Vessels circulatory system a person's upper back and chest include the main arteries and veins, as well as the heart. These vital structures are critical to the process of pumping venous blood into the lungs for gas exchange, as well as pumping blood with oxygen to the tissues of the body to support their metabolic functions.
The heart is the pump of the body's circulatory system, which is responsible for the movement of blood throughout the body. The heart acts as a double-acting pump as it pumps venous blood to the lungs and oxygenated blood to the tissues of the body with every heartbeat ... [Read below]
[Top start] ... The heart is mainly composed of the heart muscle tissuewhich requires a constant supply of oxygen to the blood. The left and right coronary arteries provide this blood supply to meet the heart's own energy needs. A small blockage in the coronary arteries leads to chest pain, this is called angina pectoris; complete blockage of the coronary arteries leads to myocardial infarction, more commonly known as a heart attack.
Pulmonary arteries and veins
Pulmonary arteries and the pulmonary veins provide vital channels, but only provide a short distance of blood flow between the heart and lungs. Coming out of the heart from the right ventricle, deoxygenated blood flows along the large pulmonary trunk before dividing into the left and right pulmonary arteries. The pulmonary arteries carry blood to the huge structure of small arterioles and capillaries in the lungs, where they are freed from carbon dioxide and receive oxygen from the air in the alveoli of the lungs. These capillaries merge into larger venules, which later merge into the left and right pulmonary veins. Each pulmonary vein carries blood from the lungs back to the heart, from where it returns through the left atrium.
Oxygenated blood leaves the left ventricle of the heart and enters the aorta, the largest artery in the human body. The ascending aorta, located above the heart, before it turns 180 degrees to the left, is called the aortic arch. From there, it passes posteriorly from the heart of the thoracic aorta towards the abdominal cavity.
The branches of the aorta, passing through the chest, branch into several large arteries, as well as many small ones.
The left and right coronary arteries branch off from the ascending aorta, which supplies the heart with its vital parts.
The arch of the branches of the aorta consists of three large arteries - the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. These arteries collectively provide oxygen to the head and arms.
The thoracic aorta continues with many small arteries that supply blood to organs, muscles, and skin chest before entering the abdomen, into the abdominal aorta.
Blood from the abdominal aorta supplies oxygen and nutrients to vital important bodies the abdominal cavity through the arteries of the celiac trunk and the common hepatic artery.
Completion of the circulatory cycle
At the end of the circulatory cycle, the veins of the upper body carry blood with decay products and carbon dioxide from the tissues of the body back to the heart, from where it again flows through the lungs to all organs of the body.
Blood returning to the heart from the lower torso and legs travels to the upper torso, into a large vein called the inferior vena cava. The inferior vena cava draws blood from the hepatic vein and the diaphragmatic vein before entering the right atrium of the heart. The blood returning from the head enters the trunk through the left and right jugular veins, and the blood returning from the hands leaves through the left and right subclavian veins.
The jugular and subclavian veins on each side merge to form the left and right brachiocephalic trunks, which merge into the superior vena cava. Several small veins that carry blood from the organs, muscles, and skin of the upper torso also drain into the superior vena cava, which carries blood from the hands and head to the right atrium of the heart.
The chest wall (chest and surrounding muscles and soft tissue) has a rich blood supply provided by the system of intercostal arteries and veins, which are located in the intervals between the ribs.
Intercostal arteries and veins form anastomoses between themselves, by means of which a fatigue network is formed blood vesselsthat surrounds the chest and supplies blood to all its structures. In each intercostal space, there is a posterior intercostal artery that originates near the spine, and two anterior intercostal arteries that begin in the sternum.
BACK! \\ OTHER ARTERIES
Arteries chest wall
The first two posterior intercostal arteries originate from the subclavian arteries. The remaining posterior arteries begin directly from the aorta (the largest central artery in the body) at the level of each of the ribs. Each posterior intercostal artery gives off the following branches.
■ Dorsal ramus — traversed posteriorly to supply blood to the spine, back muscles and overlying skin.
■ An accessory branch is a small artery that runs along the upper edge of the underlying rib.
Anterior arteries The anterior intercostal arteries originate from the internal mammary arteries, which run vertically down each side of the sternum. These arteries follow along the lower edge of each rib, along with the intercostal vein and nerve, and branch out to the upper edge of the underlying rib.
Chest veins
The intercostal veins accompany the intercostal arteries in the spaces between the ribs. In total, the human body has 11 posterior intercostal veins and one subcostal vein (lying under the 12th rib) on each side of the sternum, which, like arteries, anastamose with the corresponding anterior intercostal veins and form a dense vascular network around the chest.
L The chest diagram from the front shows the veins of the chest wall. The intercostal veins accompany the intercostal arteries and nerves and occupy the most superficial position in the costal groove.
■ Posterior veins
Blood is diverted into the azygos vein system, which lies in front of the spinal column on back surface chest wall. From there, blood returns to the heart through the superior vena cava - the main central vein of the upper chest cavity.
■ Anterior veins
Located in the same place as the arteries of the same name, the anterior veins drain blood into the internal thoracic veins, which run vertically along the anterior surface of the chest wall, accompanying the internal thoracic arteries.
Anterior intercostal artery
It bends around the chest wall, giving off branches that supply the bones, muscles and the skin located above them.
Left subclavian artery
It originates directly from the aortic arch.
Right inner thoracic artery
Starts on right side sternum from the first part of the subclavian artery.
Descending thoracic aorta
Located on the left side of the spinal column on the back of the chest wall; continues downward into the abdominal aorta.
Right subclavian artery
Departs from the brachiocephalic trunk.
▼ This diagram of the chest shows the thoracic arteries from the front, which branch off from the aorta and supply blood to the organs and tissues of the chest cavity.
Additional branch
A small branch of the posterior intercostal artery along the superior edge of the rib
Posterior intercostal artery
It begins in the back, near the spine; the right posterior intercostal arteries cross the spine behind the azygos vein
Left brachiocephalic vein
Collects blood from the left subclavian and internal jugular veins.
Unpaired vein
It flows into the superior vena cava
Posterior intercostal vein
Diverts blood to the unpaired vein
Right internal thoracic vein
Anastomoses to the left internal thoracic vein (not shown) behind the sternum
Semi-unpaired vein
It lies on the left side of the spine and is emptied into the azygos vein.
Anterior intercostal vein
Diverts blood to the internal chest vein
In 90% of cases, damage to the thoracic vessels is caused by penetrating wounds. Blunt aortic injuries occur in 10-15% of all car accidents; in 70-90% of patients with such injuries die before arriving at the hospital. Most often, with such injuries, the proximal part of the descending aorta is damaged. Typically, the aorta is damaged at the level of the arterial ligament, just distal to the orifice of the left subclavian artery. Blunt chest injuries occur in frontal collisions, although lateral impacts have played a role in recent studies. Collisions or compression can damage the brachiocephalic trunk, pulmonary veins, and vena cava.
Symptoms of damage to the chest vessels
Typically, patients with penetrating wounds accompanied by vascular damage have hemodynamic instability, often with ongoing bleeding. Such patients should be immediately taken to the operating room for emergency thoracotomy. In this case, the diagnosis is clarified at the time, at the same time the injury of the vessels of the chest is excluded or confirmed. Blunt trauma patients may initially appear hemodynamically stable, and vascular damage is often masked by concomitant trauma to other structures. The high probability of damage to the large vessels of the chest is indicated by:
- - shock / hypotension;
- - the difference in blood pressure or pulse between the two upper or lower extremities (in case of damage to the brachiocephalic trunk or subclavian artery);
- - the difference in blood pressure between the upper and lower extremities (pseudocoarctation syndrome);
- - increasing in size hematoma, located at the level of the exit from the chest;
- - pathological mobility of the chest ("dangling" chest);
- - the noise heard above the scapula;
- - palpable fracture of the sternum;
- - palpable fracture thoracic spine;
- — outward signs serious chest injury;
- - chest trauma resulting from a collision or compression of the chest.
Diagnosis of damage to the thoracic vessels
The possible scope of the diagnostic examination will depend on the severity of the general condition of the victim, as well as on the stability of hemodynamics, the nature of damage to the aorta and other structures.
Chest x-ray
Frontal projection x-ray is an important screening test and should be performed in all patients with penetrating wounds or suspicious blunt chest trauma. In patients with penetrating wounds, it is useful to use special radiopaque markers that allow you to mark the entrance and exit holes.
In 90% of cases, damage to the thoracic aorta is associated with an expansion of the mediastinum on chest radiographs, while the sensitivity of this sign is 90%, and the negative predictive value is 95%. Other x-ray signs of damage to the descending aorta include:
- changes from the mediastinum:
- expansion of the mediastinum by more than 8 cm;
- abrasion of the contour of the aortic arch;
- lowering of the left main lobar bronchus by more than 140 degrees;
- the disappearance of the paravertebral pleural line;
- lateral displacement of the tracheal contour;
- bending the contour of the gastric tube passed through the nose;
- calcification of the aortic arch;
- fractures of the sternum and scapula, as well as a fracture of the clavicle in a patient with polytrauma, multiple fractures of the ribs;
- other findings revealed on radiographs made in frontal projection: apical pleural hematoma (in the region of the apex of the lung shadow), massive left-sided, diaphragm rupture;
- the findings revealed on the lateral X-ray: displacement of the trachea anteriorly, absence of the aorto-pulmonary window.
When these findings are identified on radiographs, a more in-depth examination of the patient is shown. Angiography and spiral CT are usually necessary.
In case of damage to the thoracic vessels
Aortography allows you to identify, localize and determine the extent of the damage to the aorta, it can be used to plan surgical intervention, because depending on the type of damage to the aorta, different options for thoracotomy may be required. Aortography is indicated for patients with penetrating chest wounds suspicious of possible damage to the anonymous, carotid, or subclavian arteries, but only if their hemodynamics are stable. The proximity of the wound channel to the brachiocephalic vessels may serve as an indication for arteriography, even in the absence of any objective symptoms of vascular damage.
Spiral CT
Spiral CT is no longer used only for screening and patient selection for angiography. It is considered a decisive diagnostic procedure that allows you to accurately recognize injuries and ruptures of the aorta.
Compared to arteriography, this research method is less invasive, performed faster and more accessible. In addition, it allows you to detect damage not only to blood vessels, but also to other important structures. However, the impossibility of contact with the patient during the examination limits its use in unstable patients.
Other imaging techniques
In some cases of damage to the thoracic vessels, transesophageal echocardiography and intravascular ultrasound scanning can be additionally used, but their use is currently limited.
Treatment of damage to the thoracic vessels
Indications for emergency surgery in case of damage to the chest vessels are: hemodynamic instability, an increase in the volume of blood separated from the chest, as well as X-ray signs of an increasing hematoma.
Damage to the thoracic vessel is evidenced by an initially large volume of blood released through the drainage at the time of its placement (\u003e 1500 ml) or continued blood flow at a rate exceeding 200-300 ml / hour. In these cases, thoracotomy is indicated. However, if the patient's hemodynamics are stable, it is better to perform the operation at a later date.
In patients with stable hemodynamics, reconstructive intervention on the aorta should be postponed even if they have:
- - central injury nervous system with a coma,
- — respiratory distress due to lung contusion,
- - burns to the surface of the body,
- - heart contusion,
- - damage internal organssubject to conservative treatment,
- - retroperitoneal hematoma,
- - contaminated wounds,
- - hypothermia, coagulopathy and other conditions, the elimination of which will improve the outcome of the operation,
- - concomitant diseases, and the patient is over 50 years old.
In some situations, with minimal damage to the aorta, for example, intimal defects, small patchwork injuries, pseudoaneurysms, dynamic monitoring of the patient is possible. If tactics are chosen initially conservative treatment, then the patient should be closely monitored and controlled hypotension, maintaining the systolic pressure below 120 mm. Hg, or average arterial pressure below 80 mm. Hg Aronstam et al. reported on the positive effect of beta-blockers on the condition of patients with blunt aortic injury, therefore, currently, many protocols provide for intravenous titration of beta-blockers under the control of heart rate.
Surgical reconstruction
Adequate exposure of the proximal and distal segments of the damaged vessel is required, which makes it possible to control both central and retrograde blood flow. Before the operation, it is necessary to treat the skin of the anterior surface of the neck, chest, abdomen and lower extremities.
Surgical intervention for damage to the thoracic vessels can be performed from four approaches.
Left-sided anterolateral thoracotomy is indicated for hypotensive unstable patients with undiagnosed injuries. The patient is placed supine, and anterolateral thoracotomy is performed in the fourth intercostal space. If necessary, the access can be expanded by extending it medially, with the intersection of the sternum or posteriorly.
Posterior-lateral thoracotomy is performed in the IV intercostal space and can be complemented by resection of the V rib, as a result, an excellent view of most of the left half of the chest is provided. The incision can be extended medially to intersect the sternum or toward the abdominal wall, allowing additional revision and exclusion of other injuries.
Median sternotomy is indicated for patients with damage to the ascending aorta, the transverse part of the aortic arch, the anonymous artery, as well as the proximal segments of the carotid and subclavian arteries. For better exposure of the aortic arch and brachiocephalic branches, the incision can be extended to the neck.
To access the proximal segments of the subclavian artery, either a median sternotomy or an anterolateral thoracotomy at the level middle third intercostal space. If necessary, to stop retrograde bleeding, the subclavian artery can be isolated from a separate supraclavicular approach.
The main controversy concerns the need to use circulatory support for blood supply to organs located distal to the damaged segment of the thoracic aorta at the stage of reconstruction in case of damage to the thoracic vessel. Many people still advocate a simple clamping technique without systemic administration of anticoagulants and without the use of auxiliary shunts. However, other authors prefer to use one of the options for circulatory support. In this case, the most promising are two variants of bypass grafting - from the left atrium to the distal segment of the aorta or to the femoral artery. Regardless of the technique used, paraplegia occurs in about 8% of patients, and no randomized trials have been conducted to date on the benefits of either technique.
Endovascular reconstruction
Stent grafts have been used with success for the treatment of aneurysms of the descending aorta as well as type B aortic dissections. These techniques were successfully used to treat traumatic aortic injuries and were accompanied by significantly fewer complications and less mortality.
In hemodynamically stable patients with a suitable aortic injury, arthroplasty should be considered the preferred treatment.
The article was prepared and edited by: surgeon14424 0
The chest wall is divided into three layers: superficial, middle and deep. The layers of the chest wall are best detected on horizontal cuts of the trunk (Fig. 2, 3), introduced into practice topographic anatomy even N.I. Pirogov. The surface layer includes the skin, mammary gland, subcutaneous fatty tissue, as well as the vessels and nerves that supply the formations of this layer. The muscles covering the chest wall are located in the middle layer (Fig. 4, 5). The deep layer is formed by the ribs, intercostal muscles, ligaments, blood vessels and nerves.
Fig. 2. Topography of the organs of the chest cavity, a - horizontal cut at the level of Th3-5: 1 - subalarum with vessels and nerves; 2 - right lung; 3 - pectoralis minor; 4 - pectoralis major muscle; 5 - cartilaginous part of the I rib; 6 - collarbone. 7 - sternum handle; 8 - intercostal muscles; 9 - left lung; 10 - scapula; 11 - subspinal muscle; 12 - back straightener muscle; 13 - semi-spinal muscle of the neck. 14 - III thoracic vertebra; 15 - trapezius muscle; 16 subscapularis muscle; 17-deltoid muscle; eighteen - brachial bone; 19 - tendon of the long head of the biceps muscle. b - topography of the thoracic cavity organs, horizontal raspill at the level of Th5-7: 1 - deltoid muscle; 2 - coracohumeral muscle; 3 - axillary cavity with vessels and nerve; 4 - internal thoracic artery and vein; 5 - sternum; 6 - cartilaginous part of the II rib; 7 - pectoralis minor; 8 - pectoralis major muscle; 9 - left lung; 10 - humerus; 11 - large round muscle; 12 - body scapular muscle; 13 - infraspinatus muscle; 14 - muscle straightener of the trunk; 15 - intervertebral disc; 16 - trapezius muscle; 17 - large rhomboid muscle; 18 - right lung; 19 - triceps muscle of the shoulder.
Fig. 3. Topography of the chest cavity organs, a - horizontal cut at the Th7 level. 1 - pectoralis major muscle; 2 - sternum; 3 - internal thoracic artery and vein; 4 - heart; 5 - left lung; 6 - serratus anterior muscle; 7 - broad muscle of the back; 8 - the lower angle of the scapula; 9 - back straightener muscle; 10 - trapezius muscle; 11 - VII thoracic vertebra; 12 - "triangle of auscultation"; 13 - intercostal muscles. b - horizontal cut at the Th10 level. 1 - rectus abdominis muscle; 2 - costal part of the diaphragm; 3 - xiphoid process; 4 - the cartilaginous part of the ribs; 5 - stomach; 6 - aorta; 7 - spleen; 8 - the lower lobe of the left lung; 9 - back straightener muscle; 10 - X thoracic vertebra; 11 - trapezius muscle; 12 - right lung; 13 - the broadest muscle of the back; 14 - serratus anterior muscle; 15 - liver.
Fig. 4. Muscles of the anterior chest wall, their blood supply and innervation. 1 - head vein; 2 - arteries of the chest and brachial process; 3 - dorsal artery of the scapula; 4 - the transverse artery of the neck. five - subclavian artery and Vienna; 6 - thoracic artery; 7 - the uppermost artery of the chest; 8 - anterior pectoral nerve; 9 - lateral artery of the chest; 10 - long pectoral nerve; 11 - posterior artery of the chest; 12 - artery surrounding the scapula; 13- main ulnar saphenous vein; 14 - cutaneous dorsal nerve of the forearm; 15-brachial artery; 16-median nerve; 17 ulnar nerve; 18-musculocutaneous nerve.
Fig. 5. Muscles of the posterior surface of the chest wall.
1 - trapezius muscle; 2 - sternocleidomastoid muscle; 3 - semi-spinal muscle of the head; 4 - belt muscle of the head; 5 - muscle lifting the scapula; 6 - supraspinatus muscle; 7 - small rhomboid muscle; 8 - large rhomboid muscle; 9 - large round muscle; 10 - broad muscle of the back; 11 - muscle straightener of the trunk; 12-lower posterior dentate muscle; 13 - external oblique muscle of the abdomen; 14 - small round muscle; 15 - infraspinatus muscle; 16 - deltoid muscle.
The skin on the front and side surfaces of the chest wall is thinner than in the back, contains greasy and sweat glands... Under the skin is a layer of fiber, expressed individually. In the area of \u200b\u200bthe sternum and spinous processes, the cellulose is poorly developed, penetrated by connective tissue bridges, as a result of which the skin is inactive. In the area of \u200b\u200bthe nipple and areola of the mammary glands, there is no fiber and the skin of these areas is motionless. Superficial vessels and nerves pass through the subcutaneous tissue.
The arteries are branches of the intercostal, axillary, lateral arteries of the chest and the internal thoracic artery (Fig. 6). The veins of the chest wall (Fig. 7) form a thin subcutaneous network, especially pronounced in the area of \u200b\u200bthe mammary glands. The saphenous veins are connected by perforating branches with the axillary, subclavian, intercostal and internal thoracic veins, as well as the veins of the anterior abdominal wall. In the subcutaneous tissue, the anterior and posterior branches of the pectoral nerves branch out. The superficial branches of the medial supraclavicular nerves from the cervical plexus pass here.
Fig. 6. Arteries of the chest wall.
1 - thoracic aorta; 2 - intercostal arteries; 3 - internal thoracic artery; 4 - the superior costal branch of the intercostal artery; 5 - inferior costal branch of the intercostal artery; 6 -back branch intercostal artery.
Fig. 7. Veins of the anterior chest wall.
1 - radial saphenous vein (head vein); 2 - subalarum vein; 3 - subclavian vein; 4 - outer jugular vein; 5 - internal jugular vein; 6 - anterior jugular vein; 7 - sterno-epigastric vein; 8 - internal chest vein; 9 - lateral chest vein; 10 - ulnar saphenous vein (main vein).
A.A. Vishnevsky, S.S. Rudakov, N.O. Milanov
Lymphatic vessels and nodes of the chest cavity (Fig.,,; see Fig.), are divided into two groups: lymphatic vessels and nodes of the anterior mediastinum and lymphatic vessels and nodes of the posterior mediastinum.
- Anterior mediastinal the lymph nodes, nodi lymphatici mediastinales anteriores (see fig.,), include nodes located in the upper mediastinum. These include a number of single nodes located on the anterior surface of the aortic arch and brachiocephalic veins.
- Periosternal (parasternal) lymph nodes, nodi lymphatici parasternales, are located along the a. thoracica interna.
- Perihoracic (paramammary) lymph nodes, nodi lymphatici paramammarii (see fig.), lie along the lower part of a. thoracica lateralis.
- Prepericardial lymph nodes, nodi lymphatici prepericardiales, and lateral pericardial lymph nodes, nodi lymphatici pericardiales laterales, are represented by single nodes lying on the lower anterior and lateral surfaces of the pericardium, respectively.
- (see fig.), are located in both the anterior and posterior mediastinum. In the anterior mediastinum, they lie at the place of attachment of the diaphragm to the VII rib and xiphoid process and in front of the inferior vena cava.
In the posterior mediastinum, the following nodes are distinguished.
- Intercostal lymph nodes, nodi lymphatici intercostales (see fig.,), are located on the heads of the ribs. In addition, solitary lymph nodes lie in the posterior part of the intercostal spaces.
- Prevertebral lymph nodes, nodi lymphatici prevertebralesare represented by single nodes along the anterior and lateral surfaces of the lower half of the thoracic spine.
- Posterior mediastinal lymph nodes, nodi lymphatici mediastinales posteriores (see fig.), are represented by many lymph nodes, divided into groups according to topographic characteristics:
- pulmonary juxtaesophageal nodes, nodi lymphatici juxtaesophageales pulmonales, are located near the esophagus, mainly at the level of the hilum of the lungs;
- tracheobronchial lymph nodes, nodi lymphatici tracheobronchiales, lie in the region of the thoracic trachea and the roots of the lungs, ranging from the main bronchi to the mediastinal surface of the lungs. Distinguish upper and lower tracheobronchial lymph nodes, nodi lymphatici tracheobronchiales superiores et inferiores (see fig.). The former are located from the gate of the lungs to the division of the trachea, the latter - under the division of the trachea between the main bronchi. Solitary lymph nodes are found in the area of \u200b\u200bthe gate of the lungs and in the angles of branching of the lobar and segmental bronchi and vessels;
- , lie at the lateral surfaces of the trachea, as well as in front of it.
4. Upper phrenic lymph nodes, nodi lymphatici phrenici superiores (see fig.), are located on the diaphragm near the aortic opening. Some of these nodes lie in the anterior mediastinum.
Lymphatic vessels of the diaphragm. The lymphatic vessels of the diaphragm consist of networks of lymphocapillaries of the serous membranes (peritoneum and pleura) and of the networks of lymphatic vessels of the sub-serous base.
The diverting lymphatic vessels of the lower surface of the diaphragm are directed to the lower diaphragmatic nodes, mainly to the post-aortic nodes of the abdominal cavity.
The diverting lymphatic vessels of the upper surface of the diaphragm go from the anterior and middle parts of the diaphragm to the upper diaphragmatic lymph nodes of the anterior mediastinum; from the posterior parts of the diaphragm, some of the vessels penetrate into abdominal cavity to the post-aortic nodes, and the rest to the upper diaphragmatic lymph nodes of the posterior mediastinum.
The phrenic nodes also receive lymph from the upper surface of the liver.
The outflowing lymphatic vessels from the anterior upper diaphragmatic nodes are directed to the peri-sternal and anterior mediastinal lymph nodes and from the posterior upper diaphragmatic nodes to the posterior mediastinal nodes, and then to the broncho-mediastinal trunk.
Lymphatic vessels of the walls of the chest cavity... In the chest area, anterior and posterior intercostal lymphatic vessels are distinguished. These vessels collect lymph from the muscles and bones of the chest, as well as from the superficial and deep lymphatic plexuses of the costal pleura.
The anterior intercostal lymphatic vessels enter the peri-sternal lymph nodes, which are located in the chest cavity together with the internal thoracic vessels, receiving the outflow vessels of the anterior upper diaphragmatic and anterior mediastinal nodes.
The outflowing lymphatic vessels flow from the left side into thoracic duct, and on the right - into the right lymphatic duct.
The posterior intercostal lymphatic vessels go back along the intercostal space, take the diverting lymphatic vessels of the back region and flow into the intercostal and prevertebral lymph nodes.
The outflowing vessels of these nodes, through several branches, flow into initial department thoracic duct, within its cistern. Part of the vessels enters the posterior mediastinal lymph nodes, the outflowing vessels of which on the left side also flow into the thoracic duct, and on the right - into the right lymphatic duct.
Lymphatic vessels of the lungs.The lymphatic vessels of the lungs (see fig.,,) Are divided into superficial and deep.
The lungs are represented by the lymphocapillary network (narrow and wide-mesh) and the discharge vessels. The lymphocapillary network is embedded in the thickness of the pulmonary pleura (see Fig.). From the discharge vessels, part enters the thickness of the lungs and connects with deep vessels, and the other part goes to the lymph nodes in the area of \u200b\u200bthe gate of the lungs.
They form a network of lymphocapillaries in the interalveolar septa of the lungs and in the submucosa of the bronchi.
The outflowing lymphatic vessels of these networks go along the septa of the lung and the outer shell of the vessels and bronchi, forming the perivascular and peribronchial lymphatic plexuses. The discharge vessels of these plexuses leave the gates of the lungs and carry the lymph into bronchopulmonary (root) lymph nodes, nodi lymphatici bronchopulmonales (hilares) (see fig.,), lying along the lobar bronchi, in the area of \u200b\u200bthe gate of the lungs, then in upper and lower tracheobronchial nodes, nodi lymphatici tracheobronchiales superiores et inferiores, and from there to peri-tracheal lymph nodes, nodi lymphatici paratracheales... The latter also take lymph from posterior mediastinal lymph nodes, nodi lymphatici mediastinales posteriores, and from a number of lymphatic vessels of the esophagus.
The outflowing vessels of the peritracheal lymph nodes form broncho-mediastinal trunk, truncus bronchomediastinalis, which flows into the thoracic duct on the left, and into the right lymphatic duct on the right.
Lymphatic vessels of the esophagus. The lymphatic vessels of the esophagus (see Fig.) Are formed from the network of lymphocapillaries in the mucous and muscular membranes and from the submucous lymphatic plexus. The diverting lymphatic vessels from the upper half of the esophagus are directed to the paratracheal lymph nodes, the group of jugular juxtapoesophageal nodes and to the posterior mediastinal nodes; from the lower half of the esophagus - to the posterior mediastinal nodes and to the left gastric nodes.
Lymphatic vessels of the heart... Lymphatic vessels of the heart (see Fig.) Are divided into deep and superficial.
Deep lymphatic vessels hearts form lymphocapillary networks in the thickness of the myocardium. The lymphatic vessels of the endocardium flow into the lymphatic vessels of the myocardium.
Superficial lymphatic vessels hearts lie under the epicardium. Here they form superficial and deep networks in the area of \u200b\u200bthe ventricles, and only one network of lymphocapillaries in the area of \u200b\u200bthe atria.
From these lymphatic networks, lymph enters the plexus of the discharge vessels of the ventricles and atria.
The discharge vessels of the plexuses merge according to the branching of the coronary vessels of the heart; large discharge vessels of the heart go in the anterior and posterior interventricular and in the coronary grooves of the heart along the left and right coronary arteries and their branches. The lymphatic vessels accompanying the left coronary artery merge on the posterior surface of the pulmonary trunk into one trunk, which flows into the tracheobronchial nodes lying at the site of division of the trachea.
The lymphatic vessels accompanying the right coronary artery form one trunk that rises along the anterior surface of the ascending aorta and flows into the node of the arterial ligament, nodus lig. arteriosi, which is located near the arterial ligament. From here, the lymph flows into anterior mediastinal lymph nodes, nodi lymphatici mediastinales anteriores (see fig.,).
Lymphatic vessels of the thymus gland form two efferent lymphatic trunks, which are directed to the anterior mediastinal nodes.
