through capillary pores , as : hormones , lipids
proteins ..
 The fluid balance is maintained by draining the
extra fluid that remains after the exchange of
blood and nutrients between the tissues and 
capillaries. If not regularly drained, this
amount of fluid can accumulate and cause
swelling (edemas).
  Lymph also carries the molecules that are too
large to diffuse through the capillary wall (e.g.
proteins or lipids). This is why the small
intestine has a vast lymphatic drainage, as it is
the site where the lipids and proteins are
absorbed from during food digestion.
  The lymphatic organs house
numerous immune system cells which filter the
content of the lymph as it flows toward the
venous system. If a foreign particle is detected,
the immune cells start an immune response to
destroy the pathogen and prevent the infection
and damage. 
 Lymphatic system consists of
 Lymph
 Lymph nodes
 Lymphoid tissues and organs
 Lymph vessels
 lymph
 Latin word “ lympha = water “

 Clear , yellowish , watery fluid flow through

lymph vessels  present in most tissues of the
body. It is created as a result of the filtration of
the plasma into interstitial spaces .
 It contain many types of cells as : lymphocytes ,
macrophages , hormones , cell debris , bacteria ,
viruses … , even travelling cancer cells
 Similar to blood plasma, the lymph is
composed mainly of water. The other
components are proteins, lipids, glucose, ions,
and cells. Depending on where the lymph is
produced, the composition of lymph can vary
(e.g. lymph produced in the 
gastrointestinal system is rich in fats). A body
of a healthy individual produces an average of
2 liters of lymph per day, but this amount can
vary greatly in pathological conditions. 
 How lymph is formed
 Fluids , nutrients and other substances go
through capillary pores to cells at arterial side
 Then these fluids and nutrients are reabsorbed
at venous side , but not all contents pass back
through capillary pores at venous side
 These remnant substances , large molecules ,
cell debris … are taken by blind ended vessels
with wide pores called lymphatic vessels
 Every day about 20 liters seeps out of
capillaries
 About 17 : 18 liters reabsorbed
 2 : 3 liters are left into interstitial spaces >>
taken by lymphatic vessels >> go through
lymphatic system and drains lastly into veins
that keep constant blood volume
 If this fluid accumulate into interstitial fluid
that causes edema
 Lymph vessels
 Lymphatic capillaries
 Lymphatic vessels
 Lymph trunks
 2 lumbar trunks
 2 broncho-mediastinal trunks
 2 subclavian trunks
 2 jugular trunks
 1 intestinal trunk
 Lymphatic ducts
 Right lymphatic duct
 Thoracic duct
 Lymphatic circulation
 Lymphatic capillaries are the smallest
lymphatic vessels that collect the interstitial
fluid from the tissues. They are organized in
networks called lymphatic plexuses. Plexuses
converge to make larger lymphatic vessels that
carry the lymph away from the tissues and into
the bloodstream. 
 There are also special types of lymphatic
capillaries called lacteals. These capillaries
absorb nutrients from the small intestine. 
 NB : fatty acids get packaged into balls of fat
called chylomicrons , that can’t pass through
capillary pores >> they go through special
lymph vessels called Lacteals , as the fluid
flows through them looks like milk .. This fluid
is called Chyle
 Chyle : is lymph + fat droplets “chylomicrons”
that is formed at intestine during digestion of
fat
 Lymph vessels
 Originate as blind ended tubes in the
interstitial spaces
 Beaded vessels containing valves , Same as
blood capillaries in structure but their walls are
more permeable with wider pores
 Capillaries join to form larger lymph vessels ,
that also join together to form lymph trunks
which in turn join to form lymph ducts
 The lymphatic vessels are divided into two
large groups; superficial and deep lymphatic
vessels. The superficial vessels are located in
the subcutaneous layer of the skin where they
collect the lymph from the superficial
 structures of the body. They tend to follow the
drainage of the venous system and in the end,
drain into deep lymphatic vessels.
 The deep lymphatic vessels carry lymph from 
internal organs. In contrast to the superficial
vessels, the deep vessels are accompanied by
the arteries. These arteries lean onto the walls
of the deep lymphatic vessels, putting pressure
upon them and helping the flow of the lymph. 
 Along the way, both superficial and deep
lymphatic vessels go through lymph nodes that
monitor the content of the lymph. Lymphatic
vessels that carry lymph towards the lymph
node are known as afferent, whereas the
vessels that carry lymph away from the lymph
node are called efferent lymphatic vessels. 
 The efferent vessels empty into the lymphatic
trunks. The lymphatic trunks are named
according to the region of the body that they
drain the lymph from. There are four pairs of
trunks: lumbar, bronchomediastinal, subclavian
and jugular. There is also one unpaired
intestinal lymph trunk, that drains lymph from
the majority of organs of the gastrointestinal
tract. The duct opens in the cisterna chyli which
is the dilated origin of the thoracic duct.
 Cisterna chyli
 Dilated collecting sac located in abdomen in
front of body of L1 , L2
 It drains lymphatic trunks from lower parts of
the body
 Gives rise to thoracic duct
 The lymphatic trunks then converge into the two
lymphatic ducts; the right lymph duct and thoracic
duct. 
 The right lymphatic duct collects lymph from the
right upper limb and the right side of the head,
neck and chest. 
 The thoracic duct is a larger vessel and collects
lymph from the rest of the body.
 The lymphatic ducts take the lymph into the right
and left subclavian veins, which flow into the 
superior vena cava.
 The lymphatic vessels should not be confused
with blood vessels. First of all, the lymphatic
system is a one-way street starting blindly in
the tissues and opening into the circulatory
system on the other end.
  The lymphatic system doesn’t have a pump
that can regulate the pressure of the flow of the
lymph like the circulatory system has (the heart
). Instead, the lymph flows thanks to the 
movements of the body, pulsation of the
arteries and contractions of skeletal muscles.
The lymphatic vessels have valves that prevent
the lymph flowing backwards.
 Lymphatic vessels are located throughout the
whole body but note that some tissues and
organs are lacking the lymphatic vessels (e.g. 
epidermis, cartilage, bone , the structures of
the eye). For a long time, it has been believed
that the central nervous system doesn't contain
lymph vessels. Now there is convincing 
evidence that the lymphatics do exist in some
parts of the central nervous system.???
 Lymph nodes

 Lymph nodes are small, bean-shaped organs.

You have nodes throughout your body
including in your axilla, neck and groin. Your
lymph nodes can swell or get bigger, which is a
sign that your body is fighting an infection or
an illness.
 A lymph node’s job is to
filter substances in your lymph fluid .
phagocytic action
produce antibodies
activate T & B lymphocytes
 The cells within your lymph nodes will attack,
destroy and eliminate waste, especially foreign
invaders, to help your immune system keep
you healthy.
 Lymph nodes size varies from few mm to few
cm
 There are approximately 600 lymph nodes in
your body as an adult. The exact number varies
from person to person.
 Distribution of LNs
 Cervical groups
 Axillary groups
 Mediastinal groups
 Aortic { preaortic – paraaortic } groups
 Iliac groups
 Inguinal groups
 Femoral groups
 The lymphatic system is involved in infective,
inflammatory, and malignant diseases, and as
such, enlargement of lymph nodes can be
attributed to multiple causes. 
 Peyer’s patches
 Peyer’s patches are groupings of lymphoid
follicles in the mucus membrane that lines
your small intestine. Lymphoid follicles are
small organs in your lymphatic system that are
similar to lymph nodes.
 Peyer’s patches play an important role in
immune surveillance of materials within your 
digestive system.
 Peyer’s patches are located in your small
intestine, usually in the ileum area.
 Most people have between 30 and 40 Peyer’s
patches, and younger people tend to have more
than older people.
 Lymphoid organs
 1ry lymphoid organs
 Bone marrow
 Thymus gland

 2ry lymphoid organs

 Spleen
 Tonsils
 Lymph nodes
 Bone marrow

 Bone marrow is a sponge-like tissue found inside

the bones.
 That is where most immune system cells are
produced and then also multiply.
 At birth, many bones contain red bone marrow,
which actively creates immune system cells.
 Over the course of our life, more and more red
bone marrow turns into fatty tissue.
 In adulthood, only a few of our bones still contain
red bone marrow, including the ribs, sternum and
the pelvis.
 Thymus
 The thymus is located behind the sternum above
the heart.
 This gland-like organ reaches full maturity only in
children, and is then slowly transformed to fatty
tissue.
 Special types of immune system cells called thymus
cell lymphocytes (T cells) mature in the thymus.
 Spleen
 Largest lymphoid organ
 The spleen is located in the left upper
abdomen, beneath the diaphragm, and is
responsible for different kinds of jobs:
 It stores various immune system cells. When
needed, they move through the blood to other
organs. (phagocytes) in the spleen act as a filter
for germs that get into the bloodstream.{white
pulp }
 It stores and breaks down old platelets (thrombocytes)
and old red blood cells (erythrocytes). { Red pulp }

 There is always a lot of blood flowing through the

spleen tissue. At the same time this tissue is very soft.
In the event of severe injury, for example in an
accident, the spleen may rupture easily. Surgery is
then usually necessary because otherwise there is a
danger of bleeding to death. If the spleen needs to be
removed completely, other immune system organs
can carry out its roles.
 Tonsils
 Naso-pharyngeal tonsils { adenoids }
 Tubal tonsils
 Palatine tonsils
 Lingual tonsils
 These groups forms a ring that plays an
important role in immune system in the area of
entry of air , fluids and food
 This ring is called Waldeyer’s Ring
 Thoracic duct
 The thoracic duct drains the lymph from 75%
of the body, aside from the right upper right
limb, right breast, right lung and right side of
the head and neck (which are drained by the 
right lymphatic duct).
 The thoracic duct (also known as van Hoorne’s
canal) is the largest lymphatic vessel of the
lymphatic system of the body. It is
approximately 40 cm in length in adults, and
approximately 5 mm in width at its abdominal
origin.


The thoracic duct extends from the twelfth 

thoracic vertebra to the root of the neck. The
thoracic duct is formed from the
abdominal confluence of the left and right
lumbar lymph trunks, as well as the intestinal
lymph trunk between T12 and L2. If the
confluence of lymph trunks is saccular, it is
referred to as cisterna chyli.
 Cisterna chyli
 Dilated collecting sac located in abdomen in
front of body of L1 , L2
 It drains lymphatic trunks from lower parts of
the body
 Gives rise to thoracic duct
 The thoracic duct crosses the diaphragm at
the aortic hiatus at the level of the twelfth
thoracic vertebra.
 The aortic opening is located in the posterior 
mediastinum, and is formed either side by the
left and right crura of the diaphragm.
 The duct continues to ascend, between the
thoracic aorta on the left, and the azygous vein
on the right, and crosses over to the left side
between the fourth and sixth thoracic
vertebrae.
 From this point, the duct ascends behind the
aortic arch and the left subclavian artery.
 The duct will also lie anterior to the 
anterior scalene muscle and left phrenic nerve
 before its final destination.
 The fluid drains at the level of the venous
angle (Pirogoff’s angle) between the left
subclavian vein and the left internal jugular
vein, where it reenters the systemic venous
circulation.
 The thoracic duct drains lymph from the right
and left descending thoracic lymph trunks,
originating from the lower 6 intercostal spaces
(6 to 11).
 The duct also receives lymph from intercostal
spaces 1 to 5 via the upper intercostal lymph
trunks.
 Additional tributaries include the: 
 mediastinal lymph trunks
 left jugular trunk,
 left bronchomediastinal trunk
 left subclavian trunk
 The thoracic duct occasionally divides into
a right and left duct, with the left entering the
venous system as normal, and the right
draining into the right subclavian vein.
 The duct may also drain into the left internal
jugular vein, or into the left brachiocephalic
vein.
 Virchow's node, a left supraclavicular lymph node,
was first described by German pathologist Rudolf
Ludwig Karl Virchow (1821-1901) in 1848 as a sign of
metastatic malignancy mainly from gastric cancer.

  The term "Troisier sign"describes an enlarged

palpable hard left supraclavicular node following
Charles-Emile Troisier's work, which is now
sometimes used interchangeably with Virchow's node.
 Virchow’s node

 Virchow's node is a lymph node and is a part

of the lymphatic system. It is the thoracic duct
end node.

 When it is enlarged (positive Troisier’s sign), it

can be one of the earliest signs of intra-
abdominal malignancy, usually a gastric
carcinoma following migration of tumour
emboli through the thoracic duct.
 It is located in the venous angle, at the junction
of the left subclavian vein and the thoracic duct.

 Some think that the mechanism of this

lymphadenopathy in the setting of malignancy is
due to tumor embolization from the primary
sites through the thoracic duct, which eventually
involves the Virchow's node where some of the
cancer cells become trapped with resultant
enlargement
 The VN has been well-established as a signal
node for the spread of gastric cancer.
  In addition, the VN has been identified as a
seeding location for cancers arising from many
locations apart from the stomach,
including : the intestines, uro-genital
system, esophagus, common bile duct , liver, as
well as the pancreas, and lungs
 Considering its role in lymphatic drainage,
researchers have theorized that its involvement
in malignancies could be due to tumor
embolization along the thoracic duct
 Although there have been just a few studies on
its anatomic description, they have helped
understand the possible complications that the
mass effect of Virchow's node can cause, which
includes thoracic outlet syndrome, Horner's
syndrome, and unilateral phrenic neuropathy.
 enlarged palpable hard left supraclavicular
lymph node rarely linked to  certain infections-
tuberculosis, syphilis.
 Clinical points

 Chylothorax
 Rupture of the thoracic duct causes chyle to
leak into the pleural cavity. The aetiology of
this condition includes traumatic and non-
traumatic causes.
 Thoracic duct fistula
 This commonly occurs when surgery takes
place in the lower part of the left side of the
neck.
 Presentation will be leakage of milky white
fluid from the neck following the incision.
 Right lymphatic duct
 The right lymphatic duct is a terminal
lymphatic vessel located in the neck, anterior to
the anterior scalene muscle.
 It is typically formed by the union of the right
bronchomediastinal, right jugular and right
subclavian lymphatic trunks, although its
formation is highly variable.
  It is about 1-2 cm in length and is less
distinguishable when compared to its left
counterpart, the thoracic duct.
 The right lymphatic duct receives lymph from
the right side of the head, neck and thorax and
right upper limb. It drains into the systemic
venous system at the junction of the right 
internal jugular and right subclavian vein
 or right brachiocephalic vein within the neck.
 These ducts connect to the subclavian vein,
which returns lymph to your bloodstream.

 Returning lymph to the bloodstream helps to

maintain normal blood volume and pressure. It
also prevents the excess buildup of fluid
around the tissues (called edema).
THANK YOU