The Thoracic and Abdominal Lymphatics - Studies

lymphatic mapping, Fluorescence lymphography, lymphatic alterations, lymphatic vessel abnormalities, clinical trials, lymphatic capillary regeneration, orbital lymphatics, lymph fluid physiology, lymph fluid, cutaneous periarteritis nodosa, lymph detox, Lymphatic Vessel Hyperplasia, puffy hand syndrome, lymphatic valves, lymph flow, lymphedema roadshow, Thoracic lymphatics, Abdominal Lymphatics

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The Thoracic and Abdominal Lymphatics - Studies

Postby patoco » Sat Jul 14, 2007 1:49 pm

Lymphatic drainage between thorax and abdomen: please take good care of this well-performing machinery...

Acta Clin Belg Suppl. 2007

ZiekenhuisNetwerk Antwerpen, Campus Stuivenberg, Intensive Care Unit, Antwerp, Belgium. manu.malbrain@skynet.be

INTRODUCTION: Patients with sepsis often receive large amounts of fluids and the presence of capillary leak, trauma or bleeding results in ongoing fluid resuscitation. This increases interstitial and intestinal edema and finally leads to intra-abdominal hypertension (IAH), which in turn impedes lymphatic drainage. Patients with IAH often develop secondary respiratory failure needing mechanical ventilation with high intrathoracic pressure or PEEP that might further alter lymphatic drainage. This review will try to convince the reader of the importance of the lymphatics in septic patients with IAH.

METHODS: A Medline and PubMed literature search was performed using the terms "abdominal pressure", "lymphatic drainage" and "ascites formation".The references from these studies were searched for relevant articles that may have been missed in the primary search. These articles served as the basis for the recommendations below.

RESULTS: Induction of sepsis with lesion of the capillary alveolar barrier results in an increased water gradient between the capillaries and the interstitium in the lungs. The drainage flow to the thoracic duct is initially increased in order to protect the Lung and maintain the pulmonary interstitium as dry as possible, however this results in increased intrathoracic pressure. Sepsis also increases the permeability of the capillaries in the splanchnic beds. In analogy to the lungs the lymphatic flow in the splanchnic areas increases together with the pressure inside as a physiological response in order to limit the increase in IAP. At a critical IAP level (around 20 cmH2O) the lymph flow starts to decrease and the splanchnic water content progressively increases.The lymph flow from the abdomen to the thorax is progressively decreased resulting in increased splanchnic water content and ascites formation. The presence of mechanical ventilation with high PEEP reduces the lymph drainage further which together with the increase in IAP decreases the lymphatic pressure gradient in the splanchnic regions, with a further increase in water content and IAP triggering a vicious cycle.

CONCLUSION: Although often overlooked the role of lymphatic flow is complex but very important to determine not only the fluid balance in the lung but also in the peripheral organs. Different pathologies and treatments can markedly influence the pathophysiology of the lymphatics with dramatic effects on endorgan function.

PMID: 17469714 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum

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Lymphatic drainage of the peritoneal space: a pattern dependent on bowel lymphatics.

Parungo CP, Soybel DI, Colson YL, Kim SW, Ohnishi S, DeGrand AM, Laurence RG, Soltesz EG, Chen FY, Cohn LH, Bawendi MG, Frangioni JV.
Department of Surgery, Brigham & Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA.

John V. Frangioni
Email: jfrangio@bidmc.harvard.edu

Dr. Parungo was the recipient of an award at the SSO meeting.

Keywords: Peritoneal space - Lymph node - Lymphatic drainage - Near-infrared fluorescence - Carcinomatosis - Metastasis

BACKGROUND: Understanding lymph drainage patterns of the peritoneum could assist in staging and treatment of gastrointestinal and ovarian malignancies. Sentinel lymph nodes (SLNs) have been identified for solid organs and the pleural space. Our purpose was to determine whether the peritoneal space has a predictable lymph node drainage pattern.

METHODS: Rats received intraperitoneal injections of near-infrared (NIR) fluorescent tracers: namely, quantum dots (designed for retention in SLNs) or human serum albumin conjugated with IRDye800 (HSA800; designed for lymphatic flow beyond the SLN). A custom imaging system detected NIR fluorescence at 10 and 20 minutes and 1, 4, and 24 hours after injection. To determine the contribution of viscera to peritoneal lymphatic flow, additional cohorts received bowel resection before NIR tracer injection. Associations with appropriate controls were assessed with the chi(2) test.

RESULTS: Quantum dots drained to the celiac, superior mesenteric, and periportal lymph node groups. HSA800 drained to these same groups at early time points but continued flowing to the mediastinal lymph nodes via the thoracic duct. After bowel resection, both tracers were found in the thoracic, not abdominal, lymph node groups. Additionally, HSA800 was no longer found in the thoracic duct but in the anterior chest wall and diaphragmatic lymphatics.

CONCLUSIONS: The peritoneal space drains to the celiac, superior mesenteric, and periportal lymph node groups first. Lymph continues via the thoracic duct to the mediastinal lymph nodes. Bowel lymphatics are a key determinant of peritoneal lymph flow, because bowel resection shifts lymph flow directly to the intrathoracic lymph nodes via chest wall lymphatics.

http://www.springerlink.com/content/eg4h8k5153720420/

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Lymphatic drainage of the diaphragmatic pleura to the peritracheobronchial lymph nodes.

Surg Radiol Anat. 2003 Apr

Okiemy G, Foucault C, Avisse C, Hidden G, Riquet M.
Laboratoire d'Anatomie, UFR de Médecine, Reims, France.

Keywords:
Diaphragm, Pleural lymphatics, Mediastinum, Lymph node, Lung cancer

Non-small cell lung cancer invading the visceral pleura is characterized by a particular richness of mediastinal lymph node (LN) metastases. This may be due to subpleural lymphatic drainage of tumor cells. The aim of this study was to determine mediastinal LN lymphatic drainage from the diaphragmatic pleura. Subpleural lymphatics of 30 adult cadavers and 12 fetuses were injected with a modified Gerota's medium to permit lymph vessels and nodes to be visualized and then dissected. Each stage of the dissection was described and photographed. I

n 32 cadavers mediastinal visceral LN chains were injected, of which 29 originated from the mediolateral portion of the diaphragm. On the right, injections (n=16) demonstrated lymph vessels (n=20) ascending directly along the inferior pulmonary ligaments (n=8) or after having encircled the inferior vena cava (n=8), and lymph vessels passing between the pulmonary veins (n=4); all these lymphatics were connected to the intertracheobronchial nodes and some ascended along the tracheobronchial LN chains in the upper mediastinum.

On the left, injections (n=13) demonstrated lymph vessels (n=16) ascending along the inferior pulmonary ligament (n=5) or along the esophagus (n=11) and connecting to the intertracheobronchial nodes, some of which ascended further in the upper mediastinum (left paratracheobronchial LN chain). These mediastinal LN chains are the same as those that receive lymph from the pulmonary segments.

Lymphatic drainage of the diaphragmatic pleura may add to that of the lung involved in cancer and potentially increases lymphatic spread of tumor cells.

http://www.springerlink.com/content/fyhck5hfw5ekuh5h/

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Renal lymphatic drainage and thoracic duct connections: implications for cancer spread.

Lymphology. 2006 Mar

Assouad J, Riquet M, Foucault C, Hidden G, Delmas V.
Service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou, and Institut d'Anatomie, Biomédicale des Saints-Pères, Paris, France.

Studies on renal lymph drainage have generally described lymph nodes without further investigation of the lymph vessels. Our purpose was to revisit this organ to study the vessel drainage pattern. This investigation was performed on 16 refrigerated adult cadavers. After both kidneys were injected with a blue modified Gerota mass, lymph vessels were dissected until their termination. From the right kidneys (n = 13), lymphatics (n = 8) traveling on the anterior aspect of the inferior vena cava were dissected, reaching interaortocaval and more distant nodes, aorta bifurcation (n = 1) and left lateroaortic (n = 1); posterior lymphatics were observed in all subjects, uniformly connecting to the thoracic duct, either after crossing nodes (n = 8) or directly (n = 5). From the left kidneys (n = 13), anterior efferents (n = 16) were dissected, reaching left lateroaortic and also celiac (n = 4) and iliac (n = 1) nodes; posterior lymphatics were also demonstrated, always connecting to the thoracic duct (3 directly). Renal lymphatics have been found to reach very distant nodes as well as always connecting to the origin of the thoracic duct. This feature suggests an important role in both the formation of the thoracic duct and in the spread of renal cancer.

PMID: 16724507 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/sites/entre ... stractPlus

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Role of the lymphatics of the diaphragm in the absorption of intraperitoneal liquids

Morphologie. 2001 Mar

Cheynel N, Valleix D, Durand-Fontanier S, Mabit C, Descottes B.
Laboratoire d'Anatomie, Faculté de Médecine, 2, rue du Docteur Marcland, 87025 Limoges, France.

The diaphragm is the major site of the lymphatic absorption of the intra peritoneal liquids. Known since the middle of the last century, this lymphatic network is at present studied under transmission electron microscopy. The stomata which are intercellular sluices between adjacent mesothelial cells, are the entry of the diaphragmatic network. These stomata open into the lacunae which are dilatations the diaphragmatic subserous lymphatic network. The architecture of these structures explains their one-way character from the abdomen to the thorax and the role of the respiratory movements. This network collects the fluids into the trans diaphragmatic lymphatics. Pleural effusion appears when the quantity of liquids in the diaphragmatic lymphatic network exceeds the capacities of drainage of the lymphatic efferents, thus explaining the reactional pleural effusion caused by underdiaphragmatic inflammatory processes.

PMID: 11434113 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum

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Regional recruitment of rat diaphragmatic lymphatics in response to increased pleural or peritoneal fluid load

J Physiol. 2007 Mar

Moriondo A, Grimaldi A, Sciacca L, Guidali ML, Marcozzi C, Negrini D.
Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Università degli Studi dell'Insubria, Via J.H. Dunant 5, 21100 Varese, Italy.

Corresponding author D. Negrini: Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Università degli Studi dell'Insubria, Via J.H. Dunant 5, 21100 Varese, Italy.Email: daniela.negrini@uninsubria.it

The specific role of the diaphragmatic tendinous and muscular tissues in sustaining lymph formation and propulsion in the diaphragm was studied in 24 anaesthetized spontaneously breathing supine rats. Three experimental protocols were used: (a) control; (b) peritoneal ascitis, induced through an intraperitoneal injection of 100 ml kg(-1) of iso-oncotic saline; and (c) pleural effusion, induced through an intrapleural injection of 6.6 ml kg(-1) saline solution. A group of animals (n = 12) was instrumented to measure the hydraulic transdiaphragmatic pressure gradient between the pleural and peritoneal cavities in the three protocols. In the other group (n = 12), the injected iso-oncotic saline was enriched with 2% fluorescent dextrans (molecular mass = 70 kDa); at 30 min from the injections these animals were suppressed and their diaphragm excised and processed for confocal microscopy analysis. In control conditions, in spite of a favourable peritoneal-to-pleural pressure gradient, the majority of the tracer absorbed into the diaphragmatic lymphatic system converges towards the deeper collecting lymphatic ducts. This suggests that diaphragmatic lymph formation mostly depends upon pressure gradients developing between the serosal cavities and the lymphatic vessel lumen. In addition, the tracer distributes to lymph vessels located in the muscular diaphragmatic tissue, suggesting that active muscle contraction, rather than passive tendon stretch, more efficiently enhances local diaphragmatic lymph flow. Vice versa, a prevailing recruitment of the lymphatics of the tendinous diaphragmatic regions was observed in peritoneal ascitis and pleural effusion, suggesting a functional adaptation of the diaphragmatic network to increased draining requirements.

http://jp.physoc.org/cgi/content/abstract/579/3/835

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Mediastinal lymphatic efferents from the diaphragm.

Souilamas R, Hidden G, Riquet M.
Service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou, 20 rue Leblanc, F-75015 Paris, France.

The prognosis of non small cell lung cancer (NSCLC) invading the diaphragm is poor, probably due to the richness of the lymphatic drainage of the diaphragm. The aim of this study was to determine mediastinal lymphatic efferents from the diaphragm. The diaphragms of 20 adult cadavers (77-104 years) were injected with a dye (modified Gerota's medium) to permit the lymph vessels to be catheterised and then dissected. Each stage of the dissection was described and photographed: 23 injections on the right and 25 on the left. Diaphragmatic lymph vessels passed to one of three lymph centres: posterior (paraaortic nodes, n = 16), anterior (juxtasternal nodes, n = 16) and mediastinal (visceral nodes, n = 16). From these lymph centres arose ascending lymph pathways: posteriorly to the thoracic duct (8/16), anteriorly along the internal thoracic vessels (10/16) and in the mediastinum to the peritracheobronchial nodes (6/10). Lymphatics from the diaphragm are abundant and drain towards mediastinal node lymph centres connecting to the blood stream via the thoracic duct. These lymph pathways are common with those of the pulmonary segments. Poor prognosis of NSCLC invading the diaphragm may be explained by the common lymphatic drainage of both the lung and diaphragm.

PMID: 11490925 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/sites/entre ... stractPlus

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Anomalies of thoracic lymph duct drainage demonstrated by lymphoscintigraphy and review of the literature about these anomalies.

Eur J Surg Oncol. 2007 Jun

Bourgeois P, Munck D, Sales F.
Service of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles (ULB), 121 Bd de Waterloo, B-1000 Brussels, Belgium.

Keywords: Lymphoscintigraphy; Thoracic duct; Chylous effusion; Axillary nodes; Intrathoracic nodes; Lower limb; Axillary chylorrhea; Axillary node dissection; Melanoma; Breast

AIMS: To determine the frequency of supradiaphragmatic lymph nodes that receive lymph from the lower limbs and the intraabdominal organs.

METHODS: Three hundred and thirty-four bipedal lymphoscintigraphy results of the lower limbs were reviewed.

RESULTS: Lymph nodes were visualized in only the supraclavicular/retroclavicular (SRC) area in 113 cases (33.2%, 109 on the left and 4 on the right), in only the mediastinum in 5 cases (1.5%), in the mediastinum and the left SRC area in 18 cases (5.5%), in the mediastinum and right SRC area in 2 cases (0.6%), in the mediastinum and both SRC areas in 6 cases (1.8%), and in the mediastinum and as 1 chain draining in the left axilla in 2 cases (0.6%).

CONCLUSIONS: Supradiaphragmatic lymph nodes associated with the thoracic duct and receiving lymph and/or chyle from the infradiaphragmatic body were demonstrated in 43.2% of our patients and in 11.1% of the cases these lymph nodes were not located in the left retroclavicular area. These data should be taken in mind by surgeons when confronting an intrathoracic and even extrathoracic supradiaphragmatic chylous effusion after surgeries which imply lymph nodes and/or lymphatic vessels.

http://www.sciencedirect.com/science?_o ... c13b05f3be

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Thoracic duct tributaries from intrathoracic organs.

Ann Thorac Surg. 2002 Mar

Riquet M, Le Pimpec Barthes F, Souilamas R, Hidden G.
Service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou and Institut d'Anatomie, UER Biomédicale des Saints Pères, Paris, France. marc.riquet@hop.egp.ap-hop-paris.fr

BACKGROUND: The thoracic duct (TD) is the main collecting vessel of the lymphatic system. Little is known about the intrathoracic tributaries of the TD, which are named intercostal, mediastinal, and bronchomediastinal trunks. The purpose of the study was to identify the lymphatic tributaries from intrathoracic organs to the thoracic duct.

METHODS: The study was performed on 530 adult cadavers. The lymphatics of different organs were catheterized and injected with a dye: lungs (n = 360), heart (n = 90), esophagus (n = 50), and diaphragm (n = 30). The lymphatic tributaries draining the lymph from these organs to the thoracic duct were dissected along their course to the thoracic duct and classified.

RESULTS: The TD tributaries were observed in 147 cases: right lung (n = 46), left lung (n = 69), heart (n = 8), esophagus (n = 13), and diaphragm (n = 11). Connections with the TD were observed at its origin (n = 13), within the mediastinum (n = 87), and at the level of the TD arch (n = 47). Tributaries from the lung issued from lower paratracheal nodes 4 R (n = 14) and 4 L (n = 31), subaortic 5 (n = 4), subcarinal 7 (n = 18), pulmonary ligament 9 (n = 7), upper tracheal 2 L (n = 28), paraortic 6 (n = 11), and celiac nodes (n = 2). Tributaries from the heart connected with the TD in the mediastinum in 1 case (4 L) and with the TD arch in 7 cases. Tributaries from the esophagus connected with the thoracic duct within the mediastinum in 13 cases; anodal routes were frequent (n = 5). The TD tributaries from the diaphragm were observed in 11 cases, always connecting with the TD at its origin.

CONCLUSIONS: Injection of intrathoracic organs permits visualization of TD tributaries. These tributaries appear located at unchanging levels. Lymph of intrathoracic organs may thus drain into the general circulation through the TD. The tributaries may represent a potential route for tumor cells dissemination. When incompetent, due to valve insufficiency, they permit chylous lymph to backflow into the intrathoracic lymph nodes. Injury at this level may lead to intrathoracic chylous effusions.

PMID: 11899197 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/sites/entre ... stractPlus

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Submucosal territory of the direct lymphatic drainage system to the thoracic duct in the human esophagus.

J Thorac Cardiovasc Surg. 2003 Jun

Kuge K, Murakami G, Mizobuchi S, Hata Y, Aikou T, Sasaguri S.
Department of Surgery II, Kochi Medical School, Kochi, Japan.

OBJECTIVE: To investigate how large submucosal drainage territory extends in lymphatic drainage vessels of the esophagus with and without nodal delay and which morphologies are shown when passing through the muscularis propria.

METHODS: Submucosal territories of the 22 highly selected direct drainage vessels of 17 esophagi were histologically examined using transverse or sagittal serial sections. Afferent vessels from the esophagus to the subcarinal (6 esophagi) and para-esophageal (5 esophagi) nodes were also examined to identify their courses and drainage territories.

RESULTS: We found the direct drainage vessel from the esophagus in 17 of 75 cadavers macroscopically (22.7%). A single submucosal drainage unit gave off 1-3 thick drainage vessels passing through a complete muscle gap of the 2 muscular layers. The unit extended longitudinally for >40 mm but was restricted to the right and/or dorsal quadrants of the esophagus. In contrast, drainage routes with a nodal relay originated from the intermuscular area, except 1 case when the adjacent or concomitant esophageal artery and vein provided the complete muscle gap.

CONCLUSIONS: Due to the extended longitudinal but restricted transverse territory of the direct drainage system without a nodal relay and because of the suggested much more frequent occurrence in patients than in cadavers, when superficial carcinoma is found in the dorsal and/or right quadrants of the esophagus, we recommend detailed presurgical investigations of cervical nodes. In contrast, afferents from the esophagus to the first regional node usually seemed to be less responsible for early nodal metastasis than the direct drainage route because of their intermuscular origins.

http://www.journals.elsevierhealth.com/ ... 9/abstract

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Last-intercalated node and direct lymphatic drainage into the thoracic duct from the thoracoabdominal viscera.

Jpn J Thorac Cardiovasc Surg. 2002 Mar

Murakami G, Abe M, Abe T.
Department of Anatomy, Sapporo Medical University School of Medicine, South-1, West-17, Sapporo 060-8556 Japan.

OBJECTIVE: We clarified the configuration of the mediastinal lymphatics, focusing on the last intercalated lymph node and the direct drainage vessel to the thoracic duct, based on recent anatomical findings.

METHODS: We macroscopically observed the lymphatics during dissections of 205 cadavers in combination with routine histology. We also review the results of injection by other researchers.

RESULTS: Efferent vessels draining directly into the thoracic duct or venous angle were frequently found in the following node groups: the right paratracheal node group corresponding to the last intercalated node in 98% of cadavers (201); the brachiocephalic angle node group in 85% of cadavers (174); the right recurrent nerve group in 46% (94); the left superior phrenic node group in 73% (150); the node group at the origin of the left common carotid artery (the preaortico-carotid node) in 37% (76); the pretracheal node group in 25% (51) and the left tracheobronchial node group in 36% (74). Last intercalated nodes appeared common for multiple drainage routes or regional lymphatics. These results were mostly consistent with injection studies by Riquet et al. Direct lymphatic drainage from the esophagus to the thoracic duct was observed in 19% of cadavers (39). Direct lymphatic drainage of lung segments to distant mediastinal nodes is also reviewed. The sentinel node concept is discussed in relation to the above observations.

CONCLUSIONS: We hypothesize that the most critical sentinel node, if such usage is allowed, is situated as a guard for a limited specific route and for a common drainage route. We term it the "common terminal node".

http://www.ncbi.nlm.nih.gov/sites/entre ... stractPlus

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Lymphatics of the thoracic surface of the diaphragm especially located around the inferior surface of the pericardial sac

Kaibogaku Zasshi. 1995 Feb

Shimada K, Fujii M, Sato H, Tanaka T, Murakami G, Goto N.
Department of Anatomy, Showa University School of Medicine, Tokyo, Japan.

The lymphatics on the thoracic surface of the diaphragm, especially lying around the lateral and posterior sides of the base of the cardiac sac, were examined in 68 adult Japanese cadavers macroscopically (37 males and 24 females, aged 45-92 years, no clinical evidences of neoplasms). In this observation, a vein which drained into the terminal portion of the inferior vena cava was observed. The lymph nodes in this region were located along the vein frequently (80.9%). The vein passed through the esophageal hiatus, or penetrated the diaphragm and finally communicated with veins around the esophagogastric junction. However, lymphatic vessels were not observed passing through the phrenico-esophageal membrane and/or the diaphragm. The collecting vessels, which originated from the lymphatics, drained into the esophageal lymphatics, and it drained into the thoracic duct via the esophageal lymphatics. In pleural effusion cases, lymphatic nets were clearly observed on the thoracic surface of the diaphragm immediately under the parietal pleura. The lymphatic nets did not communicate with the diaphragmatic lymphatics around the base of the cardiac sac. Moreover, large collecting vessel from the lymphatic nets passed through the muscular crus of the diaphragm near the medial arcuate ligament and traveled inferior to merge at the original portion of the thoracic duct at the level of the renal vessels. From these observations, the lymphatics on the posterior part of the thoracic surface of the diaphragm communicated with several regional lymphatics independently. This morphological lymphatic traveling suggests that the route differs in cases of pleural effusion or cancer metastasis.

PMID: 7785406 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/sites/entre ... stractPlus

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The time course of lymphatic routes emanating from the peritoneal cavity in rats.

Anat Histol Embryol. 2007 Feb

Shibata S, Yamaguchi S, Kaseda M, Ichihara N, Hayakawa T, Asari M.
First Department of Anatomy, Azabu University School of Veterinary Medicine, Fuchinobe 1-17-71, Sagamihara, Kanagawa 229-8501, Japan.

Japan; 2First Department of Anatomy, The Jikei University School of Medicine, Nishi-shinbashi 3-25-8, Minato-ku, Tokyo 105-8461, Japan; *Corresponding author: Tel.: 042 850 2470; fax: 042 850 2470; e-mail: asari@azabu-u.ac.jp

The lymph drainage routes from the abdominal cavity in rats were observed at 3 min, 1, 2 and 4 h after India ink was administered intraperitoneally. Four systems of lymph drainage routes from the peritoneal cavity were observed. Three minutes after injection, the drainage route travelled via the intrathoracic lymph vessels located along the internal thoracic artery and returned to the anterior mediastinal lymph nodes.

One hour after injection, the drainage route travelled via the lymph vessel located along the left phrenic nerve in addition to the drainage route observed at 3 min.

Two and four hours after injection, in addition to the above-mentioned routes, the drainage that had travelled via the thoracic duct continued along the right side of the aorta and was also observed in the lateral lymph vessel located on the vertebra.

These findings suggest that lymph or cells absorbed into the peritoneal cavity at first travel towards the anterior mediastinal lymph nodes in the thorax via the ventral lymphatic channels, and then gradually course through the dorsal lymphatic channels. These routes may serve as a route for transporting cancer cells and other cells from the peritoneal cavity.

http://www.blackwell-synergy.com/doi/ab ... 06.00742.x

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The time course of lymph drainage from the peritoneal cavity in beagle dogs

J Vet Med Sci. 2006 Nov

Shibata SJ, Hiramatsu Y, Kaseda M, Chosa M, Ichihara N, Amasaki H, Hayakawa T, Asari M.
Laboratory of Anatomy 1st, School of Veterinary Medicine, Azabu University, Kanagawa, Japan.

KEY WORDS: beagle dog, lymph drainage, peritoneal cavity

Lymph drainage routes from the abdominal and pelvic cavities in beagle dogs were observed serially by following the time course of India ink administered intraperitoneally. Four systems of lymph drainage routes from the peritoneal cavity were observed in this study. The earliest drainage returned to the cranial mediastinal lymph nodes via the sternal lymph vessels; subsequently, the sternal lymph nodes located along the internal thoracic artery became involved. Then, a drainage route via the lymph vessel along the left vagus nerve was observed. The final drainage route flowed into the lateral lymph vessel through the thoracic duct located on the vertebra. These results show that India ink is absorbed from the peritoneal cavity, and that the lymph drainage first flows mainly towards the cranial mediastinal lymph nodes through the ventral lymphatic channels. Our serial observations suggest that, over time, the lymph drainage routes changed from the ventral abdominal to the dorsal thoracic lymphatic channels in the thorax.

http://www.jstage.jst.go.jp/article/jvm ... 3/_article

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Lymphatic drainage of the peritoneal cavity in sheep.

Am J Physiol. 1991 Mar

N. J. Abernethy, W. Chin, J. B. Hay, H. Rodela, D. Oreopoulos and M. G. Johnston
Department of Pathology, University of Toronto, Ontario, Canada.

Lymphatic drainage of the peritoneal cavity has been investigated in anesthetized sheep. Studies involving intraperitoneal administration of a complex of Evans blue dye and bovine serum albumin demonstrated the existence of three anatomically distinct pathways. In the first pathway, dye is removed from the peritoneal cavity by diaphragmatic lymphatics that pass into caudal sternal lymph nodes. Efferent lymphatics from these nodes transport the material to cranial sternal lymph nodes. Efferent cranial sternal lymphatics then convey the material either directly or indirectly, via tracheal lymphatic trunks, to the right lymph duct. In the second pathway, the complex is transported from the peritoneal cavity by diaphragmatic lymphatics that pass into the caudal mediastinal lymph node. Efferent lymphatic ducts from this node transport the material to the thoracic duct. The third pathway appears to involve transport of the dye across the mesothelial lining of the abdominal viscera and removal from the interstitium by afferent visceral lymphatics. Material taken up in this manner is ultimately transported to the thoracic duct by efferent visceral lymphatics. Experiments involving measurements of lymphatic absorption of 125I-labeled human serum albumin from the peritoneal cavity indicated that, over the 6-h period studied, 4.55 +/- 1.20 and 1.43 +/- 0.56% of the injected tracer could be recovered in thoracic duct lymph and caudal mediastinal efferent lymph, respectively, and the sum of these values represented 26% of the recovered radioactivity. On the other hand, 16.95 +/- 6.93% of the injected radioactivity could be found in the blood over the same period

http://ajprenal.physiology.org/cgi/cont ... 260/3/F353

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Pat O'Connor
Lymphedema People
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