Lower Limb

Lymphatics

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Overview


Most of the lymphatic drainage of the pelvic viscera is into the lymph nodes associated with the internal and external iliac arteries and their branches. These drain into lymph nodes distributed along the common iliac arteries and then into the para-aortic lymph nodes which are related to the abdominal aorta.


Gross Anatomy


The main lymph node groups in and around the pelvis are:

1)     Inferior mesenteric lymph nodes          drain into         à Para-aortic lymph nodes

2)     Internal iliac lymph nodes                                           à Common iliac lymph nodes

3)     External iliac lymph nodes                                          à Common iliac lymph nodes

4)     Superficial and deep inguinal lymph nodes                à External iliac lymph nodes

5)     Sacral lymph nodes                                                     à Internal iliac / Common iliac lymph nodes

 

The sacral lymph nodes are situated in the concavity of the sacrum. They are closely related to the middle and lateral sacral arteries.

 

The table below gives a simplified outline of the drainage of the pelvic viscera. Several organs are drained by more than one lymph node group.

 

 

Para-aortic

 

Testis and ovary

Body of uterus

 

Common iliac nodes

Inferior mesenteric

 

Superior rectum

Sigmoid

 

 

 

Sacral lymph nodes

 

Rectum (lower)

Prostate

 

External iliac

 

Cervix

Vagina (upper)

Body of uterus

 

Membranous urethra (male)

Cavernous urethra (male)

Prostate

Seminal vesicles

 

Glans penis/clitoris

Intra-pelvic ureter

Bladder (anterior)

 

Inguinal nodes

Internal iliac

 

Cervix

Vagina (middle)

Whole urethra (female)

 

Membranous urethra (male)

Prostatic urethra (male)

Prostate

Seminal vesicles

 

Intra-pelvic ureter

Bladder (posterior)

 

Inferior rectum

Upper anal canal (above dentate line)

 

 

Inguinal (superficial and deep)

 

Vagina (lower)

 

 

 

Cavernous urethra (male)

 

 

 

Glans penis/clitoris

Perineum and external genitalia (including scrotum/vulva)

 

Anus

Lower anal canal (below dentate line)

 

 


Clinical Anatomy


Important differentiations to remember which will aid you clinically when faced with a patient with a prominent lymph node:

  • Useful in differentiating a scrotal lump versus a testicular lump
    • Testis à Para-aortic lymph nodes
    • Scrotum à Inguinal lymph nodes
  • Remember to examine the anus and lower anal canal (proctoscopy) in patients presenting with a palpable lymph node in the groin. Anus and lower anal canal à inguinal lymph nodes.      

Quick Anatomy


Key Facts

    

Aide-Memoire

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Summary


The internal and external iliac lymph nodes provide the majority of the lymphatic drainage of the pelvis. These lymph nodes then drain into the common iliac lymph nodes followed by the para-aortic lymph nodes. 


References


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