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VEINS AND LYMPHS
Dentistry II
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VEINS
CAPILLARIES, SINUSOIDS,
POSTCAPILLARY VENULES
VENULES, VEINS
TUNICA INTIMA, MEDIA, ADVENTITIA
VASA VASORUM,
SYMPATHETIC AND AFFERENT NERVES
VALVES, SINUS
PHLEBOGRAPHY
VENAE COMITANTES
PHLEBOGRAPHY
(VENOGRAPHY)
Venous thrombosis surrounded by contrast,
the so-called ‘tram-track’ sign (arrows)
v. cava superior
v. cava inferior
Vena cava superior
- v. brachiocephalica dx. et sin.
- v. azygos
Venae brachiocephalicae
Angulus venosus dx. a sin.
- v. jugularis int.
- v. subclavia
(angulus venosus)
- v. jugularis ext.
- vv. thyroideae inf.
- vv. thymicae
- vv. tracheales
- vv. mediastinales
- vv. bronchiales
- vv. pericardiacae
- v. vertebralis
- v. thoracica int.
- v. cervicalis prof.
- v. intercostalis sup. sin.
- 1st v. intercostalis post.
V. AZYGOS
- v. lumbalis ascendens dx. + v. subcostalis dx.
(vv. lumbales dx.)
- v. phrenica sup. dx.
- vv. intercostales post. dx. (5th – 11th)
- v. intercostalis suprema dx. (2nd – 4th)
- v. hemiazygos
- vv. oesophageales, bronchiales,
mediastinales
V. HEMIAZYGOS
- v. lumbalis ascendens sin. + v. subcostalis sin.
(vv. lumbales sin.)
- v. phrenica sup. sin.
- vv. intercostales post. sin.
(9th-11th)
- v. hemiazygos accessoria
(vv. intercostales post. sin.
5th – 8th)
- vv. oesophageae
- vv. bronchiales,
- vv. mediastinales
Vena jugularis interna
• INTRACRANIAL TRIBUTARIES
(region supplied by a. carotis interna)
• EXTRACRANIAL TRIBUTARIES
(region supplied by a. carotis externa)
Intracranial tributaries
venae cerebri
venae emissariae
venae diploicae
venae ophtalmicae
Anterior (separately, from stem…)
• v. facialis
• v. lingualis
• v. thyroidea superior
• v. thyroidea media
Medial (separately)
• v. pharyngea (plexus pharyngeus)
Posterior (vena jugularus externa)
• v. auricularus posterior
• v. occipitalis
Stem (vena retromandibularis)
• v. temporalis superficialis
• v. maxillaris (plexus pterygoideus)
Extracranial tributaries
Žíly hloubky obličejeDeep veins of the face
V. JUGULARIS INT.
- vv. pharyngeae
- v. facialis communis
- v. lingualis
- v. thyroidea sup.
- v. thyroidea media
V. RETROMANDIBULARIS
- v. temporalis spf.
- v. maxillaris
- v. temporalis media
- v. transversa faciei
V. FACIALIS
- v. angularis
- v. prof. faciei
- v. palatina ext.
PLEXUS PTERYGOIDEUS
- v. alveolaris inf. et sup.
- v. sphenopalatina
- vv. palatinae
V. JUGULARIS EXT.
- v. retromandibularis
- v. auricularis post.
- v. occipitalis
- v. jugularis ant.
arcus venosus juguli
(- v. mediana colli)
- v. transversa colli
- v. suprascapularis
Vena jugularis anterior Venae pharyngeae
(plexus pharyngeus)
19
VEINS OF THE UPPER LIMB
Deep – acompany arteries, same names
Superficial
Rete digitale dorsale – vv. metacarpales dorsales – rete
venosum dorsale manus (rete venosum palmare manus –
vv. intercapitulares)
v. basilica antebrachii (hiatus basilicus) – v. basilica
v. cephalica antebrachii – v. cephalica
V. mediana cubiti
V. mediana antebrachii – v. mediana cephalica et basilica
V. AXILLARIS
- v. basilica
- vv. brachiales (deep veins)
- vv. thoracoepigastricae
- v. thoracica lateralis
- v. cephalica
Trig. clavipectorale
(deltoideopectorale)
V. cephalica
Trigonum deltoideopectorale
Fascia clavipectoralis
VENA CAVA SUPERIOR
Vena subclavia
- v. axillaris
- vv. pectorales
- v. scapularis dorsalis
v. cava inferior
v. iliaca comm. sin.v. iliaca comm. dx.
v. iliaca ext.
v. iliaca int.
LE
pelvis
abdomen
L4-5
26
VEINS OF THE LOWER LIMB
Deep – acompany arteries, same names
Superficial
Vv. digitales dorsales – vv. metatarseae dorsales – arcus
venosus dorsalis (rete venosum dorsale pedis)
arcus venosus plantaris (rete venosum plantare pedis)
– vv. intercapitulares
v. marginalis med. – v. saphena magna
v. marginalis lat. – v. saphena parva (v. femoropoplitea)
femur
v. saphena magna
V. SAPHENA MAGNA
- v. saphena accessoria
- v. epigastrica spf.
- v. circumflexa ilium spf.
- vv. pudendae ext.
vv. perforantes
VARICOSE VEINS
Vena iliacae (comm., externae et internae)
V. ILIACA COMMUNIS
- v. iliaca ext - v. femoralis
- v. epigastrica inf.
- v. circumflexa ilium prof.
- v. iliaca int.
V. ILIACA INTERNA
- plexus venosus vesicalis – vv. vesicales
- plexus venosus prostaticus – v. dorsalis penis prof.
- plexus venosus vaginalis – v. dorsalis clitoridis prof.
- plexus venosus uterinus – vv. uterinae
- plexus venosus rectalis – v. rectalis sup., media, inf.
- plexus venosus sacralis – vv. sacrales lat.
Parietal and visceral tributaries (plexuses)
V. CAVA INF.
- v. iliaca communis dx. et sin.
- vv. lumbales
- vv. phrenicae inf.
- v. sacralis mediana
- v. testicularis dx.
(- v. ovarica dx.)
- vv. renales
- v. suprarenalis dx.
- vv. hepaticae
v. hemiazygos accessoria
v. lumbalis asc. dx.
vv. lumbales
v. subcostalis dx.
v. azygos
v. hemiazygos
Th 4
Th 7-9
Cavo-caval anastomoses
1) Plexus venosi vertebrales
2) Vena azygos
VENA CAVA INFERIOR
Vena portae
- vv. cysticae
- v. gastrica sin.
- v. gastrica dx.
- v. mesenterica sup.
- vv. pancreaticoduodenales
- vv. pancreaticae
- v. gastroomentalis dx.
- vv. jejunales et ileales
- v. ileocolica
- v. colica dx. et media
- v. splenica/lienalis
- vv. gastricae breves
- v. gastroomentalis sin.
- vv. pancreaticae
- v. mesenterica inf.
- v. colica sin., vv. sigmoideae,
v. rectalis sup.
Porto-caval anastomoses
Fetal blood circulation
v. umbilicalis: branch IIA
ductus venosus: to v. cava inferior
(1/2 blood to liver)
foramen ovale
ductus arteriosus: to arcus aortae
aa. umbicales
The blood of the fetus is not mixed
With the blood of the mother!!
Remnants of the fetal circulation
- v. umbilicalis – lig. teres hepatis
- ductus venosus – lig. venosum
- foramen ovale – fossa ovalis
- ductus arteriosus – lig. arteriosum
- aa. umbilicales –chordae aa. umbilicales
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Lymph
Vasa lymph. :
capillaries, network
collecting vessels
(superficial and deep)
truncs
Folliculi lymphatici
Lymph nodes
Tonsils
Spleen
Thymus
mucosa-associated lymphoid tissue
Lymph
Lymphoid tissue:
Without lymphoid drainage:
epithel
cartilage
bone marrow
CNS
placenta
lens, vitreous body, sclera, cornea
hair, nails
Vasa lymphocapillaria – rete lymphocapillare
Vasa lymphatica – vas afferens, vas efferens
Trunci lymphatici: ductus thoracicus
tr. lymphaticus dx.
Vasa lymphatica
Nodus lymphaticus
- capsula
- trabeculae
- cortex
- medulla
- hilum
- sinus subcapsularis
- sinus corticalis
(peritrabecularis)
- sinus terminalis
(medullaris)
Tributary region
Regional lymph nodes Vas efferens
Vas afferens
Knowledge is important for understanding of
the pathological spread processes!
Lymph
■ clear fluid, 1½-2 l daily
■ origin from tissue fluid (+ products of tissue
metabolism) and fluid filtered at the arterial end of
capillaries
■ composition similar to blood plasma (+ lymphocytes)
In GIT milky (food fats) = chylus
■ the flow direction is centripetal
Pathological circumstances may cause retrograde flow
Tonsilla palatina
Tonsilla lingualis
Tonsilla pharyngea
Tonsilla tubaria
Waldeyer's tonsillar ring
Tonsilla abdominalis –
appendix vermiformis
Lien, splen
Largest lymph. organ in the body
Thymus
Located in upper
mediastinum (area
thymica)
Lobus dx. et sin.
Color: pink, yelowish
soft
Changes according to
the age
2 years 24
years
structure:
capsula fibrosa - septa - lobuli (cortex, medulla)
function: differentiation and functional maturation of
T lymphocytes and maintaining their adequate
circulation and peripheral lymphatic org.
Tr. subcl.
sin
Tr.br-med..
sin
Tr. jug.
sin.
Ductus thoracicus
L1-2
Tr. int.Tr.lumb.
dx
Tr.lumb.
sin
40-45 cm
Ductus lymph.
dx.
Tr. subcl.
dx
Tr. jug.
dx
Tr.br-med..
sin
1 cm
Nll. cerv. spf.
Nll. cerv. prof.
Nll.: occipitales
retroauriculares
parotidei
submentales
submandibulares
retropharyngei
Nll.: faciales
Head

• superficiales
alongside vena jugularis externa
(alongside v. jugularis anterior)
• profundi
alongside vena jugularis interna
alongside nervus accesorius
alongside arteria transversa coli
(supraclavicular)
Along organs larynx, trachea, thyroid gland
• anteriores
superficial - alongside vena jugularis anterior
deep – around larynx, trachea, thyroid gland
Nodi lymphatici cervicalesNECK
Nll. submandibulares
Lymphatic drainage
of the head and neck:
Nodi lymph. occipitales
Nll. retroauriculares
Nll. parotidei
Nll. submandibulares
Nll. submentales
Nll. cervicales ant. spf. et prof.
Nll. cervicales lat. spf. et prof.
(nll. jugulares int.
nll. supraclaviculares)
tr. jugularis
Superficial lymph vessels:
- collectors:
lateral (v. cephalica)
medial (v. basilica)
anterior (medii)
Nll. cubit. spf.
Nll. cubit. prof.
> Nll. axillares
Upper limb
Deep lymph vessels
(along arteries)
Nll. axillares
1 Laterales
(av. brachialis)
2 Subscapulares
(av. subscap.)
3 Pectorales
(av. thoracica lat.)
4 Centrales cca 10
5 Apicales (infraclav.)
(av. subclavia cca 12)
Tr. subclavius
1
4
3
2
5
Wall of the thorax and
diaphragma
Organs of mediastinum
Region of the hilum
pulmonis
> Tr. bronchomediast.
THORAX
1 Nll. parasternales
(vasa thoracica int.)
2 Nll. intercostales
3 Nll. phrenici sup.
4. Nll.
praevertebrales
Wall of the thorax
and diaphragma
1
2
3
4
Organs of mediastinum
1 Nll. mediast. ant.
(along: v. cava inf.
arcus aortae
nn. phrenici)
Nll. mediast. post.
11
Tr. bronchomediast.
sin. dx.
1 Nll. pulm.
2 Nll. bronchopulm.
3 Nll. tracheobronch.
4 Nll. paratrach.
1
2
3
4
Region of the hilum
pulmonis:
tr. bronchomediastinalis
Nll. axillares
Nll. parasternales
Nll. supraclavicul.
Nll. intercostales
Nll. mediastinales ant.
Epigastric way
Lymph drainage of the breast
Trunci lumbales
from the abdominal and pelvic wall
from paired abdominal organ from
pelvic organ (and from LL)
Truncus intestinalis
from unpaired abdominal
organ
> cisterna chyli > dct. thoracicus
Abdomen and pelvis
Nll. gastrici dx. et sin.
Nll. gastroepiploici dx.e
Nll. pancreaticoduodena
sup. et inf.
Nll. lienales
Nll. coeliaci
Nll. hepatici
Nll. pancreatici
sup. et inf.
Nll. coeliaci
liver
stomach
spleen
pancreas
duodenum
small intestine
large intestine
Tr. intestinalis
Origin of tr. intestinalis
>vasa efferentia
Nodi ileocolici
Nodi colici dx.
Nodi colici medii
Nodi colici sinistri
Nodi sigmoidei
Nodi rectales sup.
Nodi mesenterici sup.
Nodi mesenterici inf.
Nll. iliaci ext. (from LL)
Nll. iliaci int.
(wall+ unpaired pelvic org.:
urinary bladder
uterus, vagina
Nll. sacrales (rectum, unp.
org.)
> Nll. iliaci comm.
> Nll. lumbales
(posterior abdominal wall+
paired. org., lumbal region)
Tr. lumb. dx. et sin.>
Origin of trr. lumbales
vasa efferentia
Nll. iliaci interni
- nll. paravesicales
- nll. paravaginales
- nll. parauterini
(Bayer)
- nll. pararectales
- nll. glutei sup. et inf.
- nll. sacrales
Nll. iliaci externi
Nll. iliaci communes
♂
Nll. iliaci
ext. et int.
Nll.
sacrales
Nll. iliaci comm.
Nll. lumbales
♀
Nll. paravag.
Nll. paraves.
Nll. parauterini
(Bayer)
Nll. pararect.
Nll. iliaci
int.
Nll. lumbales
Nll. sacrales
Nll. inguinales
Superficial lymph vessels:
collectores:
med. (along v. saph. magna)
lat.
post. (along v. saph. parva)
Nll. poplitei prof.
Nll. inguin. prof.
Nll. inguin. spf.
Nll. poplitei spf.
Lower limb
Deep lymph vessels
Nll. inguinales prof.
(Cloquet-Rosenmüller)
Nll. poplitei
Lymfography
Illustrations were copied from:
Atlas der Anatomie des Menschen/Sobotta.
Putz,R., und Pabst,R. 20. Auflage. München:
Urban & Schwarzenberg, 1993)
Čihák R: Anatomie 2 (Splanchnologia).
Avicenum,
zdravotnické nakladatelství, Praha, 1988.