Henry Gray (18251861). Anatomy of the Human Body. 1918.
7. The Lymphatic Vessels of the Thorax
The lymph glands of the thorax may be divided into parietal and visceralthe former being situated in the thoracic wall, the latter in relation to the viscera.
The parietal lymph glands include the sternal, intercostal, and diaphragmatic glands.
1. The Sternal Glands (lymphoglandulæ sternales; internal mammary glands) are placed at the anterior ends of the intercostal spaces, by the side of the internal mammary artery. They derive afferents from the mamma, from the deeper structures of the anterior abdominal wall above the level of the umbilicus, from the upper surface of the liver through a small group of glands which lie behind the xiphoid process, and from the deeper parts of the anterior portion of the thoracic wall. Their efferents usually unite to form a single trunk on either side; this may open directly into the junction of the internal jugular and subclavian veins, or that of the right side may join the right subclavian trunk, and that of the left the thoracic duct.
2. The Intercostal Glands (lymphoglandulæ intercostales) occupy the posterior parts of the intercostal spaces, in relation to the intercostal vessels. They receive the deep lymphatics from the postero lateral aspect of the chest; some of these vessels are interrupted by small lateral intercostal glands. The efferents of the glands in the lower four or five spaces unite to form a trunk, which descends and opens either into the cisterna chyli or into the commencement of the thoracic duct. The efferents of the glands in the upper spaces of the left side end in the thoracic duct; those of the corresponding right spaces, in the right lymphatic duct.
3. The Diaphragmatic Glands lie on the thoracic aspect of the diaphragm, and consist of three sets, anterior, middle, and posterior.
The anterior set comprises (a) two or three small glands behind the base of the xiphoid process, which receive afferents from the convex surface of the liver, and (b) one or two glands on either side near the junction of the seventh rib with its cartilage, which receive lymphatic vessels from the front part of the diaphragm. The efferent vessels of the anterior set pass to the sternal glands.
The middle set consists of two or three glands on either side close to where the phrenic nerves enter the diaphragm. On the right side some of the glands of this group lie within the fibrous sac of the pericardium, on the front of the termination of the inferior vena cava. The afferents of this set are derived from the middle part of the diaphragm, those on the right side also receiving afferents from the convex surface of the liver. Their efferents pass to the posterior mediastinal glands.
The posterior set consists of a few glands situated on the back of the crura of the diaphragm, and connected on the one hand with the lumbar glands and on the other with the posterior mediastinal glands.
The superficial lymphatic vessels of the thoracic wall ramify beneath the skin and converge to the axillary glands. Those over the Trapezius and Latissimus dorsi run forward and unite to form about ten or twelve trunks which end in the subscapular group. Those over the pectoral region, including the vessels from the skin covering the peripheral part of the mamma, run backward, and those over the Serratus anterior upward, to the pectoral group. Others near the lateral margin of the sternum pass inward between the rib cartilages and end in the sternal glands, while the vessels of opposite sides anastomose across the front of the sternum. A few vessels from the upper part of the pectoral region ascend over the clavicle to the supraclavicular group of cervical glands.
The Lymphatic Vessels of the Mamma originate in a plexus in the interlobular spaces and on the walls of the galactophorous ducts. Those from the central part of the gland pass to an intricate plexus situated beneath the areola, a plexus which receives also the lymphatics from the skin over the central part of the gland and