19 - breast - lymphatic drainage

The lymphatic and venous drainages of the breast are of great importance in the spread of carcinoma. 

About three quarters of the lymphatic drainage is to the axillary nodes: 

(1) Lymphatics pass around the edge of the pectoralis major and reach the pectoral group of axillary nodes; 

(2) routes through or between the pectoral muscles may lead directly to the apical nodes of the axilla; 

(3) lymphatics follow the blood vessels through the pectoralis major and enter the parasternal (internal thoracic) nodes; 

(4) connections may lead across the median plane and hence to the contralateral breast; 

(5) lymphatics may reach the sheath of the rectus abdominis and the subperitoneal and subhepatic plexuses.

It should be noted that free communication exists between nodes below and above the clavicle and between the axillary and cervical nodes.

check out this mcq :

Q. find the incorrect statement about the lymphatic drainage of the breast ?

1. there is free communication between the subclavicular and supraclavicular lymph nodes
2. the lymph nodes along the internal mammary chain are involved in about half the cases in which the axillary nodes are implicated by carcinoma
3. the thoracic chain of lymph nodes lie along the internal mammary vessels
4. some lymph nodes lie between the greater and lesser pectoral muscles

answer: c .

18 - adamkiewicz's artery

In human anatomy, the Artery of Adamkiewicz is the largest anterior segmental medullary artery.

It has several other names, including Adamkiewicz artery, major anterior segmental medullary artery, artery of the lumbar enlargement,great radicular artery of Adamkiewicz,great anterior radiculomedullary artery and great anterior segmental medullary artery.

It typically arises from a left posterior intercostal artery, which branches from the aorta, and supplies the lower two thirds of the spinal cord via the anterior spinal artery.

In a study of approximately 70 people that examined the spinal cord's blood supply it was found that

1. The Adamkiewicz artery sometimes arises from a lumbar vessel.
2. In approximately 30% of people it arises from the right side.
3. One quarter of people have two large anterior segmental medullary arteries.

When damaged or obstructed, it can result in anterior spinal artery syndrome, with loss of urinary and fecal continence and impaired motor function of the legs; sensory function is often preserved to a degree.

It can be important to identify the location of the artery when treating an abdominal aortic aneurysm. Its location can be identified with computed tomographic angiography.

It is named for Albert Wojciech Adamkiewicz.