Lymphatic System — Study Notes
Lymphatic drainage, major ducts, nodes, spleen & thymus
1. Overview & Functions
• Drains excess interstitial fluid (as lymph) back into the venous circulation
• Transports absorbed dietary fats (via lacteals in small intestine) as chyle
• Immune surveillance and response — houses lymphocytes, filters lymph through lymph nodes
2. Components
• Lymphatic vessels — thin-walled, valved vessels similar to veins, carry lymph unidirectionally toward the heart
• Lymph nodes — bean-shaped filters along lymphatic vessels, contain lymphocytes and macrophages
• Primary lymphoid organs — bone marrow (B cell maturation), thymus (T cell maturation)
• Secondary lymphoid organs — spleen, lymph nodes, tonsils, Peyer's patches (site of immune response activation)
3. Major Lymphatic Trunks & Ducts
Structure Drainage
Right lymphatic duct Drains right upper limb, right side of head/neck, right thorax → right
subclavian/internal jugular vein junction
Thoracic duct Drains everything else (both lower limbs, abdomen, left thorax, left upper
limb, left head/neck) — largest lymphatic vessel, begins at cisterna chyli
(L1-L2) → left subclavian/internal jugular vein junction
Cisterna chyli Sac-like dilation at the origin of the thoracic duct, receives lymph from
lower limbs and intestinal trunks — located anterior to L1-L2 vertebrae
4. Major Lymph Node Groups
Region Nodes / Drainage Area
Cervical Head and neck structures
Axillary Upper limb, breast (lateral quadrants primarily), thoracic wall
Mediastinal/Hilar Lungs, mediastinal structures — key in lung cancer staging
Mesenteric/Para-aortic Abdominal GI organs, retroperitoneal structures
Inguinal Lower limb, external genitalia, perineum, lower anal canal
Popliteal Lower leg and foot, drains into deep inguinal nodes
5. Spleen
• Largest lymphoid organ, located in left upper quadrant, protected by ribs 9-11
• Functions: filters blood (removes old/damaged RBCs), reservoir for platelets, immune response (white pulp —
lymphocytes; red pulp — RBC filtration)
• Splenic artery (from celiac trunk) supplies; splenic vein drains into portal vein (joins SMV to form portal vein)
6. Thymus
• Located in the anterior/superior mediastinum, largest relative to body size in childhood, involutes (shrinks, replaced by
fat) after puberty
• Site of T-lymphocyte maturation ('T' stands for thymus)
7. Imaging Correlation
• Lymph node size criteria — generally >10mm short-axis diameter on CT is considered potentially abnormal (varies by
region, e.g., >8mm for some groups)
• PET-CT — assesses metabolic activity of lymph nodes, useful in lymphoma/cancer staging beyond size alone
• Splenomegaly — assessed on ultrasound/CT; normal spleen length is generally <12-13 cm
• Lymphangiography (historical, largely replaced by CT/MRI/lymphoscintigraphy) — direct contrast injection into
lymphatic vessels
• Sentinel lymph node biopsy (nuclear medicine + surgery) — identifies first draining node from a tumor site (e.g., breast
cancer, melanoma)
8. Common Pathologies
Lymphadenopathy
• Reactive (infection/inflammation) vs malignant (lymphoma, metastasis) — imaging features (size, shape, necrosis,
matting) help differentiate but tissue diagnosis often needed
Lymphoma
• Hodgkin's — often contiguous nodal spread, mediastinal involvement common; Non-Hodgkin's — often non-
contiguous, extranodal involvement more frequent
Splenomegaly
• Causes: portal hypertension, hematological malignancy, infection (e.g., mononucleosis, malaria), storage diseases
9. Common Pitfalls
• The thoracic duct drains roughly 3/4 of the body's lymph (everything except right upper quadrant) — a commonly tested
asymmetry
• Node size alone is an imperfect malignancy marker — small nodes can harbor metastasis (e.g., micrometastases) and
large nodes can be reactive
• The spleen is intraperitoneal and highly vascular — susceptible to traumatic rupture, especially with pre-existing
splenomegaly (e.g., in mononucleosis)
• Cisterna chyli location (anterior to L1-L2) is a useful landmark but is not always visualized on routine imaging due to its
variable size