Sara Paterson-Brown, in straightforward Science in Obstetrics and Gynaecology (Fourth Edition), 2010

The lymphatic system

Lymphatic vessels

The extracellular tissues of the body space constantly obtaining fluid and also debris (from capillary leakage, cabinet death, etc.) and also the function of the lymphatics is to remove this and return it come the venous circulation. The lymphatic capillaries have actually the same an easy structure together vascular capillaries yet their distribution is not uniform throughout the body. The lymphatics in the limbs tend to it is in superficial, when those the the viscera have tendency to drain via networks on the posterior abdominal muscle and thoracic walls.

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The lymphatic vessels return the lymph come the venous device via two main channels:

The right lymphatic duct drains the right thorax, upper limb, head and neck

The thoracic duct drains every lymph from the lower half of the body.


The pre- and para-aortic lymphatics drain into the cisterna chyli i beg your pardon is an elongated sac-like vessel that lies over the body of L1 and L2 behind the worse vena cava and between the aorta and also the azygous vein. It i do not care the thoracic duct together it ascends through the diaphragm at the level that T12. It starts ~ above the ideal side the the oesophagus, yet as it ascends through the thorax the thoracic duct overcome behind the oesophagus (at T5) to reach its left side, then superiorly that passes end the left subclavian artery and the dome the the left pleura to drainpipe into the confluence that the left subclavian through the left interior jugular veins.

Lymphatics, like blood vessels (and uneven somatic nerves), deserve to cross the midline, but in contrast they happen to and from lymph nodes (afferent and efferent lymphatics) and they consist of an anastomosing low-pressure system.

Lymphatic tissue

These make up concentrations that lymphocytes and occur in mucosal and also submucosal collection in the gut (e.g. Peyer's job in the ileum) and in the thymus, the spleen and lymph nodes themselves.

The anatomical clinical importance of this mechanism relates come the drainage trends of each team of nodes, i beg your pardon is summary in Table 5.1, but also described because that the separation, personal, instance organs in your relevant local anatomy sections.


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A. Kaipainen, D.R. Bielenberg, in Encyclopedia the the Eye, 2010

Structure and role of the Lymphatic System

The lymphatic system develops a one-way route, moving lymph from the periphery of tissues through the thoracic duct or the right lymphatic duct into the venous blood. These two key lymphatic ducts are associated with the venous mechanism at the junction the the left interior jugular vein and also the left subclavian vein and also at the veins of the ideal jugulo-subclavian confluence, respectively. However, other potential lymphaticovenous communications (e.g., iliac and also renal areas) may become functional when lymphatic pressure rises or in a pathological situation.

Beyond its key function, the drainage of extravasated organization fluid ago to the venous circulation, the lymphatic device serves numerous other features which encompass transport because that immune defense and absorption that lipids from the intestine. Almost all vascularized tissues, other than the main nervous mechanism (CNS), are invested through lymphatic vessels. The CNS lacks lymphatics since it has actually a blood-neural obstacle that is much less permeable than various other tissues and is immune-privileged. In the eye, lymph drainage is present in the conjunctiva, sclera, and choriocapillaris, while there is no lymph drainage for the anterior chamber, vitreous cavity, subretinal space, or cornea.


In the peripheral tissues, lymphatic vessels and blood vessels are found in close proximity, yet the two systems never intermix (Figure 1). Lymphatic attributes are reflect in the specific structure that the lymphatic vessels. A main characteristic is the discontinuity of the basement membrane in ~ the interface in between the lymphatic endothelium and also the bordering connective tissue that facilitates active fluid transport. In some tissues, including intestine, lung, and also skin, lymphatic vessels fully lack a basement membrane. A second significant characteristic is the tight connection of the lymphatic endothelial cells (LECs) come the neighboring matrix with anchoring filaments (AFs). It has been propose that organization expansion due to excess interstitial fluid tightens the AFs, which pull on the lymphatic capillaries, thereby producing gaps in between the LEC to increase the input of fluid. A third characteristic of the lymphatic vessels is the valves in the vessel wall surface are currently present in ~ the level that capillaries, unlike in the venous blood device where lock are uncovered only in venules and larger vessels. These valves ensure unidirectional circulation of the lymphatic fluid, i beg your pardon starts in the blind-ended capillaries. Furthermore, LECs are significantly larger 보다 the blood endothelial cells; this allows elongation the the cells to accommodate the organization stretch (see Table 1 because that a perform of differences between lymphatic vessels and also blood vessels).


*

Blood vesselsLymphatic vessels
Circular systemUnidirectional system
Artery → capillary → veinCapillary → collector → TD → vein
Formed E6.5–9.5 (mice)Sprout native vein at E9.5–12.5 (mice)
Capillaries have actually BMCapillaries have actually discontinuous or lack BM
SMC might surround capillariesCapillaries absence SMC
No anchoring filamentsCapillaries have actually anchoring filaments
Flow is dictated by love beatFlow is dictated by interstitial pressure
No valves in capillariesCapillaries have actually valves
Blood inside the vesselsLymph within the vessels
Contain every the hematopoietic cellsContain immune cells and no RBC
Retina has blood vesselsRetina lacks lymphatic vessels

BM, basement membrane; RBC, red blood cells; SMC, smooth muscle cells; TD, thoracic duct.


David L. Hirsch, Michael J. Spink, in present Therapy In Oral and also Maxillofacial Surgery, 2012

Cervical Lymphatics

Henri Rouvière schematically explained the lymphatic drainage the the head and also neck as two concentric narrowing funnels draining caudally come the thoracic duct (left) and also lymphatic duct (right). This paradigm is oversimplistic yet is still teach in colleges today. Regional metastases native the dental cavity often drainpipe to Robbins levels i to III, hence the rationale because that supraomohyoid neck dissection. Skip metastases space possible, and the tongue and soft palate room often uncovered to have bilateral regional metastases on final pathologic evaluation. Table 53-1 illustrates the anatomic level of the neck and their importance.

Predictable drainage the the dental cavity come the very first echelon of the lymphatic basin does exist. However, together a an outcome of data from huge clinical outcome studies and the ability of lymphoscintigraphy come map sentinel nodes, surgeons now recognize the drainage deserve to be top top an separation, personal, instance basis. Skip metastases to level IV in lateral tongue SCC and also retropharyngeal drainage of the soft palate follow this paradigm. Another caveat lector is that formerly operated necks may have actually hitherto undiagnosed, nascent, or recurrent metastases. Therefore, lymphatic drainage can be unpredictable after surgery, and clinically hopeful (cN+) or negative (cN0) nodes through micrometastases might go undetected.

Radiologists incorporate nodal critical size and also morphology to determine “suggestive” cervical adenopathy. Hesitation for regional metastases is high in the setting of OSCC if nodes screen a central hypointensity regular with central necrosis; if they are round and not kidney bean shaped, which represents expansion; if the surrounding fascial plane is obliterated, i beg your pardon signifies organization necrosis or fixation; if your dimensions are greater than 15 mm at level II and also greater 보다 10 mm elsewhere; or if a spiculated periphery indicative the extracapsular spread is present. This critical characteristic is a significant poor prognostic indicator for OSCC.


Alfonso López, Shannon A. Martinson, in Pathologic communication of Veterinary disease (Sixth Edition), 2017

Chylothorax.

The buildup of chyle (lymph affluent in triglycerides) in the thoracic cavity (Fig. 9-116) is a an outcome of the rupture of significant lymph vessels, typically the thoracic duct or the right lymphatic duct. The clinical and also pathologic effects of chylothorax are similar to those of the other pleural effusions. Causes include thoracic neoplasia (the many common reason in human being beings however a distant 2nd to idiopathic cases in dogs), trauma, congenital lymph vessel anomalies, lymphangitis, dirofilariasis, and also iatrogenic rupture of the thoracic duct during surgery. The source of the leakage of chyle is rarely discovered at necropsy. As soon as the leakage the chyle occurs in the abdominal muscle cavity, the problem is referred to as chyloabdomen. Cytologic and biochemical examination of fluid collected by thoracocentesis frequently reveals large numbers the lymphocytes, lipid droplets, couple of neutrophils in chronic cases, and high triglyceride content.


Robert G. Carroll PhD, in Elsevier's integrated Physiology, 2007

Lymphatics

Lymphatics room a network the endothelial tubes that merge to type two huge systems that get in the veins. Lymph indigenous the right side of the head, best trunk, and right eight drains right into the ideal lymphatic duct. Lymph from the remainder the the human body drains into the thoracic duct, which empties into the thoracic vena cava.

Terminal lymphatics (Fig. 8-3) absence tight junctions, allowing big proteins (and metastasizing cancer cells) to enter the circulatory mechanism through the lymphatic system. Lymph composition carefully resembles interstitial liquid composition. In the GI tract, lymphatics permit digested fats to get in the circulation. Lymph is pushed by (1) massaging from nearby muscle, (2) organization pressure, and (3) convulsion of the lymph vessels. Valves ensure the the flow of lymph is toward the vena cava. End 24 hours, the volume that lymph flow in the body is equal to approximately 5 L, the same as the complete blood volume. Lymph is filtered in lymph nodes prior to progressing back to the circulation.


Mary ann Jackson, J. Christopher Day, in Principles and also Practice the Pediatric transmittable Diseases (Fifth Edition), 2018

Lymphatic Drainage that the Lungs and also Pleura

As displayed in Fig. 18.1, lymph indigenous the thoracic viscera (heart, pericardium, lungs, pleura, thymus, and also esophagus) traverses among three feasible sets that nodes before entering the thoracic duct or right lymphatic duct. Anterior mediastinal nodes are situated anterior to the aortic arch, innominate veins, and large arterial trunks top from the aorta. They receive afferents from the thymus and pericardium, the sternal nodes, and the thyroid gland.

Posterior mediastinal nodes lied dorsal to the pericardium and adjacent to the esophagus and also descending aorta. They obtain afferents from the esophagus, dorsal pericardium, diaphragm, and convex surface ar of the liver. Middle or mediastinal nodes drain the lungs and also pleura. Lymphatic drainage the the lungs is written of superficial and deep plexuses. The superficial plexus lies beneath the visceral pleura. Lymph flows approximately the border the the lung to get in the bronchopulmonary (hilar) nodes. The deep plexus accompanies branches the the pulmonary vessels and also ramifications the the bronchi throughout the lungs.

Lymphatic drainage that the lung overcome through four sets that lymph nodes (Table 18.1). Intrapulmonary lymph nodes are situated within the lung, chiefly at the bifurcations the the larger bronchi. Bronchopulmonary or hilar nodes are situated at the pulmonary hilus in ~ the site of entry of the main bronchi and vessels. Tracheobronchial nodes are separated into superior and inferior groups. The superior team lies in the obtuse angle between the trachea and bronchi ~ above both sides. The inferior, or subcarinal, team lies under the carina in ~ the tracheal bifurcation. The 4th group, the tracheal or paratracheal nodes, lies beside and also somewhat anterior come the trachea. A fifth group the lymph nodes of prominence in the drainage that the lungs is the worse deep cervical (scalene or supraclavicular) chain, i beg your pardon is situated over the lower portion of the interior jugular vein, just above the clavicle and also usually under the scalenus anterior muscle. The apical pleurae drain straight to these deep cervical nodes, as execute the paratracheal chains. A detect of supraclavicular lymphadenopathy should lead to investigation for intrathoracic or intra-abdominal pathology.

Ultimately, every lymph from the lungs and pleurae will the tracheobronchial and also paratracheal lymph nodes. Generally, lymph native the lungs flows from left come right, a probable explanation because that the preeminence of right upper paratracheal and also supraclavicular lymphadenopathy in contagious pulmonary processes, particularly tuberculosis. Lymph native the left lower lobe (and usually additionally the lingula) flows from the hilar nodes come the reduced tracheobronchial nodes, and then to the ideal paratracheal nodes. Lymph indigenous the ideal hilar nodes travels to the right paratracheal nodes (see Table 18.1).

Lymph vessels from the paratracheal nodes sign up with with lymph trunks native the anterior mediastinum to form the right and left bronchomediastinal trunks. This trunks then join with the lymphatic trunks from the supraclavicular nodes to form the ideal lymphatic duct and left thoracic duct.


Bruce H. Culver, Robb W. Glenny, in Clinical Respiratory medicine (Fourth Edition), 2012

Lymphatic Circulation

Pulmonary lymphatics are not found in alveolar walls yet originate in interstitial spaces in ~ the level the the respiratory bronchioles and also at the pleural surface, climate follow the bronchovascular majority to the hila. The lymph flows with the ideal lymphatic duct and also the thoracic duct into the right and left brachiocephalic veins. The complete flow indigenous the lungs is fairly low under normal conditions (less than 0.5 mL/minute in experimental animals) but can rise many-fold through pulmonary edema. The lymphatics have valves to protect against backflow and also can generate adequate pressures to maintain circulation when systemic venous push is as high as 20 cm H2O.


Mary anne Jackson, J. Christopher Day, in Principles and also Practice the Pediatric infectious Diseases (Fifth Edition), 2018

Anatomy and role of Lymphoid Tissue

The lymphoid mechanism is composed of comprehensive capillary network the drains lymph into elaborate systems of collecting vessels. The collecting vessels merge and also empty lymph right into the bloodstream by means of the thoracic duct at its entry right into the left subclavian vein or by the right lymphatic duct, i beg your pardon empties right into the ideal subclavian vein. Devoted lymphatic frameworks interspersed along the collecting vessels encompass the tonsillar tissues of the Waldeyer ring, the thymus, the spleen, mucosa-associated lymphoid nodules, and lymph nodes (Table 16.1).

The Waldeyer ring that lymphoid tissue that surrounds the oropharyngeal isthmus and the opening of the nasopharynx right into the oropharynx is uniquely positioned to interact with foreign material start the sleep or mouth. The ring is created superiorly by the midline pharyngeal (adenoid) tonsil, i m sorry is situated in the roof that the nasopharynx, and also inferiorly by the lingual tonsils in the posterior third of the tongue. Top top either side of the pharynx, the lateral pharyngeal bands the lymphoid tissue connect the adenoid to the tubal tonsils the Gerlach in ~ the openings that the eustachian tubes and also to the faucial (palatine) tonsils. Smaller sized aggregates that lymphoid tissue in this area incorporate the posterior pharyngeal granulations and also the lymphoid organization within the laryngeal ventricle.

Small submucosal lymphoid nodules located throughout the respiratory, gastrointestinal, and also genitourinary tracts room composed that phagocytic and also lymphoid cell collections without a connective tissue capsule. These nodules room ideally located to respond come mucosal antigens.

The thymus, i beg your pardon is situated over the premium vena cava in the anterior mediastinum, is reasonably protected indigenous antigens. Surrounded by a thin connective tissue capsule, the thymus is uniquely composed of epithelial and lymphatic elements.

The spleen is the biggest lymphatic body organ in the body and the only lymphatic tissue devoted to filter blood. Comparable to the lymph nodes, the spleen is a ingredient of the peripheral lymphoid system and is composed of red pulp (i.e., red blood cells) and also an inner of white pulp, which contains lymphoid nodules with germinal follicles.

Normal lymph nodes are small, oval or bean-shaped bodies that room strategically located along the course of lymphatic vessels to filter lymph ~ above its way to the bloodstream. Lymphatic vessels enter approximately the perimeter of the nodes. Lymph filters through the cortex to the medulla the the node and exits through the hilum. Blood vessels enter and also leave with the hilum, which is connected to capillaries that course v the node. During this process, lymphocytes deserve to leave the blood and re-enter the lymphatic circulation.

Nodes space densely packed through lymphocytes the are organized loosely right into cortical nodules and also medullary cords by connective organization trabeculae and lymphatic sinuses. The junxtap location of phagocytic cells, antigen-processing cells, and also lymphocytes in an area of sluggish blood flow is ideally suited to carry out the very first line of defense against pathogens. As lymph gradually filters v the rich reticular network, organisms are trapped and can it is in ingested through phagocytic cells, stimulating the release of cytokines, which recruits lymphocytes because that immunologic responses. The lymph node teams in the body can be divided into the superficial and peripheral nodes, which usually are conveniently palpable, and also the depth groups nearby to major vessels and viscera (see Table 16.1).


C.J. Carati, B.J. Gannon, in Encyclopedia of respiratory Medicine, 2006

Lymphatic networks in the lung are discovered in close association v blood vessels and bronchi, and in the pleura. This networks anastomose in ~ the lung surface and interlobular septa, and drain via the hilar region into the mediastinal and also tracheobronchial lymphatic system, and also thence to the ideal lymphatic duct or thoracic duct. Interstitial liquid from the alveolar walls drains right into the parenchyma that the alveolar ducts, where it enters blind-ended lymphatic capillaries consists of an easy discontinuous yet overlapping endothelial cells. These in turn drainpipe into collecting lymphatic vessels that contain smooth muscle and also one-way valves to help pump the lymph centrally along the network, significantly aided by respiratory and vascular movement. This drainage maintains common tissue hydration, however is overcome in cardiovascular and also lung condition resulting in fluid buildup at the alveolar level. The lymphatics also carry out a route of removed of inflammatory and also pathological material, including tumor cells, which often end up in lymph nodes. Components that can compromise lymphatic drainage from the lungs include reduced lymphatic pumping by endangered respiratory, vascular, or human body movement; inhibition that lymphatic pump by inflammation cytokines or cells; constriction that lymphatic vessels by exterior forces; obstruction of the lymphatics by tumor; or increased main venous pressure. Pleural fluid drainage is via intercellular gaps referred to as stomata in the pleural mesothelial lining, i m sorry directly affix the pleural caries to lymphatics that drain the dependent regions of the parietal pleura.


The following code and also results are an illustration of just how one can do semantic consistency check in one ontology like the FMA. Us specifically focus on the lymphatic system because it will be revisited in section 5.5.3. Below are two certain requirements because that consistency and also completeness in the lymphatic system:

1.

Every lymphatic chain should have efferent-to relations just to various other lymphatic chain or come lymphatic ship such as the Thoracic duct or the best lymphatic duct.

2.

Starting with any type of lymphatic drainage native an organ or organ part, all courses using the efferent-to relationship should finish up at either the Thoracic duct or the ideal lymphatic duct.


The an initial requirement is a slightly more stringent need than the existing FMA specifies in the “efferent to” relation, but it is vital in order come get coherent pathways. In the FMA specification that the “efferent to” relation, the following are allowed classes:

Lymphatic chain

Lymphatic vessel

Anodal lymphatic tree

Lymphatic plexus

Lymph node

The Thoracic duct and also Right lymphatic duct room lymphatic trunks, which space subclasses of Lymphatic vessel, therefore they should be allowed, in addition to other trunks. Anodal lymphatic tree are tiny networks of lymphatic vessels that directly drain structures.


The tests will be perform in a sequence of steps. Of food for totally automated checking these steps might easily be combined. First, for the lymphatic chains and vessels, we get all the instances, using the all-subclasses role previously defined.

> (setq allchains (all-subclasses "Lymphatic chain"))

("Pulmonary lymphatic chain"

 "Subdivision of pulmonary lymphatic chain"

 "Axillary lymphatic chain" "Subdivision of axillary lymphatic tree"

 "Posterior mediastinal lymphatic chain"

 "Tracheobronchial lymphatic chain"

 "Tributary of tracheobronchial lymphatic chain"

 "Left cardiac tributary of tracheobronchial lymphatic chain"

 "Brachiocephalic lymphatic chain"

 "Right cardiac tributary of brachiocephalic lymphatic chain" …)

> (setq allvessels (all-subclasses "Lymphatic vessel"))

 ("Variant lymphatic vessel" "Lymphatic capillary"

 "Tributary that lymphatic trunk" "Tributary that lymph node"

 "Superficial lymphatic vessel" "Deep lymphatic vessel"

 "Lymphatic trunk" "Incomplete appropriate lymphatic duct"

 "Absent thoracic duct" "Absent cisterna chyli" …)


Checking the lengths that the 2 lists that result, it shows up there room 353 chains and 670 vessels. For each that the item in the 2 lists, us retrieve the worths in the “efferent to” slot. This is conveniently done by creating a function to go through each list, obtain the “efferent to” contents, and also pair it with its chain or vessel.

(defun get-efferents (terms)

(mapcar #’(lambda (x)

(list x (efferent-to x)))

terms))


We apply it to both lists, providing the adhering to results.

> (setq chain-slots (get-efferents allchains))

 (("Pulmonary lymphatic chain" ("Bronchopulmonary lymphatic chain"))

("Subdivision of pulmonary lymphatic chain" NIL)

("Axillary lymphatic chain"

("Subclavian lymphatic trunk" "Subclavian lymphatic tree"))

 ("Subdivision of axillary lymphatic tree" NIL)

 ("Posterior mediastinal lymphatic chain"

("Thoracic duct" "Tracheobronchial lymphatic chain"))

 ("Tracheobronchial lymphatic chain"

("Bronchomediastinal lymphatic trunk"

"Bronchomediastinal lymphatic tree"))

 ("Tributary of tracheobronchial lymphatic chain" NIL)

 ("Left cardiac tributary the tracheobronchial lymphatic chain" NIL)

 ("Brachiocephalic lymphatic chain"

("Bronchomediastinal lymphatic trunk"

 "Bronchomediastinal lymphatic tree"))

 ("Right cardiac tributary of brachiocephalic lymphatic chain" NIL)

 …)

> (setq vessel-slots (get-efferents allvessels))

 (("Variant lymphatic vessel" NIL) ("Lymphatic capillary" NIL)

 ("Tributary of lymphatic trunk" NIL)

 ("Tributary the lymph node" NIL)

 ("Superficial lymphatic vessel" NIL) ("Deep lymphatic vessel" NIL)

 ("Lymphatic trunk" NIL) ("Incomplete ideal lymphatic duct" NIL)

 ("Absent thoracic duct" NIL) ("Absent cisterna chyli" NIL) …)


Now we have the right to just iterate v these lists check if the entries complement our criteria above. In every entry, the second item should be a list of only lymphatic chain or vessels, in which situation we put it ~ above a “good” list, or it is nil, definition no info is entered, and we put it top top a “not done” list, or it is some other things, in which situation we placed it top top a “bad” list.

(defun check-efferents (termslots allowed)

"termslots is a perform of chains or vessels and their efferent to

 slot values. Enabled is the complete list of allowed values"

 (let (good negative not-done)

(dolist (chain termslots)

(let ((efferents (second chain)))

(cond ((null efferents) (push chain not-done))

((every #’(lambda (x)

(find x permitted :test #’string-equal))

efferents)

(push chain good))

(t (push chain bad)))))

(list good bad not-done)))


Strictly speaking over there is nothing in this role about the “efferent to” relation. It deserve to be offered to check any list the (term slot-value) pairs against a list of allowed values. Below are the outcomes for the list of chains:

> (setq chain-checks (check-efferents chain-slots

(append allchains allvessels)))

((("Left submental lymphatic chain"

("Left submandibular lymphatic chain"

"Left jugulo-omohyoid lymphatic chain"))

("Right submental lymphatic chain"

("Right submandibular lymphatic chain"

"Right jugulo-omohyoid lymphatic chain")) …)

 (("Left parasternal lymphatic chain"

("Left bronchomediastinal lymphatic tree"))

("Right parasternal lymphatic chain"

("Right bronchomediastinal lymphatic tree")) …)

 (("Left level using lymphatic chain" NIL)

("Right level vi lymphatic chain" NIL)

("Left level V lymphatic chain" NIL) …))


We think about a slot good if its worths come from one of two people the chain perform or the vessel list. Now, how countless are over there of each?

> (length (first chain-checks))

140

> (length (second chain-checks))

11

> (length (third chain-checks))

202


So, 140 that the chains room correct, 11 have actually some problem, and 202 room still not completed. If we look in ~ the 11 that have actually a problem, that is noticeable that these entries are largely ones whereby a lymphatic tree has actually been entered. It seems problematic that a chain might be efferent to a subtree the the lymphatic system, return this is anatomically correct. A chain the is part of a tree connects come the tree and the lymphatic liquid flows native the chain right into that branch that the tree. However, for course tracing, that is no useful, due to the fact that the flow from that chain does not go v the whole tree, yet only with a subset the branches. For this reason this needs to be solved in order to do sound course tracing. There space so couple of that that is relatively easy to settle this modeling problem.

> (pprint (second chain-checks))

(("Left parasternal lymphatic chain"

("Left bronchomediastinal lymphatic tree"))

 ("Right parasternal lymphatic chain"

("Right bronchomediastinal lymphatic tree"))

 ("Left tracheobronchial lymphatic chain"

("Left bronchomediastinal lymphatic trunk"

 "Left bronchomediastinal lymphatic tree"))

 ("Right tracheobronchial lymphatic chain"

("Right bronchomediastinal lymphatic trunk"

 "Right bronchomediastinal lymphatic tree"))

 ("Lymphatic chain of reduced lobe of left lung"

("Left bronchopulmonary lymph node"))

 ("Lymphatic chain of reduced lobe of appropriate lung"

("Right bronchopulmonary lymph node"))

 ("Parasternal lymphatic chain"

("Bronchomediastinal lymphatic trunk"

 "Bronchomediastinal lymphatic tree"))

 ("Infraclavicular lymphatic chain"

("Subclavian lymphatic tree" "Apical axillary lymphatic chain"

 "Subclavian lymphatic chain"))

 ("Brachiocephalic lymphatic chain"

("Bronchomediastinal lymphatic trunk"

 "Bronchomediastinal lymphatic tree"))

 ("Tracheobronchial lymphatic chain"

("Bronchomediastinal lymphatic trunk"

 "Bronchomediastinal lymphatic tree"))

 ("Axillary lymphatic chain"

("Subclavian lymphatic trunk" "Subclavian lymphatic tree")))


Now the exact same checks have the right to be performed on the ship list, and the counts because that the 3 categories come out together follows:

> (length (first vessel-checks))

13

> (length (second vessel-checks))

2

> (length (third vessel-checks))

655


On inspection of the 2 that space flagged together bad, the same difficulty appears. A tree has actually been gone into where us would intend a trunk, vessel, or chain.

The 2nd check, to identify whether all routes terminate at the Thoracic duct or best lymphatic duct, is much more challenging. The truth that plenty of “efferent to” relationships room still no done provides it extremely likely that there are numerous incomplete paths, so this check is more than likely premature. Nevertheless, it must be clear exactly how to execute it. Indigenous the list of chains and vessels, one traces the paths, and examines their end points. Looking ago to the example for the Soft palate, you can see that starting there, a route ends in ~ the Jugular lymphatic trunk. However, there room two jugular lymphatic trunks, a right and a left. One goes come the thoracic duct and also one goes come the appropriate lymphatic duct. So it is correct to have no entry in ~ the higher level that generality. This is yet another complication in checking consistency and also completeness, and also in using the expertise to clinical difficulty solving. Over there are numerous such locations where anatomical frameworks are defined as general classes, and also then have more specific right and left instances (subclasses). This is an extremely important, because geography is important and also (especially through radiation therapy) one have to specify top top which side the entities of interest are. The presence of the general and right/left instances makes reasoning difficult to automate. Over there is room for some more innovation here.

So, no one of the results over should be taken into consideration as deficiencies in the FMA. Rather, our check have determined some further complexities in the version itself. An additional possibility is the the path examine may reveal circularities. The path tracing code described previously would certainly not terminate in this case, and a various kind of examine is needed, where one keeps track of nodes already visited and flags any kind of returns to together nodes.

The questions interface defined here, while quiet operational, is peculiar to the FMA, and also not fine matched come standards and also methods used widely in Semantic net research and also implementation. The FMA can additionally be stood for as a graph structure using RDF <271>, and a generalization that the SPARQL ask language <426> has been emerged to support the facility queries the are becoming important in medicine <90,375>.

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Anatomy, crucial as the is, is periodically viewed together a “dead” subject, with tiny or nothing brand-new to it is in discovered. However, despite several thousand year of dissection, study, and advance of terminology, it seems that much remains to it is in done. The FMA project, through its goal to develop a continuous computational theory of anatomy, is one of the many ambitious ontology building projects in biomedical informatics. We have learned native it the the expressivity that the metaclass idea, and also the representation of relations themselves as entities, are both vital elements of facility biomedical theories. Another an extremely important realization comes the end of this job-related as well. Biomedical informatics is not just straightforward application of well-established computer system science methods. As note Musen has actually said, “ours is the discipline that cares around the content” <291>. Biomedical informatics gives formal shape to biomedical content, and in the struggle to acquire it right, feeds earlier to computer system science and information science brand-new ideas and also challenges. This is precisely parallel come the relation between theoretical physics and mathematics.