THE LYMPH GLANDS OF THE ABDOMEN AND PELVIS 703 



three are present, the lowest is situated just below the junction of the great saphe- 

 nous and femoral veins, the middle in the femoral canal, and the highest in the 

 lateral part of the femoral ring. The middle one is the most inconstant of the 

 three, but the highest, the gland of Cloquet or Rosenmuller, is also frequently absent. 

 They receive as afferents the deep lymphatic trunks which accompany the femoral 

 vessels, the lymphatics from the glans penis vel clitoridis, and also some of the 

 efferents from the superficial subinguinal glands. 



The Lymphatic Vessels of the Lower Extremity. 



The lymphatic vessels of the lower extremity consist of two sets, superficial 

 and deep, and in their distribution correspond closely with the veins. 



The superficial lymphatic vessels lie in the superficial fascia, and are divisible 

 into two groups: a medial, which follows the course of the great saphenous vein, 

 and a lateral, which accompanies the small saphenous vein. The vessels of the 

 medial group (Fig. 610) are larger and more numerous than those of the lateral 

 group, and commence on the tibial side and dorsum of the foot; they ascend both 

 in front of and behind the medial malleolus, run up the leg with the great saphe- 

 nous vein, pass with it behind the medial condyle of the femur, and accompany 

 it to the groin, where they end in the subinguinal group of superficial glands. 

 The vessels of the lateral group arise from the fibular side of the foot; some ascend 

 in front of the leg, and, just below the knee, cross the tibia to join the lymphatics 

 on the medial side of the thigh; others pass behind the lateral malleolus, and, 

 accompanying the small saphenous vein, enter the popliteal glands. 



The deep lymphatic vessels are few in number, and accompany the deep blood- 

 vessels. In the leg, they consist of three sets, the anterior tibial, posterior tibial, 

 and peroneal, which accompany the corresponding bloodvessels, two or three with 

 each artery; they enter the popliteal lymph glands. 



The deep lymphatic vessels of the gluteal and ischial regions follow the course 

 of the corresponding bloodvessels. Those accompanying the superior gluteal 

 vessels end in a gland which lies on the intrapelvic portion of the superior gluteal 

 artery near the upper border of the greater sciatic foramen. Those following 

 the inferior gluteal vessels traverse one or two small glands which lie below the 

 Piriformis muscle, and end in the hypogastric glands. 



The Lymph Glands of the Abdomen and Pelvis. 



The lymph glands of the abdomen and pelvis may be divided, from their situa- 

 tions, into (a) parietal, lying behind the peritoneum and in close association with 

 the larger bloodvessels; and (6) visceral, which are found in relation to the visceral 

 arteries. 



The parietal glands (Figs. 611, 612) include the following groups: 



. 



External Iliac. Iliac Circumflex. /'Lateral Aortic. 



Common Iliac. Hypogastric. Lumbar -j Preaortic. 



Epigastric. Sacral. iRetroaortic. 



The External Iliac Glands, from eight to ten in number, lie along the external 

 iliac vessels. They are arranged in three groups, one on the lateral, another 

 on the medial, and a third on the anterior aspect of the vessels; the third group is, 

 however, sometimes absent. Their principal afferents are derived from the inguinal 

 and subinguinal glands, the deep lymphatics of the abdominal wall below the umbili- 

 cus and of the adductor region of the thigh, and the lymphatics from the glans 



THE LYMPHATICS OF THE ABDOMEN AND PELVIS. 



