The tributaries of the thoracic lymphatic duct are. Structure and functions of the thoracic lymphatic duct. Thoracic lymphatic duct

1. Right lymphatic duct (ductus lymphaticus dexter). Topography, structure of the right lymphatic duct.
2. Lymph nodes and vessels of the lower limb (leg). Topography, structure, location of lymph nodes and vessels of the leg.
3. Lymph nodes and vessels of the pelvis. Topography, structure, location of the lymph nodes and vessels of the pelvis.
4. Lymph nodes and vessels of the abdominal cavity (stomach). Topography, structure, location of lymph nodes and vessels of the abdominal cavity (stomach).
5. Lymph nodes and vessels of the chest. Topography, structure, location of the lymph nodes and vessels of the chest.
6. Lymph nodes and vessels of the upper limb (arm). Topography, structure, location of lymph nodes and vessels of the upper limb (arm).
7. Lymph nodes and vessels of the head. Topography, structure, location of the lymph nodes and vessels of the head.
8. Lymph nodes and vessels of the neck. Topography, structure, location of lymph nodes and vessels of the neck.

Thoracic duct (ductus thoracicus). Topography, structure of the thoracic duct

Thoracic duct, ductus thoracicus, according to D. A. Zhdanov, has a length of 30 - 41 cm and starts from the confluence right and left lumbar trunks, truncus lumbales dexter et sinister.

Commonly described in textbooks as the third root of the thoracic duct truncus intestinalis It occurs infrequently, sometimes it is paired and flows into either the left (usually) or the right lumbar trunk. The level of the beginning of the thoracic duct varies between the XI thoracic and II lumbar vertebrae.

At the beginning The thoracic duct has an expansion, cisterna chyli. Having arisen in the abdominal cavity, the thoracic duct passes into the chest cavity through the aortic opening, where it fuses with the right leg of the diaphragm, which, through its contraction, promotes the movement of lymph along the duct.

Having penetrated the chest cavity, ductus thoracicus goes upward in front of the spinal column, located to the right of the thoracic part of the aorta, behind the esophagus and further behind the aortic arch. Having reached the aortic arch, at the level of the V-III thoracic vertebrae, it begins to deviate to the left.

At the level of the VII cervical vertebra, the thoracic duct enters the neck and, forming an arch, flows into the left internal jugular vein or into the angle of its connection with left subclavian (angulus venosus sinister).

The confluence of the thoracic duct from the inside is equipped with two well-developed folds that prevent blood from penetrating into it. They flow into the upper part of the thoracic duct truncus bronchomediastinalis sinister, collecting lymph from the walls and organs of the left half of the chest, truncus subclavius ​​sinister- from the left upper limb and truncus jugularis sinister- from the left half of the neck and head.

Thus, thoracic duct collects about 3/4 of all lymph, from almost the entire body, with the exception of the right half of the head and neck, the right arm, the right half of the chest and the cavity and lower lobe of the left lung. From these areas, lymph flows into the right lymphatic duct, which flows into the right subclavian vein.

After the lymph has passed through the lymph nodes, it is collected in lymphatic trunks And lymphatic ducts. A person has six such large trunks and ducts. Three of them flow into the right and left venous angles.

The main and largest lymphatic vessel is the thoracic duct. The thoracic duct carries lymph from the lower extremities, organs and walls of the pelvis, the left side of the chest cavity and the abdominal cavity. Through the right subclavian trunk, lymph flows from the right upper limb into the right jugular trunk from the right half of the head and neck. From the organs of the right half of the thoracic cavity, lymph flows into the right bronchomediastinal trunk, which flows into the right venous angle or into the right lymphatic duct. Accordingly, through the left subclavian trunk, lymph flows from the left upper limb, and from the left half of the head and neck through the left jugular trunk, from the organs of the left half of the thoracic cavity, lymph flows into the left bronchomediastinal trunk, which flows into the thoracic duct.

Thoracic lymphatic duct

The formation of the thoracic duct occurs in the abdominal cavity, in the retroperitoneal tissue at the level of the 12th thoracic and 2nd lumbar vertebrae during the connection of the right and left lumbar lymphatic trunks. The formation of these trunks occurs as a result of the fusion of the efferent lymphatic vessels of the right and left lumbar lymph nodes. From 1 to 3 efferent lymphatic vessels belonging to the mesenteric lymph nodes, called intestinal trunks, flow into the initial part of the thoracic lymph duct. This is observed in 25% of cases.

The lymphatic efferent vessels of the intercostal, prevertebral and visceral lymph nodes flow into the thoracic duct. Its length is from 30 to 40 cm.

The initial part of the thoracic duct is its abdominal part. In 75% of cases, it has an ampulla-shaped, cone-shaped or spindle-shaped expansion. In other cases, this beginning is a reticular plexus, which is formed by the efferent lymphatic vessels of the mesenteric, lumbar and celiac lymph nodes. This expansion is called a tank. Usually the walls of this tank are fused with the right leg of the diaphragm. During breathing, the diaphragm compresses the thoracic duct, facilitating the flow of lymph.

The thoracic lymphatic duct from the abdominal cavity enters the chest cavity through the aortic opening and penetrates the posterior mediastinum. There it is located on the anterior surface of the spinal column, between the azygos vein and the thoracic aorta, behind the esophagus.

The thoracic part of the thoracic duct is the longest. It originates at the aortic opening of the diaphragm and goes to the upper thoracic aperture, passing into the cervical part of the duct. In the region of the 6th and 7th thoracic vertebrae, the thoracic duct deviates to the left and emerges from under the left edge of the esophagus at the level of the 2nd and 3rd thoracic vertebrae, rising up behind the left subclavian and left common carotid artery and the vagus nerve. In the superior mediastinum, the thoracic duct passes between the left mediastinal pleura, the esophagus and the vertebral column. The cervical part of the thoracic lymphatic duct has a bend, forming an arch at the level of 5-7 cervical vertebrae, which bends around the dome of the pleura from above and slightly behind, and then opening at the mouth into the left venous angle or into the terminal section of the veins that form it. In half of the cases, the thoracic lymphatic duct expands before entering the vein; in some cases, it bifurcates or has 3-4 stems flowing into the venous angle or into the terminal sections of the veins that form it.

The passage of blood from the vein into the duct is prevented by a paired valve located at the mouth of the thoracic lymphatic duct. Also along the entire length of the thoracic duct there are from 7 to 9 valves that prevent the reverse movement of lymph. The walls of the thoracic duct have a muscular outer shell, the muscles of which promote the movement of lymph to the mouth of the duct.

In some cases (approximately 30%), the lower half of the thoracic duct is duplicated.

Right lymphatic duct

The right lymphatic duct is a vessel with a length of 10 to 12 mm. The bronchomediastinal trunk, jugular trunk and subclavian trunk flow into it. It has on average 2-3 sometimes more stems flowing into the angle formed by the right subclavian vein and the right internal jugular vein. In rare cases, the right lymphatic duct has one mouth.

Jugular trunks

The right and left jugular trunks originate in the efferent lymphatic vessels of the lateral deep cervical right and left lymph nodes. Each consists of one vessel or several short ones. The right jugular trunk enters the right venous angle, the terminal part of the right internal jugular vein, or forms the right lymphatic duct. The left jugular trunk enters the left venous angle, the internal jugular vein, or the cervical part of the thoracic duct.

Subclavian trunks

The right and left subclavian trunks originate from the efferent lymphatic vessels belonging to the axillary lymph nodes, most often the apical ones. These trunks go to the right and left venous angle, respectively, in the form of one trunk or several small ones. The right subclavian lymphatic trunk flows into the right venous angle, or into the right subclavian vein, the right lymphatic duct. The left subclavian lymphatic trunk drains into the left venous angle, the left subclavian vein, and in some cases it drains into the terminal part of the thoracic duct.

Thoracic duct, ductus thoracicus, according to D. A. Zhdanov, has a length of 30-41 cm and begins from the confluence of the right and left lumbar trunks, truncus lumbales dexter et sinister. Usually described in textbooks as the third root of the thoracic duct, the truncus intestinalis is not common, sometimes it is paired and flows into either the left (more often) or the right lumbar trunk.

The level of the beginning of the thoracic duct varies between the XI thoracic and II lumbar vertebrae. At the beginning, the thoracic duct has an expansion, cisterna chyli. Having arisen in the abdominal cavity, the thoracic duct passes into the chest cavity through the aortic opening, where it fuses with the right leg of the diaphragm, which, through its contraction, promotes the movement of lymph along the duct. Having penetrated the chest cavity, the ductus thoracicus is directed upward in front of the spinal column, located to the right of the thoracic aorta, behind the esophagus and further behind the aortic arch.

Having reached the aortic arch, at the level of the V-III thoracic vertebrae, it begins to deviate to the left. At the level of the VII cervical vertebra, the thoracic duct enters the neck and, forming an arch, flows into the left internal jugular vein or into the angle of its connection with the left subclavian vein (angulus venosus sinister). The confluence of the thoracic duct from the inside is equipped with two well-developed folds that prevent blood from penetrating into it. The truncus bronchomediastinalis sinister flows into the upper part of the thoracic duct, collecting lymph from the walls and organs of the left half of the chest, truncus subclavius ​​sinister - from the left upper limb and truncus jugularis sinister - from the left half of the neck and head.

Thus, the thoracic duct collects about 3/4 of the total lymph, from almost the entire body, with the exception of the right half of the head and neck, the right arm, the right half of the chest and the cavity and lower lobe of the left lung. From these areas, lymph flows into the right lymphatic duct, which flows into the right subclavian vein. The thoracic duct and large lymphatic vessels are supplied with vasa vasorum. All lymphatic vessels have nerves in their walls - afferent and efferent.
Drainage of the thoracic duct is performed under local anesthesia. Indications: increasing endotoxemia caused by acute inflammatory diseases (destructive pancreatitis, cholecystitis, diffuse peritonitis), positional compression and prolonged crush syndromes, other types of tissue destruction, acute renal and acute hepatorenal failure. Operation technique: A horizontal (4-6 cm long) or better vertical skin incision is made above the left clavicle between the legs of the sternocleidomastoid muscle, which are bluntly separated. The space behind the middle fascia of the neck is infiltrated with a solution of novocaine and opened with a longitudinal incision along the vascular bundle. The fatty lump is bluntly prepared at the venous angle in the prescalene space, the internal jugular vein is pulled outward and the sternocleidomastoid muscle is retracted from the neurovascular bundle, providing access to the left venous angle posteriorly, where the thoracic duct often flows into it. Cannulation of the thoracic duct is performed in the area of ​​the ascending section of its arch using special techniques. The rate of lymphatic drainage from the drainage should be 0.5-1 ml/min, so people with low blood pressure, intravenous pressure and hyperproteemia need to undergo preliminary therapy.

Complications: damage to large veins of the neck, vagus nerve, formation of a temporary lymphatic fistula, coagulation of lymph during lymphosorption.

Topography of the cellular spaces of the retroperitoneal region. Peritoneal and extraperitoneal approaches to the organs of the retroperitoneal space. Ways of spread of purulent processes through cellular spaces.

The retroperitoneal space is located between the parietal peritoneum of the posterior abdominal wall and the intraperitoneal fascia, which, lining the muscles of the posterior abdominal wall, acquires their names. The layers of the retroperitoneal space begin from the intra-abdominal fascia.

1. The retroperitoneal tissue space in the form of a thick layer of fatty tissue stretches from the diaphragm to the iliac fascia. Dividing to the sides, the fiber passes into the preperitoneal fiber of the anterolateral abdominal wall. Medially behind the aorta and inferior vena cava it communicates with the same space on the opposite side. From below it communicates with the retrorectal cellular space of the pelvis. At the top it passes into the tissue of the subphrenic space and through the sternocostal triangle communicates with the prepleural tissue in the chest cavity. In the retroperitoneal cellular space there are the aorta with the abdominal aortic plexus, the inferior vena cava, lumbar lymph nodes, and the thoracic duct.

2. The renal fascia begins from the peritoneum at the site of its transition from the lateral to the posterior wall of the abdomen, at the outer edge of the kidney it is divided into posterior and anterior layers, limiting the perinephric tissue. Medially it is attached to the fascial sheath of the aorta and inferior vena cava.

3. Pericolic fiber is concentrated behind the ascending and descending colon. At the top it reaches the root of the mesentery of the transverse colon, at the bottom - the level of the cecum on the right and the root of the mesentery of the sigmoid colon on the left, outside it is limited by the attachment of the renal fascia to the peritoneum, medially it reaches the root of the mesentery of the small intestine, behind it is limited by the prerenal fascia, in front - by the peritoneum of the lateral canals and retrocolic fascia. The retrocolic fascia (Toldi) is formed as a result of fusion of the layer of the primary mesentery of the colon with the parietal layer of the primary peritoneum during rotation and fixation of the colon; in the form of a thin plate, it lies between the paracolic tissue and the ascending or descending colon, separating these formations.

Fedorov section begin at the intersection of the 12th rib and the erector spinae muscle, lead in an oblique transverse direction to the navel and end near the edge of the rectus abdominis muscle. After dissecting the skin and subcutaneous tissue, the broad muscles are divided layer by layer along the fibers and stretched in different directions. Then the transverse fascia is opened, and the peritoneum along with the tissue is pushed forward. A dense and shiny retrorenal fascia appears in the wound, which is incised and bluntly pulled apart, widening the hole. The kidney is walked around with a finger, peeling off the fatty capsule from the fibrous capsule and, checking for the presence of accessory arteries, it is brought out into the surgical wound.

Bergman-Israel section provides access to the kidney or ureter almost along its entire length. They start from the middle of the 12th rib, lead it obliquely downward and forward, not reaching 3 cm to the iliac crest. If necessary, the incision can be continued to the middle and medial third of the inguinal (pupart) ligament. After dissecting the skin and subcutaneous tissue, the latissimus dorsi muscle, external oblique muscle, posterior inferior serratus muscle and internal oblique muscle, transverse abdominis muscle and its fascia are dissected in layers. The peritoneum is pushed anteriorly, and the iliohypogastric nerve is pushed posteriorly. The fascial capsule of the kidney is cut, after which it is sequentially isolated from the perinephric fat body.

Pirogov section to access the ureter, it begins at the superior anterior iliac spine and is carried out 3 cm above the inguinal fold and parallel to it to the edge of the rectus muscle. At the same time, the peritoneum is pushed inward and upward. Near the lower corner of the incision, the inferior epigastric artery and vein are isolated and ligated. However, you need to keep in mind that the ureter is located on the posterior surface of the peritoneum and is tightly fused with it, so they exfoliate together. It should also be remembered that significant mobilization of the ureter from nearby tissues can lead to necrosis of its wall. The Pirogov incision allows you to expose the ureter to its peri-vesical section.

Hovnatanyan access- an arcuate, low-traumatic incision with a convexity downward, allowing one to expose the lower parts of both ureters simultaneously 1 cm above the pubic symphysis. During its execution, the skin, subcutaneous tissue, sheath of the rectus muscles are dissected, the rectus and pyramidal muscles are stretched in different directions. The peritoneum is retracted upward and medially. The ureters are searched near their intersection with the iliac vessels and mobilized to the bladder.

Thoracic duct, ductus thoracicus (Fig., see Fig.), collects lymph from both lower extremities, organs and walls of the pelvic and abdominal cavities, the left lung, the left half of the heart, the walls of the left half of the chest, from the left upper limb and the left half of the neck and head.

The thoracic duct is formed in the abdominal cavity at the level of the II lumbar vertebra from the fusion of three lymphatic vessels: left lumbar trunk and right lumbar trunk, truncus lumbalis sinister et truncus lumbalis dexter, And intestinal trunk, truncus intestinalis.

The left and right lumbar trunks collect lymph from the lower extremities, walls and organs of the pelvic cavity, abdominal wall, retroperitoneal organs, lumbar and sacral parts of the spinal column and the membranes of the spinal cord. The intestinal trunk collects lymph from the digestive organs of the abdominal cavity.

Both lumbar trunks and the intestinal trunk, when connected, sometimes form an expanded section of the thoracic duct - thoracic duct cistern, cisterna chyli. Often it may be absent, and then these three trunks flow directly into the thoracic duct. The level of education, shape and size of the thoracic duct tank, as well as the shape of the connection of these three ducts are individually variable.

The thoracic duct cistern is located on the anterior surface of the vertebral bodies from the II lumbar to the XI thoracic, between the crura of the diaphragm. The lower part of the cistern lies behind the aorta, the upper part along its right edge. It gradually narrows upward and continues directly into the thoracic duct. The latter, together with the aorta, passes through the aortic opening of the diaphragm into the chest cavity.

In the chest cavity, the thoracic duct is located in the posterior mediastinum along the right edge of the aorta, between it and v. azygos, on the anterior surface of the vertebral bodies. Here the thoracic duct crosses the anterior surface of the right intercostal arteries, being covered in front by the parietal pleura.

Heading upward, the thoracic duct deviates to the left, goes behind the esophagus and at the level of the III thoracic vertebra is to the left of it and thus follows to the level of the VII cervical vertebra. Then the thoracic duct turns forward, goes around the left dome of the pleura, passes between the left common carotid artery and the left subclavian artery and flows into the left venous angle - the confluence of v. jugularis and v. subclavia sinistra.

In the chest cavity at the level of the VII-VIII vertebra, the thoracic duct can split into two or more trunks, which are then reconnected. The end section may also split if the thoracic duct flows into the venous angle with several branches. In the chest cavity, the ductus thoracicus contains small intercostal lymphatic vessels, as well as a large left bronchomediastinal trunk, truncus bronchomediastinalis sinister, from organs located in the left half of the chest: the left lung, the left half of the heart, the esophagus and trachea - and from the thyroid gland.

At the point where it enters the left venous angle, the ductus thoracicus receives two more large lymphatic vessels: 1) left subclavian trunk, truncus subclavius ​​sinister, collecting lymph from the left upper limb; 2) left jugular trunk, truncus jugularis sinister, – from the left half of the head and neck.

The length of the thoracic duct is 35-45 cm. The diameter of its lumen is not the same everywhere: in addition to the initial expansion - the cistern, it has a slightly smaller expansion in the terminal section, near the confluence with the venous angle.

Along the duct there are a large number of lymph nodes. The movement of lymph along the duct is carried out, on the one hand, as a result of the suction effect of negative pressure in the chest cavity and in large venous vessels, on the other hand, due to the pressor action of the legs of the diaphragm and the presence of valves. The latter are located throughout the thoracic duct. There are especially many valves in its upper section. The valves are located in the area where the duct enters the left venous angle and prevent the reverse flow of lymph and the entry of blood from the veins into the thoracic duct.

There are 3 types of blood vessels in the human body. Each of them performs vital functions. These include arteries, veins and lymphatic vessels. All these formations are located throughout the body. Lymphatic and venous vessels collect fluid from each anatomical structure. As blockage develops, significant disruptions occur. Therefore, it is important that the outflow of biological fluid is constantly carried out.

Thoracic lymphatic duct - what kind of organ is it?

As you know, lymphatic formations are classified as organs of the immune system. It is very important, because the ability to fight various infectious agents depends on its work. One of the largest organs of this system is the thoracic lymphatic duct. Its length ranges from 30 to 40 cm. The main purpose of this organ is to collect lymph from all anatomical structures.
The histological structure of the thoracic duct resembles venous tissue. Its inner surface is lined with endothelium (like other vessels). The fabric also contains elastic and collagen fibers. There are valves in the inner lining of the duct. With their help, lymph moves upward. The middle layer of the thoracic duct is composed of smooth muscle tissue. In this way, the tone is maintained and the organ contracts. On the outside, the duct consists of connective tissue fibers. At the level of the diaphragm, the wall of the organ thickens.

Structure of the lymphatic system

The lymphatic system plays an important role in the body. It is necessary to protect against harmful substances. The thoracic lymphatic duct, as well as vessels and nodes, belong to the organs of the immune system. Therefore, with the development of inflammation, these formations begin to work in an accelerated rhythm. In addition, the lymphatic organs are closely related to the cardiovascular system. Thanks to them, useful substances enter the blood. This system is represented by the following bodies:

All these formations are interconnected. If one of the links of the lymphatic system is damaged, the disturbances affect its other components. As a result, disturbances occur throughout the body.

The course of the thoracic lymphatic duct: anatomy

The left and right lumbar lymphatic trunk take part in the formation of the thoracic duct. That is, the organ is formed in the retroperitoneal space. Where does the thoracic lymphatic duct begin and where does it drain? The right and left trunks merge with each other at the level between the last (12) thoracic and 2nd lumbar vertebrae. In some people, 1-3 more vessels flow into the thoracic duct. These are intestinal trunks that carry lymph from the mesenteric nodes. At the level of the diaphragm, the duct is divided into 2 parts - abdominal and thoracic. The first is formed by a network of mesenteric, lumbar and celiac lymph nodes. In most cases, in the abdominal part of the duct there is a cone-shaped (ampulla-shaped extension - a cistern. This anatomical formation connects to the right leg of the diaphragm. Due to this, during breathing, lymph is pushed upward. The thoracic part of the duct begins at the level of the aortic opening located in the diaphragm. Reaching 3-5 vertebrae , the vessel deviates to the left. Along the duct, the bronchomediastinal, jugular and subclavian lymphatic trunks flow into it. They collect fluid from the left arm, half of the chest, neck and head. At the level of the 7th vertebra, the vessel forms an arch. After which the thoracic lymphatic duct flows into the left venous angle. There is a valve at the mouth of the vessel. It is necessary to prevent the reflux of blood from the venous system.

Location of the lymphatic thoracic duct

The topography of the thoracic lymphatic duct is the location of this organ in relation to other anatomical formations. The abdominal part of this large vessel is located behind the esophagus and in front of the spinal column. Penetrating into the chest cavity, the duct enters the posterior mediastinum. There it is located between the aorta and azygos vein. At the level of the 2-3 thoracic vertebrae, the duct emerges from under the esophagus and rises higher.
Anterior to it are the left subclavian vein, the common carotid artery and the vagus nerve. Thus, the organ ends up in the upper mediastinum. To the left of the strait is the pleura, behind is the spine, and to the right is the esophagus. The arc of the thoracic duct is formed at the level of the vessels - the jugular vein and the common carotid artery. It goes around the pleural dome and then passes into the mouth. There the organ flows into the left venous angle.

Functions of the thoracic lymphatic duct

The thoracic duct performs the following functions:

It is worth noting that the thoracic duct cannot act independently. Its functions are carried out with the coordinated work of all parts of the immune system.

Location of lymphatic vessels in the body

Based on how the anatomy of the thoracic lymphatic duct is arranged, you can understand where the vessels are located. They are located throughout the body. The choroid plexuses arise from all anatomical structures. Then they go along the veins and arteries. Near each organ there are groups of lymph nodes. Their biological fluid is enriched with immune cells. The nodes form efferent vessels that flow into the lymphatic trunks. In turn, these formations merge into the right and thoracic ducts. Next, the connection of lymphatic and blood vessels occurs.

Lesions of the thoracic duct: symptoms

Depending on the level of damage to the lymphatic duct, various clinical manifestations may be observed. This organ belongs to a large anatomical formation, therefore, in case of injury to this vessel, urgent surgical assistance is required. Damage also means blockage of the duct or inflammation of the wall. The following symptoms may occur:

Diseases of lymphatic vessels and nodes: diagnosis

With inflammatory diseases of the lymphatic vessels and nodes, they increase in size. In this case, hyperemia and a local increase in temperature may be observed. The nodes become denser, and unpleasant sensations are noted on palpation. If oncological processes in the lymphatic organs are suspected, a biopsy and histological analysis are performed. Diagnostic procedures also include ultrasound and computed tomography.

Which doctor should I contact if I suspect thoracic duct disease?

If you experience frequent inflammatory diseases of the respiratory tract, skin, muscles and intercostal nerves, you should consult a doctor. Thoracic duct pathology can be diagnosed using a special lymphography study. If you suspect inflammation or an oncological process, you should consult a general practitioner, who will refer you to a specialized doctor (immunologist, oncologist, physiotherapist).