Lymphatic drainage and Nerve supply of the chest wall
Lymphatic drainage of the chest wall
Lymph drainage from the:
• Anterior chest wall: is to the anterior axillary nodes.
• Posterior chest wall: is to the posterior axillary nodes.
• Anterior intercostal spaces: is to the internal thoracic nodes.
• Posterior intercostal spaces: is to the para-aortic nodes.
Nerve supply of the chest wall
The intercostal nerves are the anterior primary rami of the thoracic segmental nerves. Only the upper six intercostal nerves run in their intercostal spaces, the remainder gaining access to the anterior abdominal wall.
Branches of the intercostal nerves include:
• Cutaneous anterior and lateral branches.
• A collateral branch which supplies the muscles of the intercostal space (also supplied by the main intercostal nerve).
• Sensory branches from the pleura (upper nerves) and peritoneum (lower nerves). Exceptions include:
• The 1st intercostal nerve is joined to the brachial plexus and has no anterior cutaneous branch.
• The 2nd intercostal nerve is joined to the medial cutaneous nerve of the arm by the intercostobrachial nerve branch. The 2nd intercostal nerve consequently supplies the skin of the armpit and medial side of the arm.