K) Peripheral Lymph Node Regions

The peripheral nodal groups include the epitrochlear, axillary, popliteal and inguinal lymph nodes. Although the topic also refers to external iliac nodes, and these are important lymph nodes in the leg, they are considered in the pelvic lymph nodes topic.

Supratrochlear Nodes (Epitrochlear Nodes)

The supratrochlear node(s) lie above the deep fascia just proximal to the medial epicondyle of the humerus. Efferents follow the basilic vein to deep lymphatic vessels and the lateral lymph node group in the axilla.

Axillary Nodes

There a five groups of nodes in the axilla:

  • Lateral nodes lie behind the axillary vein. They drain most of the upper arm except a few vessels which accompany the cephalic vein.
  • Pectoral nodes lie just lateral of pectoralis minor with lateral thoracic vessels. They drain lymph from the anterolateral thorax above the umbilicus, including the breast.
  • Subscapular nodes lie at the inferior margin of the posterior axilla. They drain lymph from the posterior inferior neck and the back (above the iliac crest).
  • The three peripheral groups drain mostly to the central group. These lie posterior to the axillary vessels and the pectoralis minor.
  • Apical nodes lie in the apex of the axilla, medial to the axillary vessels. They drain lymph from all other axillary nodes, lymph accompanying the cephalic vein and occasionally the superior parts of the breast.

Popliteal Nodes

Popliteal nodes lie in the popliteal fossa. One lies at the junction of the popliteal vein and the short saphenous vein, the remainder about the popliteal vessels. Afferent vessels arise from the deep tissues of the lower leg and the skin of the lateral lower leg and foot. Efferent vessels drain to deep inguinal nodes.

Inguinal Nodes

There are three groups of superficial nodes and a single deep group.

  • Medial proximal superficial nodes lie below the inguinal ligament. They receive lymph from the perineum and medial anterior abdominal wall. In women, lymph from the uterus may pass to this group along round ligament lymphatics.
  • Lateral proximal superficial nodes drain lymph from the lateral abdominal wall and the gluteal region.
  • Distal superficial nodes lie along the long saphenous vein before it pierces the fascia lata. They drain lymph from the superficial thigh, the medial lower leg and foot.
  • There are three deep inguinal nodes. The lowest lies distal to the junction of the long saphenous and femoral veins. It drains lymph from the deep tissues of the leg. The next lies above this junction; and the most proximal lies beneath the inguinal ligament.