Veins and lymphs/ Physioterapeuts/ ANATOMY/Department of Anatomy, Faculty of Medicine, Masaryk University Brno1
Overview of the veins and lymphs
RNDr. Michaela Račanská, Ph.D.
Veins and lymphs/ Physioterapeuts/ ANATOMY/Department of Anatomy, Faculty of Medicine, Masaryk University Brno2
VEINS
V. cava sup.
abdomen
pelvis
LL
V. cava inf.
Head
Neck
UL
Thorax
Atrium dx. Atrium sin.
Vv. pulm.
V. PORTAE
CAPILLARIES, SINUSOIDS,
POSTCAPILLARY VENULES
VENULES, VEINS
TUNICA INTIMA, MEDIA, ADVENTITIA
VASA VASORUM,
SYMPATHETIC AND AFFERENT NERVES
VALVES, SINUS
PHLEBOGRAPHY
VENAE COMITANTES
V. subclavia
Vv. brachiocephalicae
V. CAVA SUP.
UL
head
neck
UL
V. jugularis int.
thorax
6 cm
VENA CAVA SUPERIOR
behind art. sternocostalis III. opens out into the right atrium
(behind art. sternoclavicularis )
v. azygos
Venae brachiocephalicae Angulus venosus dx. a sin.
The truncal tributaries
v. jugularis int.
- v. subclavia
(angulus venosus)
The collateral branches
from the thyroid gland,
the larynx,
the trachea
vena vertebralis
vena thoracica interna
from the mediastinal organs
Vena jugularis interna
•The cranial cavity, the facial areas of the head,
the neck
•It starts as bulbus superior venae jugularis
internae, behind the sternoclavicular joint it is
extended as bulbus inferior venae jugularis
internae
• INTRACRANIAL TRIBUTARIES
(region supplied by a. carotis interna)
• EXTRACRANIAL TRIBUTARIES
(region supplied by a. carotis externa)
HEAD AND NECK
Intracranial tributaries
venae cerebri
venae emissariae
venae diploicae
venae ophtalmicae
(without the smooth muscle
and valves)
• sinus durae matris
Anterior (separately, from stem…)
• v. facialis
• v. lingualis
• from thyroid gland, larynx and trachea
Medial (separately)
• v. pharyngea (plexus pharyngeus)
Posterior (vena jugularus externa
– the subcutaneous vein)
• v. auricularus posterior
• v. occipitalis
Stem (vena retromandibularis)
• v. temporalis superficialis
• v. maxillaris (plexus pterygoideus)
Extracranial tributaries
vv. jugulares ant.
(v. transv. colli et
suprascapularis)
v. jug. int.
v. subclavia
Venous angle
Originate from fusion
v. occipitalis
v. auricularis post.
tributaries
 v. jugularis ext.
HEAD AND NECK
10
VEINS OF THE UPPER LIMB
Deep – acompany arteries, same names
Superficial - subcutaneous
V. cephalica
V. basilica
Vv. digitales
radiales
ulnares
interosseae
brachiales v. axillaris
They create the
subcutaneous nets
(rete venosum dorsale
et palmare manus)
Veins and lymphs/ Physioterapeuts/ ANATOMY/Department of Anatomy, Faculty of Medicine, Masaryk University Brno
vv. digitales
> vv. metatarsales
> rete venosum dorsale
through vv. intercapitulares
Tributaries from rete ven. palmare
Superficial veins
Thumb  v. cephalica
Small finger  v. basilica
vena salvatellavena cephalica pollicis
These two veins are interconnected
through vena mediana cubiti, in the region
of the cubital fossa
Place where to take the blood
i.v. injections application
V. mediana cubiti
V. mediana antebrachii – v. mediana cephalica et basilica
V. basilica
- sulcus bicipitalis med.
V. cephalica
- sulcus bicipitalis lat.
- trigonum deltoideopectorale
→ vv. brachiales
→ v. axillaris
Tributaries
vv. brachiales (truncal branches)
v. cephalica
v. thoracica lat.
v. thoracoepigastrica
venae costoaxillares – join to the
intercostal veins
V. axillaris
Continuation of vv. brachiales
from collum chirurgicum – Co1
V. SUBCLAVIA
V. subclavia
tributaries
v. jugularis ext.
transversa colli
suprascapularis
Co1 – angulus venosus
Superficial
vv. digitales
metatarsales
tibiales
poplitea
Deep – acompany arteries,
same names
connections – perforating branches
v. saphena magna et parva
V. femoralis
VEINS OF THE LOWER LIMB
behind malleolus lateralis - v. saphena parva
In front of the medial malleolus- v. saphena magna
vv. digitales
> vv. metatarsales
> rete ven. dorsale
through vv. intercapitulares
Tributaries from rete ven. plantare
Arcus venosus dorsalis
Superficial veins
V. saphena parva
→ v. poplitea
19
VARICOSE VEINS
tributaries
v. epigastr. inf.
v. circum. ilium prof.
V. iliaca ext.
Continuation of v. femoralis
Lacuna vasorum – art. sacroliliaca
V. iliaca int.
vv. iliolumbales
sacrales lat.
gluteae
obturatoriae
pudendae int.
plx. venosi vesicalis
rectalis
♂ prostaticus
♀ uterinus
vaginalis
Parietal tributaries – branches from pelvic wall
Visceral tributaries
Pelvis
v. iliaca ext. et int. → vv. iliacae comm.
vv. iliacae comm. + v. sacralis mediana
→ v. cava inferior
v. cava inf.
Vv. iliacae com.
v. iliaca ext.v. iliaca int.
LLpelvis
abdomen
L4
V. CAVA INFERIOR
art. sacroiliaca
It begins on the right side of the lumbar
vertebral column at the level of L4 as a
connection of vena iliaca communis
dextra et sinistra, it opens out into the
right cardiac atrium
It has the parietal and visceral
tributaries
The parietal tributaries
• venae iliacae communes
• from the abdominal wall
• from the diaphragm
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno
25
vv. test. / ovaricae
renales
suprarenales
hepaticae
vv. lumbales
phrenicae inf.
Parietal tributaries
Visceral tributaries
Abdomen
V. azygos
V. hemiazygos
Venous systems in the
region of the spine that
will connect VCS ans
VCI.
They play a role in the
cases of closure of
caval veins
Cavo-caval anastomoses
Plx. venosi vertebrales interni et externi
V. hemiazygos acc.
V. lumb. asc. dx
V. azygos
V. hemiazygos
Th 4
Th 7-9
V. lumb. asc. sin
VCS
VCI
V. subcost. sinV. subcost. dx
The cavocaval anastomoses
thorax
vv. intercost. post.
vv. phrenicae sup.
organs of posterior mediastinum
esophagus
bronchi
pericard
abdomen
vv. lumbales
Tributaries of AZYGOS
V. PORTAE
origin:
V. mesenterica sup.
V. lienalis
v. mesenterica inf.
 Behind the caput pancreatis
 Inside of lig. hepatoduod.
 enter porta hepatis
 through vv. hepaticae to
v. cava inf.
8cm
Esophagus
Umbilicus
Rectum
Porto-caval anastomoses
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
Veins and lymphs/ Physioterapeuts/ ANATOMY/Department of Anatomy, Faculty of Medicine, Masaryk University Brno34
LYMPH
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno35
FUNCTION
• it begins in the peripheral parts of the body, leads only
centripetally and the termminal sections open out into the veins
• it provides the return transport of the water and the metabolites
from the interstitial fluid into the blood
• System- superficial
- deep
• Function- dreinage and transport
- imunology
The tissues without the lymphatic vessels:
hair, nails, epidermis, the sclera, the cornea, the lens, the
cartilages, the nervous tissue, the bones
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno36
Vasa lymph. :
capillaries, network
collecting vessels
(superficial and deep)
truncs
Folliculi lymphatici
Lymph nodes
Tonsils
Spleen
Thymus
mucosa-associated lymphoid tissue
Lymph
Lymphoid tissue
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno37
Lymphoid tissue
Folliculi lymphatici
Lymph nodes
Tonsils
Spleen
Thymus
mucosa-associated lymphoid
cells
Tonsils (Tonsillae)
• agreggation of the lymphatic
tissue below the epithelium
• production of lymphocytes
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno38
Thymus
̶ area interpleuralis superior = thymica
̶ Lobus dexter, sinister
̶ The lymphatic organ
̶ capsula thymi ,septa
̶ cortex, medulla
̶ T – lymfocytys – differentiation and maturation
̶ Adipose tissue
2 years
24
years
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno39
Spleen
Largest lymph. organ in the body
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno40
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
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno41
Lymphatic vessels
They begin blindly
The wall is thin
Numerous valves
Within their course, there are the lymphonodes inserted
lymphatic capillaries→ lymphatic capillary plexuses →
lymphatic vessels→lymphatic plexuses→lymph ducts
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno42
vas afferens (více)
vas efferens
(1)
capsula (trabeculae)
hilus
Cortex – more lymphocytes
medulla – less lymphocytes
convex part - „aferent“ – vasa afferentia (more)
concave hilus - „eferent“ – vas efferens
They filtrate the lymph
The lymph nodes -
structure
Tributary region
Sentinel lymph node
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno43
Main lymph ducts
tr. subclavius
sin.
tr.
intestinalis
tr.lumbali
s dx.
tr.
jugularis
sin.
tr.
bronchomediast.
sin.
tr. lumbalis
sin.
Ductus
thoracicus
L1-
2
• pars abdominalis (retroperitoneally)
• pars thoracica (mediastinum
posterius, aorta and the esophagus)
• pars cervicalis (angulus venosus
sinister C7) takes tr. jugularis sin.
and tr. subclavius sin.,
tr. bronchomediastinalis sin.
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno44
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno45
Truncus lymphaticus dx
tr. jugularis
dx.
tr. subclavius dx.
tr. bronchomediast. dx.
.
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno46
Watersheds of lymph
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno47
n.l. parotidei
n.l. retroauriculares
n.l. occipitales
n.l. submandibulares
n.l. submentales
N.l. cervicales profundi
The lymphatic drainage of the head
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno48
The lymphatic drainage of the neck
1. N.l. cervicales superficiales
̶ Along v. jugularis externa
̶ vassa efferentia into n.l. cervicales profundi
2. N.l. cervicales profundi—> truncus jugularis
̶ 15-30, Wood´s lymphnode,
along v. jugularis int., n. accesorius, nodi supraclaviculares
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno49
The lymphatic drainage of the thorax
1. The thoracic walls
• Superficial layer → nodi axillares
• Innner side of wall → nodi parasternales et intercostales
2. The thoracic organs:
• Organs of the mediastinum→ nodi tracheobronchiales sup. et. inf. → truncus
bronchomediastinalis
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno50
The lymphatic drainage of the abdomen
1. The superficial system– nodi axillares
- nodi inguinales
• The border line is at the level
of the umbilicus
2. The deep system
• parietal – along the large vessels
• visceral – unpaired and paired abdominal organs
(around the unpaired branches of the aorta)
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno51
The lymph nodes along the
large vessels
(retroperitoneally):
Nodi lumbales—>tr. lumbalis
Nodi iliaci communnes
Nodi iliaci externi
Nodi iliaci interni
Nodi parauterini (Bayer)/
nodi retroprostatici
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno52
Nodi gastrici
Nodi pylorici
Nodi pancreaticolienales
Nodi pancreaticoduodenales
Nodi hepatici
Nodi mesenterici
Nodi colici et paracolici
Nodi rectales et pararectales
Nodi coeliaci (in
front of the aorta)
Truncus intestinalis
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno53
Nodi lumbales
Nodi iliaci externi
Nodi inguinales
profundi
Nodi iliaci communes
Nodi iliaci interni
Nodi iliaci communes
Nodi lumbales
The lymph from the pelvic organs– nodi iliaci interni – nodi iliaci communes –
nodi lumbales – truncus lumbalis – ductus thoracicus
The lymph from the lower limb– nodi inguinales profundi – nodi iliaci externi
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno54
The lymphatic drainage of the UL
Superficial collectors
̶ anterior
̶ lateral
̶ medial
Deep systém – along large vessels
nll. cubitales
superf.
nll. cubitales prof.
nll. axillares
nodi axillares
pl. lymphaticus axillaris
nodi brachiales
n. l. cubitales profundi
truncus subclavius
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno55
Axilla
nodi lymphatici:
•pectorales (Sorgius)
•subscapulares
•interpectorales
•laterales (humerales)
•centrales
•apicales (infraclaviculares)
40 lymph nodes
6 groups
Truncus subclavius
plexus lymphaticus axillaris
ductus thoracicus
ductus lymphaticus dexter
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno56
nll. poplitei prof.
nll. inguinales prof.
nll. poplitei superf.
nll. inguinales
superf.
Medial
Lateral
Posterior
The lymphatic drainage of the LL
The superficial collectors
The deep system
nodi lymf. inguinales profundi
(lymphonodus Cloqueti)
nodi iliaci externi
nodi lumbales
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno57
Lymfedema
• The stopping of the drain of the
• lymph → lymphoedema
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno58
Lymphatic drainage massage
Define footer – presentation title / department59
Thank you for your attention
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.
www. kenhub.com
Veins and lymphs/Physioterapeuts-Anatomy (Department of Anatomy Faculty of Medicine, Masaryk University Brno