Azygos system of veins

Venous drainage of thoracic wall

Anterior intercostal veins

Posterior intercostal veins

1-6 spaces

7-9 spaces

Brachiocephalic & azygos veins

Internal thoracic veins

Musculophrenic veins

Azygos system of veins

Right side Left side

Azygos vein

1. Hemiazygos (inf.hemiazygos) 2. accessory hemiazygos (sup. hemiazygos)

SVC Arch of azygos Sup. hemiazygos T7

Azygos vein T8 IVC level of L2 Inf. hemiazygos Left renal vein (L2)

1st

right

TRIBUTARIES OF AZYGOS 2 4 3 T7

1st left
Lt sup. Intercostal vein

Right superior intercostal vein

4-11 post. Inter. vein T8

8 9-11

+ Ascending lumbar vein

Subcostal vein

IVC Rt K

Relation of the Azygos vein

Anterior relation of the azygos

1. Root of right lung. 2. Esophagus

Azygos system of veins

Drains: Posterior intercostal veins Posterior abdominal wall Pericardium. Bronchi Esophagus. Mediastinum.

Thoracic duct
In superior mediastinum

In posterior mediastinum

Aortic opening of diaphragm

beginning

Thoracic duct (in sup. Mediastinum)

Thoacic duct esophagus

Thoracic duct (drainage)

Lt IJV T4 T5

Lt Venous angle

Lt subclavian vein

Azygos vein Aortic opening of diaphragm THORACIC DUCT

Aorta

Right lymphatic duct

Jugular lymph trunk Subclavian lymph trunk Bronchomediastinal lymph trunk

Thoracic duct

Cisterna chyli Intestinal Lumbar lymph trunk

Thoracic duct
Drains : Lower half of the body (below the diaphragm). Left half of thoracic cavity (Lt bronchomediastinal l.t.). Left side of head and neck (Lt jugular l.t.). Left upper limb (Lt subclavian l.t.). N.B. Right half of the body above the diaphragm --------- right lymphatic duct

Lymph Nodes of the Lower Thorax

1. Intercostal Lymph Nodes 2. Paravertebral Lymph Nodes 3. Superior Phrenic Lymph Nodes

Visceral Lymph Nodes of the Thorax

1. Pulmonary 2. Bronchopulmonary (Hilar) 3. Superior Tracheobronchial 4. Inferior Tracheobronchial 5. Paratracheal

Parietal Lymph Nodes of the Thorax

1. 2. 3. 4. Prepericardial Lateral pericardial Anterior mediastinal Node of ligamentum arteriosum 5. Node of arch of azygos vein (part of posterior mediastinal group)

Case 1
A 31 year-old soldier, received shrapnel wound in the neck. Recently, during physical examination, it was noticed that when he blew his nose or sneezed, the skin above the right clavicle bulged upward. 1. Which part of the lung exists in the root of the neck? 2. Can you describe its surface anatomy? 3. What structure in the neck is protecting such part? 4. Describe the vertebral attachment of this structure? 5. Can you reach the cause of the bulging seen in the case?

Case 2
On examination of a postero-anterior chest x-ray of an 18 yearold-girl, it was seen that the left dome of the diaphragm was higher than the right dome. 1. Which dome of the diaphragm is normally higher? why? 2. What are the structures in relation to the base of the left lung? 3. What could be the causes of the x-ray changes described ?

Case 3
A 15 year-old-boy was rescued after falling in a lake in winter. The next day he developed a severe cold, and 3 days later his general condition deteriorated. He had fever and cough with blood-stained sputum. At first he had no chest pain, but later, when he coughed he experienced severe pain over the right 5th intercostal space in the midclavicular line.

Discussion
1. What is the clinical condition of the child that leads to cough and bloody sputum? 2. In this particular case, what is the clinical condition that leads to chest pain? Which structure is involved? 3. From the site of pain, can you guess which lobe of the right lung is affected?

Case 4
A 2 year-old-boy was sitting and playing with his toy car, when his baby-sitter noticed that a small metal nut was missing from the car. Two days later the child developed cough and became febrile.
1. How can we proof that the child had inhaled the metal nut (technique)? 2. This metal nut is likely to be lodged in which 1ry bronchus? Why? 3. If it succeed to reach the lung, in which bronchopulmonary segments it will pass?