Pelvic lymph nodes and vessels
Generally speaking, lymphatic drainage of the pelvis mirrors the pathway of venous drainage, with the exception of the external iliac lymph nodes. All lymph drained from the pelvic region is returned to the venous circulation via the thoracic duct, which empties its contents in or around the junction of the left internal jugular and subclavian veins.
Familiarity with the pelvic lymph nodes and lymphatic drainage pathways is of great importance for staging and grading pelvic tumors.
This article will discuss the anatomy and function of the pelvic lymph nodes.
|Definition||A series of parietal and visceral interconnected lymph nodes and lymph vessels which drain lymph from the pelvic cavity|
|Inguinal lymph nodes||
Superficial inguinal lymph nodes → External iliac lymph nodes
Deep inguinal lymph nodes → External iliac lymph nodes
|Iliac lymph nodes||
External iliac lymph nodes → Common iliac lymph nodes
Medial group (obturator lymph nodes)
Internal iliac lymph nodes → External iliac lymph nodes/common iliac lymph nodes
Lateral sacral lymph nodes → Lumbar lymph nodes
Gluteal lymph nodes → Common iliac lymph nodes
Common iliac lymph nodes → Lateral aortic lymph nodes
|Lumbar lymph nodes||
Right lateral aortic lymph nodes → Right lumbar trunk
Left lateral aortic lymph nodes → Right lumbar trunk
Preaortic lymph nodes → Right lumbar trunk
|Visceral lymph nodes||
Paravesical lymph nodes of bladder → External iliac lymph nodes, internal iliac lymph nodes
Parauterine lymph nodes → External iliac lymph nodes, internal iliac lymph nodes
Paravaginal lymph nodes → External iliac lymph nodes, internal iliac lymph nodes, superficial inguinal lymph nodes
Pararectal lymph nodes → External iliac lymph nodes, internal iliac lymph nodes
Parietal lymph nodes: Receive, filter and transport lymph drainage from surrounding pelvic lymph nodes and viscera towards the thoracic trunk and back into the bloodstream.
Visceral lymph nodes: Receive, filter and transport lymph drainage from surrounding pelvic viscera to parietal pelvic lymph nodes.
- Definition and function
- Parietal pelvic lymph nodes
- Visceral pelvic lymph nodes
- Clinical relations
Definition and function
Pelvic lymph nodes can generally be divided into parietal and visceral lymph nodes. Parietal pelvic lymph nodes include the common, external and internal iliac lymph nodes, as well as lumbar and inguinal lymph nodes. Visceral lymph nodes are associated with pelvic viscera and include the paravesical lymph nodes of the bladder, parauterine, paravaginal and pararectal lymph nodes. Lymph vessels from pelvic viscera either drain to the visceral lymph nodes or directly to the parietal pelvic lymph nodes.
Similar to other lymph nodes around the body, pelvic lymph nodes are typically named according to the structures in which they surround. For example, iliac lymph nodes are clustered around the internal, external and common iliac arteries.
Pelvic lymph nodes are highly connected through afferent and efferent pelvic lymph vessels. Lymph nodes of the pelvis receive lymph from pelvic viscera via afferent lymphatic vessels and function to filter harmful substances such as bacteria, viruses, parasites, and other foreign material. Efferent pelvic lymphatic vessels empty filtered lymph into nearby greater lymph nodes in an effort to return lymph to the thoracic duct and back into the bloodstream.
Parietal pelvic lymph nodes
Inguinal lymph nodes
Inguinal lymph nodes are located within the groin region adjacent to the inguinal canal and are the most peripheral of the pelvic lymph nodes. They are divided into superficial and deep inguinal lymph nodes.
Superficial inguinal lymph nodes reside below the inguinal ligament and drain the anal canal, skin of the pelvis, scrotum and vulva within the pelvic region. The superficial inguinal lymph nodes are further subdivided into superior, inferior, superolateral, and superomedial nodes.
Deep inguinal lymph nodes lie within the femoral sheath just medial to the femoral vein. These lymph nodes drain the glans penis or clitoris while also receiving lymph from the superficial inguinal nodes.
Both the superficial and deep inguinal lymph nodes drain to the external iliac lymph nodes.
Iliac lymph nodes
The iliac lymph nodes (external, internal and common iliac lymph nodes) are found adjacent to the external, internal and common iliac arteries. These nodes function to drain the superior parts of the middle to anterior pelvic organs, inferior pelvic viscera, deep perineum and the gluteal region.
For more details about the lymphatics of the pelvis, take a look at the study unit below:
External iliac lymph nodes
The external iliac lymph nodes accompany the external iliac arteries and are divided into medial, posterior and lateral groups.
The medial group of external iliac lymph nodes drains the urinary bladder, prostate, membranous part of the urethra, cervix and upper part of the vagina. The medial group of lymph nodes contain the obturator lymph nodes. Obturator lymph nodes are variably present within the obturator canal and lie in close proximity to the obturator internus muscle. The posterior group of external iliac lymph nodes drains the internal iliac lymph nodes while the lateral group drains the superficial and deep inguinal lymph nodes.
While most of the pelvic lymph nodes and vessels mimic the venous drainage pathway, the external iliac lymph nodes do not. Efferent vessels of the external iliac lymph nodes communicate and empty into the common iliac lymph nodes.
Internal iliac lymph nodes
Internal iliac lymph nodes are located along the internal iliac arteries and receive lymph from all of the pelvic viscera, parts of the perineum and the gluteal muscles. Internal iliac lymph nodes follow the course of adjacent venous vessels and empty into the external iliac and common iliac lymph nodes.
Internal iliac nodes are divided into two main groups: the gluteal lymph nodes and the lateral sacral nodes. Lateral sacral lymph nodes are located within the pelvis at the concavity of the sacrum and receive lymph from the posteroinferior pelvic viscera. They drain directly to the lumbar lymph nodes. Gluteal lymph nodes are further subdivided into superior and inferior groups and are located along the gluteal vessels of the posterior pelvis.
Common iliac lymph nodes
Similar to the external and internal iliac lymph nodes, common iliac lymph nodes accompany the common iliac arteries and are divided into lateral, medial and posterior groups.
The lateral group of common iliac lymph nodes drains the external iliac lymph nodes, while the medial group receives lymphatic drainage from the internal iliac lymph nodes. The posterior group of common iliac lymph nodes receive efferents from both the internal and external iliac lymph nodes.
The common iliac lymph nodes travel in parallel with the veins of the pelvis and empty into the left and right lateral aortic nodal chains, which are part of the lumbar lymph nodes.
Would you like to learn more about the anatomical structure and function of the lymphatics of the human body? Check out our diagrams and quizzes on the lymphatic system of the human body.
Lumbar lymph nodes
The lumbar lymph nodes are divided into three main groups: the right lateral aortic, left lateral aortic, and preaortic lymph node groups. The right lateral aortic lymph nodes are further subdivided into paracaval and retrocaval lymph nodes. The preaortic lymph nodes also include the precaval lymph nodes. The right and left lateral aortic lumbar nodes tend to receive lymph drained from common iliac and sacral nodes, and also from the ovaries or testes. The preaortic nodes receive lymph from the rectum, anal canal, colon and anterior abdominal wall while retroaortic/retrocaval nodes receive drainage from the posterior abdominal wall.
Collectively, the efferent vessels of the lumbar lymph nodes join the right lumbar trunk which drains into the cisterna chyli.
Visceral pelvic lymph nodes
Visceral pelvic lymph nodes surround the pelvic viscera and empty into the parietal lymph nodes of the pelvis.
Paravesical lymph nodes of the bladder
The paravesical lymph nodes are found in the subperitoneal tissue surrounding the bladder and function to receive lymphatic drainage from the bladder. They can be divided into three groups according to their location relative to the bladder: the prevesical, lateral vesical and postvesical lymph nodes.
Efferent vessels of the paravesical lymph nodes typically empty into the external and internal iliac lymph nodes of the pelvis.
Parauterine lymph nodes
The parauterine lymph nodes are located around the uterus, specifically within the broad ligament of the uterus.
This group of lymph nodes functions to drain lymph from the body of the uterus and cervix to the external or internal iliac lymph nodes via efferent vessels. Some vessels may also drain into the sacral or superficial inguinal lymph nodes of the pelvis.
Paravaginal lymph nodes
The paravaginal lymph nodes are situated around the vagina. This group of lymph nodes can be separated into superior, intermediate and inferior lymph nodes according to their location and drainage route.
The most superior paravaginal lymph nodes accompany the uterine artery and drain into the internal and external iliac lymph nodes. Intermediate nodes are located adjacent to the vaginal artery and drain solely into the internal iliac lymph nodes. Meanwhile, the most inferior paravaginal lymph nodes drain lymph from the vulva and perineal skin and empty into the superficial inguinal lymph nodes.
Pararectal lymph nodes
The pararectal lymph nodes surround the rectum and are associated with the middle and inferior rectal arteries. They drain the lower portion of the rectum and return the lymph to the external and internal iliac lymph nodes of the pelvis.
Test your knowledge on the lymphatics of the male genitalia with this quiz.
The pelvic lymph nodes are highly interconnected allowing lymphatic fluid to pass in almost any direction, between any pelvic or abdominal organ. While this highly connected network allows for efficient and prolific lymphatic drainage it also allows for cancerous tissue to spread in virtually any direction, to any pelvic or abdominal viscera.
As a result, the lymphatic system of the pelvis may be used in the diagnosis and treatment of cancers that affect organs in the pelvic region. However, while pelvic lymphatic drainage tends to parallel venous drainage, the pattern is not sufficiently predictable and therefore the progression of pelvic tumors may still remain uncertain.
Cancer of the bladder can spread through the internal iliac and obturator nodes. Cervical cancer spreads easily through the internal, external and obturator nodes. The removal of these nodes helps to stop the spread and therefore improves treatment.
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