Lymphatic Drainage of the Liver and Pathways of Lymph Node Metastasis

The lymphatic drainage of the liver consists of two major pathways: the deep pathways and the superficial pathways.1 The lymphatic vessels in the liver are believed to originate in the perilobular connective tissue. The perilobular lymphatic vessels from the lobules deep inside the parenchyma drain into the deep networks along the periportal space in the Glisson's sheath toward the porta hepatis and along the hepatic veins. The perilobular lymphatic vessels from the lobules near the surface of the liver drain into the numerous superficial lymphatic networks under the capsule of the liver (Fig. 6-1).

Table 6-3 summarizes various pathways of lymphatic drainage and potential pathways of lymph node metastasis of the liver based on anatomic study by Rouvier and various clinical studies.1,6-8

The deep lymphatic networks follow the portal veins, drain into the lymph nodes at the hilum of the liver (known as the hepatic or hilar lymph nodes), and then drain to the nodes in the hepatoduodenal ligament (Fig.

Splenorenal Ligament

Fig. 6—1. Superficial pathways of lymphatic drainage of the liver.

Note that the anterior diaphragmatic nodes consist of two groups: the lateral anterior diaphragmatic group and the medial group, which includes the pericardiac nodes and the subxiphoid nodes behind the xiphoid cartilage. The nodes in the falciform ligament drain into the anterior abdominal wall along the superficial epigastric and deep epigastric lymph nodes. The epigastric and the subxiphoid nodes drain into the internal mammary nodes. (This figure also appears in the color insert.)

Fig. 6—1. Superficial pathways of lymphatic drainage of the liver.

Note that the anterior diaphragmatic nodes consist of two groups: the lateral anterior diaphragmatic group and the medial group, which includes the pericardiac nodes and the subxiphoid nodes behind the xiphoid cartilage. The nodes in the falciform ligament drain into the anterior abdominal wall along the superficial epigastric and deep epigastric lymph nodes. The epigastric and the subxiphoid nodes drain into the internal mammary nodes. (This figure also appears in the color insert.)

Table 6-3. Pathways of Lymphatic Drainage of the Liver

Deep lymphatic network

Descending chains (hepatoduodenal ligament) Hepatic hilar nodes

Anterior periportal chains: hepatic artery and celiac nodes Posterior periportal chains: portocaval, superior retro pancreatic, and inferior retro pancreatic nodes Descending chains (hepatic vein): Inferior vena cava terminal nodes Superficial lymphatic network

Anterior ascending chain (falciform ligament): anterior diaphragmatic nodes Posterior descending chain (bare areas): right and left inferior phrenic nodes Paracardial chain (gastrohepatic ligament): left gastric nodes Anterior descending chain (falciform ligament): deep superior epigastric nodes

6-2). The nodes in the hepatoduodenal ligament can be separated into two major chains; the anterior periportal (hepatic artery) chain and posterior periportal chain. The anterior periportal chain (Figs. 6-3 and 6-4) begins at the hepatic artery nodes, follows the common hepatic artery to the nodes at the celiac axis, and drains into the cisterna chyli. The posterior periportal chain (Fig. 6-3), which begins at the portocaval nodes, is located posterior to the portal vein in the hepatoduodenal ligament. This chain drains into the superior and inferior retro-pancreatic nodes and the aortocaval nodes before draining into the cisterna chyli and ascending to the thoracic duct.

The deep networks along the hepatic veins drain into the lymph nodes around the inferior vena cava (IVC) above the diaphragmatic opening through which the IVC passes (Fig. 6-5). This nodal group is known as the IVC terminal nodes or juxtaphrenic nodes.

Deep Lymphatic Pathways

Fig. 6—2. Deep pathways of lymphatic drainage of the liver.

The deep pathways follow the hepatic veins to the inferior vena cava nodes and the juxtaphrenic nodes that follow along the phrenic nerve. These nodal groups are considered as the middle diaphragmatic nodes. The pathways that follow the portal vein drain to the hepatic hilar nodes and the nodes in the hepatoduodenal ligament. They drain into the celiac node and the cisterna chyli. (This figure also appears in the color insert.)

Fig. 6—2. Deep pathways of lymphatic drainage of the liver.

The deep pathways follow the hepatic veins to the inferior vena cava nodes and the juxtaphrenic nodes that follow along the phrenic nerve. These nodal groups are considered as the middle diaphragmatic nodes. The pathways that follow the portal vein drain to the hepatic hilar nodes and the nodes in the hepatoduodenal ligament. They drain into the celiac node and the cisterna chyli. (This figure also appears in the color insert.)

Superficial Lymphatic Pathways

The numerous superficial lymphatic networks are located under the capsule of the liver. They form several collecting trunks draining in various directions along the ligaments that attach to the liver.

Along the anterior surface, several collecting trunks follow the falciform ligament, ascending to the anterior diaphragmatic nodes above the diaphragm (Fig. 6-5). These trunks can also descend and join the lymphatic networks at the inferior surface to drain into the hepatic hilar nodes. On rare occasions, a collecting trunk can be identified in the falciform ligament that drains downward into a lymph node in the deep superior epigastric chain in the anterior abdominal wall (Fig. 6-6).

From the superior surface, the collecting trunks fol low the triangular and coronary ligaments and penetrate the diaphragm to several nodal groups above the diaphragm, including the anterior diaphragmatic nodes, retrosternal or retroxiphoid nodes, IVC terminal orjux-taphrenic nodes, and paraesophageal nodes.

Along the posterior surface of the liver are several collecting trunks that follow the IVC to the IVC terminal nodes and that follow the inferior leaf of the coronary ligaments and join the right and left inferior phrenic arteries to drain to the inferior phrenic nodes and the paraaortic nodes.

Along the inferior surface are the collecting trunks that drain mostly into the hepatic hilar nodes and that join the lymphatic vessels in the hepatoduodenal ligament and gastrohepatic ligament. The group in the gas-trohepatic ligament may drain into the paracardial chain

Common Hepatic Artery Lymph Node

Fig. 6—3. Metastatic colon carcinoma to the liver and lymph node metastasis to the common hepatic and posterior periportal nodes.

(a) Node (N) at the common hepatic artery. M = hepatic metastasis.

(b) Node (N) at the posterior periportal chain or node at the foramen of Winslow. Note that the nodal mass displaces pancreas (P) and duodenum (D) anteriorly.

Fig. 6—3. Metastatic colon carcinoma to the liver and lymph node metastasis to the common hepatic and posterior periportal nodes.

(a) Node (N) at the common hepatic artery. M = hepatic metastasis.

(b) Node (N) at the posterior periportal chain or node at the foramen of Winslow. Note that the nodal mass displaces pancreas (P) and duodenum (D) anteriorly.

Foramen Foramen Winslow Lymph Node

Fig. 6—4. Fibrolamellar hepatocellular carcinoma (HCC) with lymph node metastasis to hepatic hilar node and common hepatic artery node where gastrohepatic ligament attaches. Proved at surgery.

(a) Metastatic node (N) at hepatic hilum from large primary fibrolamellar HCC (M) in lateral segment (segment 2 and 3). Node is located at junction between the cystic duct and common hepatic duct.

(b) Metastatic node (N) at common hepatic artery (arrow). Note that node is also anterior to portal vein (PV).

of the left gastric nodes. The lymphatic network at the surface of the caudate lobe frequently follows the IVC to the IVC terminal nodes.

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Responses

  • ISA
    Does the inferior vena cava run through the liver?
    7 years ago
  • ludovico
    What color is drainage from a liver?
    7 years ago
  • Justin
    What lymph nodes are around the hepatic hilum?
    7 years ago
  • swen schultheiss
    Where are juxtaphrenic lymph nodes?
    5 years ago
  • Charles
    Can portocaval node retropancreatic?
    4 years ago
  • patricia darosa
    What do the portacaval lymph nodes drain?
    4 years ago
  • jamie
    Where are the periportal and gastrohepatic?
    4 years ago
  • consolata lorenzo
    Where are pergastrics nodes in periportal and celiac axis?
    3 years ago
  • brad
    What is segment 2 lymph node?
    3 years ago
  • mandy
    Where is aortocaval lymph node?
    3 years ago
  • eric pfeffer
    Which lymphnode drain the liver?
    3 years ago
  • melba
    Where is portacaval lymph node located?
    3 years ago
  • phillipp
    What are the nodes lymphatic of the liver can be drained?
    2 years ago
  • Bosco Zaragamba
    Are hepatic nodes a type of lymph node?
    2 years ago
  • merja
    What chain are portal lymph nodes?
    2 years ago
  • Ulla
    Which lymphatics drains the liver?
    2 years ago
  • brenda englert
    Where does the lymphatic drainage from the liver starts from?
    2 years ago
  • regina
    What are periportal lymph nodes?
    2 years ago
  • stephan
    Are portacaval lymph nodes intrathoracic lymph nodes?
    1 year ago
  • Dalila
    Does the lymphativ vessel goes to the liver?
    12 months ago
  • Veijo
    Which lymph liver drains into?
    12 months ago
  • CORNELIO
    What does periportal lymph node drain?
    10 months ago
  • Crispina
    Does the caudate lobe of the liver drain directly into the ivc?
    9 months ago
  • SILKE
    What causes a enlarged "lymph node" drainage pathway of the liver do?
    9 months ago
  • cesarina
    Do lymphatics pass through the liver?
    8 months ago
  • marina
    Do lymphatics run throught the liver?
    8 months ago
  • erica
    Where are the periportal lymph nodes located?
    8 months ago
  • medhane
    Can you use lymphatic drainage massage for alcohol liver disease?
    5 months ago
  • Genet
    Where are lymph nodes around liver?
    5 months ago
  • santeri
    Does the liver help the lymph drain?
    4 months ago
  • sky
    Where are the lymph nodes located by the liver?
    4 months ago
  • rudi
    Which lymph nodes drain liver?
    3 months ago
  • miniya
    What does the liver do in the lymphatic system?
    2 months ago
  • Marco
    Can lymphatic drainage help improve liver function?
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