LYMPHATIC DRAINAGE
Up to 1\2 of lymph draining into the thoracic duct drains from the liver.
The liver drains into the following group of nodes which lie in a ssociation with the
arteries: hepatic nodes, cystic nodes, and subpyloric nodes.
These nodes then drain into the celiac axis nodes together with the nodes from the rest of the foregut organs. An alternate route of drainage is via the diaphragmatic routes into the parasternal nodes and mid-diaphragmatic nodes.
Some of the lymphatics accompany the hepatic veins and enter the thoracic cavity with the IVC.
The liver represents the largest single source of lymph in the body, producing nearly 20% of overall total volume. Most hepatic lymphatics leave the liver at the porta hepatis and drain into hepatic nodes along the hepatic artery. Lymph is a clear fluid that is collected from the various organs and tissues of the body, flows through the lymphatic vessels, and eventually rejoins the venous circulation.
The lymphatic fluid is collected by small side channels called the spaces of Disse, which run along and in parallel with the sinusoids. These become confluent and form small lymphatic channels that surround the portal vessels – particularly the arterioles and portal vein.
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Lymphatics of the liver |
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This image, hopefully a familiar one, shows the schematic relationship of the ductules, in yellow, with the portal triad. The portal triad is therefore not really a triad when accompanied by lymphatics and nerves. (Image courtesy of Ashley Davidoff M.D.) |
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Lymphatics of the liver |
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The lymphatics are too small to visualize and the expected distribution within the capsule and along the portal triads has been intimated in yellow. Portal lymph nodes are colored in as yellow “nodes” in the porta hepatis. (Image courtesy of Ashley Davidoff M.D.) |
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Lymph nodes of the liver |
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Normal lymph nodes are not usually visualized. In this section of the liver at least two small nodes are seen in the porta. Can you see them? A second set is seen close to the crus of the diaphragm. The next image highlights these nodes. (Image courtesy of Ashley Davidoff M.D.) |
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Lymph nodes of the liver |
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In this section of the liver the two small nodes have been overlaid in yellow. A second set is seen close to the crus of the diaphragm. (Image courtesy of Ashley Davidoff M.D.) |
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Lymph nodes and lymphatics of the liver |
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This color overlay represents the hepatic artery in red and a schematic imposition of lymphatics in yellow. The lymphatics travel with the hepatic artery culminating in lymph nodes around the main hepatic artery near the porta and at its origin around the celiac axis. (Image courtesy of Ashley Davidoff M.D.) |
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Lymph nodes along the celiac territory |
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Lymph nodes along the celiac axis and hepatic artery are not usually visualized and if they are seen in the normal patient, they are between 5 and 7 mm in dimension. This color overlay shows the lymph node distribution around the celiac axis and hepatic artery and the position of the lymphatic duct with the aorta and IVC in the retrocrural space. (Image courtesy of Ashley Davidoff M.D.) |
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Impaired lymphatic drainage caused by congestion of the hepatic veins results in fluid in the portal triad