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Lymphatics


Lymphatic system

Phase 1 images are taken on day one and best show the vessels whereas phase 2 are taken at about 48 hours and best image the lymph nodes.

Lymphatic system – methylene blue test

A

Thymus

  • lying in the superior and anterior mediastinum as seen through a split-sternal approach

The palatine tonsils (commonly referred to as ‘the tonsils’) are masses of lymphoid tissue that are frequently enlarged in childhood but become much reduced in size in later life. Together with the lymphoid tissue in the posterior part of the tongue (lingual tonsil) and in the posterior wall of the nasopharynx (pharyngeal tonsil) and the tubal tonsil they form a protective ‘ring’ of lymphoid tissue (Waldeyer's ring) at the upper end of the respiratory and alimentary tracts.

B

Chest radiograph of a child

Child's thymus can normally be seen under the age of 2 on a plain chest radiograph, appearing as a spinnaker sail (sail sign), as outlined by the interrupted line.

C

Palatine tonsils

The pits on the medial surfaces of these operation specimens from a child aged 14 years are the openings of the tonsillar crypts. The arrows indicate the intratonsillar clefts (the remains of the embryonic second pharyngeal pouch). These palatine tonsils are easily seen at the back of the opened mouth in the pharyngeal arches each side of the uvula.

  • 1

    Brachiocephalic trunk (artery)

  • 2

    Inferior thyroid vein

  • 3

    Internal thoracic vein, right

  • 4

    Left brachiocephalic vein

  • 5

    Left common carotid artery

  • 6

    Lung, upper lobe right

  • 7

    Pectoralis major

  • 8

    Pericardium, fibrous

  • 9

    Pleura

  • 10

    Pleura (cut edge of left sac)

  • 11

    Pleura (cut edge of right sac)

  • 12

    Pleural cavity

  • 13

    Right brachiocephalic vein

  • 14

    Superior vena cava

  • 15

    Thymic vein draining into internal thoracic vein

  • 16

    Thymus gland (bilobed)

  • 17

    Trachea

Thymus

Tonsillitis

A

Neck dissection

  • termination of the thoracic duct into the left subclavian vein in the root of neck – as seen from left side

  • 1

    Ascending cervical artery and vein

  • 2

    Cervical lymphatic trunk

  • 3

    Clavicle (left)

  • 4

    Common carotid artery

  • 5

    Dorsal scapular artery

  • 6

    Inferior thyroid artery

  • 7

    Internal jugular vein

  • 8

    Lymph nodes, deep cervical chain

  • 9

    Lymph vessel from node to cervical trunk

  • 10

    Muscular arterial branches to longus colli

  • 11

    Prevertebral fascia

  • 12

    Scalenus anterior

  • 13

    Sternocleidomastoid (reflected and pinned)

  • 14

    Subclavian vein

  • 15

    Superficial cervical artery

  • 16

    Supraclavicular node (Virchow – enlarged)

  • 17

    Suprascapular artery

  • 18

    Thoraco-acromial artery, clavicular branch

  • 19

    Thoracic duct

  • 20

    Thoracic duct, termination

  • 21

    Thoracic duct, ampulla

  • 22

    Tracheostomy site (midline)

  • 23

    Transverse cervical artery

  • 24

    Vagus nerve

  • 25

    Vertebral vein

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