The right lymphatic duct drains the upper right body including the right head and neck, right upper extremity, right diaphragm, right lung, lower left lung, most of the heart, and part of the right lobe of the liver [13]. It is formed by the joining together of the right jugular, right subclavian, and right bronchomediastinal lymphatic trunks and measures 2 cm in length, respectively. The right bronchomediastinal trunk is the vestigial portion of the embryologic right thoracic duct [13]. The right lymphatic duct mainly terminates in the junction of the right subclavian and right internal jugular veins; however, it has numerous variations like the thoracic duct [13].

The cisterna chyli is a 2–5 cm elongated sac located retroperitoneally approximately at the second lumbar vertebra. It is the beginning of the thoracic duct. It drains lymph from the right and left lumbar trunks, the intestinal trunk, and the lowest intercostal vessels. These vessels either form a single sac or multiple sacculations. The union of the individual vessels may occur in the thoracic region instead of the abdomen [14]. The lumbar trunks obtain lymph from the pelvis, kidneys, adrenal glands, and area of the abdominal wall below the umbilicus. The intestinal trunk drains lymph from the celiac and superior mesenteric arteries [13].

In the extremities there is an epifascial and a subfascial lymphatic system. The epidermal valveless lymphatics drain toward the subdermal valved lymphatics which then flow to collecting vessels above the fascia. The subdermal lymphatics are responsible for draining the integument and normally follow along with the veins. The epifascial and subfascial lymphatics communicate via perforators. The deep lymphatics flow below the deep fascia and course parallel with the main vascular structures [5]. In both the superficial and deep lymphatic system several small afferent lymphatic vessels lead lymph fluid to lymph node sinuses. The fluid exits the lymph node hilum via large efferent channels on its return to the cardiovascular system [5, 17]. The epifascial lymph nodes interconnect into four central draining chains: the paired axillary and inguinal lymph node systems [5].

The superficial lymphatic system of the upper extremity is divided into an ulnar bundle and a radial bundle. The ulnar bundle drains the medial arm and follows the basilic vein to the axillary lymph nodes [5]. Part of the ulnar bundle branches at the hiatus basilicus and connects with the deep lymphatic system of the upper extremity via perforators. The radial bundle obtains lymph from the lateral arm and accompanies the cephalic vein until it joins the axillary lymph nodes at the lower margin of the pectoralis major muscle [5]. Lymph will then drain from the axillary lymph nodes to either the supraclavicular and/or infraclavicular lymph node and then to either the thoracic duct (left upper extremity) or the right lymphatic duct (right upper extremity) [5].

The epifascial system of the lower extremity collects lymph from the skin and subcutaneous layers and is divided into two bundles: ventromedial and dorsolateral bundles [5]. The dorsolateral bundle parallels the lesser saphenous vein, passes through the popliteal nodes, continues as the subfascial lymphatics of the thigh, and ends either in the deep inguinal or anterior iliac nodes. The ventromedial bundle runs with the greater saphenous vein but has greater variability in how it terminates [5]. The subfascial system accompanies the anterior and posterior tibial vasculature until they join with the dorsolateral bundle at the popliteal nodes. These collector vessels drain the muscles and fascia of the lower extremity [5].

The lymphatic vasculature recycles interstitial fluids from veins back to the circulatory system, contributes to the immune response, and participates in the digestive tract [1, 5, 18]. Fifty to 100 % of plasma exits into the interstitium daily and provides nourishment to surrounding tissues [19, 20

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