The Lymph Glands and Vessels of the Thorax

1. The intercostal lymph glands (Lg. intercostales) are small and are situated at the sides of the bodies of the thoracic vertebræ, in series corresponding to the intercostal spaces. They receive afferents from the vertebral canal, the spinal muscles, the diaphragm, intercostal muscles, and pleura. The efferent vessels go to the thoracic duct.

In the young subject these glands are more numerous than in the adult, and there are also glands along the dorsal face of the thoracic aorta which seem to disappear later.

2. The anterior mediastinal lymph glands (Lg. mediastinales craniales) (Fig. ) are numerous. Some are situated on the course of the brachial arteries and their branches; on the right side they are related deeply to the trachea, on the left to the œsophagus also. They are variable in size and disposition and are continuous in front with the prepectoral glands. Other glands lie along the ventral face of the trachea on the anterior vena cava and the right atrium of the heart; these are continuous behind with the bronchial glands. A few glands usually occur along the dorsal surface of the trachea, and there is often one at the angle of divergence of the brachiocephalic trunk. The afferent vessels come chiefly from the pleura, the pericardium, the heart, the thymus or its remains, the trachea, and the œsophagus. Their efferent vessels pass to the prepectoral glands and the thoracic duct.

The glands along the ventral face of the trachea are frequently enlarged and usually pigmented in dissecting-room subjects. The left recurrent nerve lies above them on the ventral face of the trachea.

3. The bronchial lymph glands (Lg. bronchiales) are grouped around the terminal part of the trachea and the bronchi. One group lies on the upper surface of the bifurcation of the trachea and is continued a short distance backward under the œsophagus (Fig. ). Others lie below the trachea and bronchi and also occupy the angle between the aortic arch and the pulmonary artery, concealing the left recurrent nerve and often covering the vagus in this part of its course. Small glands occur along the chief bronchi in the substance of the lungs (Lg. pulmonales). They receive the deep and most of the superficial lymph vessels of the lungs, and the efferents from the posterior mediastinal glands. Their efferent vessels go to the thoracic duct and the anterior mediastinal glands. The deep lymph vessels of the lung arise in plexuses which surround the terminal bronchi and accompany the bronchi to the root of the lung. The superficial vessels form a rich network under the pleura; most of them pass to the bronchial glands.

The bronchial glands are commonly pigmented except in young subjects and are often enlarged and indurated.

4. The posterior mediastinal lymph glands (Lg. mediastinales caudales) are usually small and are scattered along the posterior mediastinum above the œsophagus. They receive afferent vessels from the œsophagus, mediastinum, diaphragm, and liver. The efferents go to the bronchial and anterior mediastinal lymph glands, partly to the thoracic duct directly.

Sometimes one or two small glands are situated in the acute angle between the posterior vena cava and the diaphragm.