The gallbladder is drained by lymphatics that arise from the lamina propria and serosal adventitial layers and become confluent pass over the anterior and posterior surfaces of the gallbladder, much like the distribution of the arteries. Lymph also drains via lymphatics in the gallbladder fossa directly into the lymphatics of the liver.
From the anterior and posterior wall the main drainage is along the cystic duct to their first nodal station – Calot’s node located within Calot’s triangle near the neck of the gallbladder.
04766b05b04.59ak.8s Calot’s triangle calot’s lymph node anatomy normal Davidoff art copyright 2008 |
From the Calot’s node, there are then two major pathways sometimes via the hepatic nodes. The dominant pathway of lymphatic drainage is the cholecystopancreatic nodes. This pathway courses along the cystic duct and common bile duct and then to nodes that are posterior to the pancreas and the duodenum.
04766b05b04.59dk.8s gallbladder lymphatics Calot’s lymph node blood supply cystic artery anterior branch posterior branch cystic duct common hepatic duct common bile duct Calot’s triangle calot’s lymph node anatomy lymphatic drainage pancreatic node cholecystopancreticoduodenal pathway normal bile duct Davidoff art copyright 2008 Davidoff art copyright 2008 |
The second pathway is the cholecystoceliac where the lymphatics drain from hepatic nodes, and cystic node they pass along the hepatoduodenal ligament close to the foramen of Winslow and drain into to the celiac nodes
The third pathway is the cholemesenteric pathway via the posterior pancreatic nodes and then to aortocaval and paraaortic nodes.
The lymph nodes of the hilum of the liver are usually involved also in the drainage of the gallbladder.
Cystic Lymph Node (green) Among Other Foregut Nodes |
58 year old female with a biopsy proven liver biopsy of sarcoidosis with cirrhosis shows a CT scan through the abdomen with enlarged, lightly calcified nodes where the dominant calcification is on the periphery of the node. These nodes are characteristic of sarcoidosis. The calcified cystic node (green aka Calot’s node) lies medial to the cholecystectomy clip (arrow) The liver is cirrhotic and there is portal hypertension accounting in part for the splenomegaly which may also be enlarged as a result of the sarcoidosis. The portocaval node (yellow) lies between the portal vein (maroon) and the cava (blue). A pancreatic node (light orange) lies anterior and medial to the cystic node and anterior to the neck of the pancreas (pink). A left paraaortic node (orange is the only node on the left side of the foregut group of nodes shown.
82840c02.8s code sarcoidosis lymph node biopsy proven sarcoidosis of the liver with cirrhosis portal hypertension splenomegaly lymph node foregut cystic node node of Calot calcification CTscan Courtesy Ashley DAvidoff MD copyright 2008 |
26477b02arrow |
Courtesy Ashley Davidoff MD pancreas anatomy lymph node lymphatic drainage fx calcified calcification dx sarcoidosis kidney mass calcification calcified imaging radiology CTscan 26477b02arrow |
40432c02 Courtesy Ashley Davidoff MD code pancreas peripancreatic lymph nodes fx enlarged prominent code dx Hodgkin’s lymphoma imaging radiology CTscan neoplasm malignant tumor |
Histology
Lymphatic vessels Distended with Lymph |
The endothelial lined and distended lymphatics (overlaid in dark pink) are identified in the serosal and adventitial layer. The arrows point to associated endothelial lined small blood vessels containing red cells.
00141.1c01.8s Pools of endothelial lined foamy fluid (dark pink) filled vessels represent dilated lymphatics in the gallbladder fossa. Two small endothelial lined capillaries with a few red cells are also seen arrows lymphatics capillaries connective tissue Courtesy Ashley Davidoff MD |
There is a direct route of lymphatic drainage from the gallbladder fossa to the lymphatic channels of the liver through the adventitial surface in the gallbladder fossa.
00140c03.8s gallbladder wall gallbladder fossa normal artery duct liver interface histopathology |
Applied Biology
Inflammation of the gallbladder and liver are characterized by exudation of fluid due to hyperemia, and increased capillary leakage as a normal response by the body to the noxious agent. The increased extravascular fluid, may accumulate either by design to dilute the noxious agent or as a result decreased drainage of an overwhelmed lymphatic syatem that fails to drain effectively. As a result fluid may accumulate in the soft tissues of the gallbladder and the fluid is often visible to radiologic imaging.
In acute cholecystitis fluid may accumulate in the wall of the gallbladder, but more specifically pools in the gallbladder fossa .
00543c03s.8 right upper quadrant pain RUQ pain positive Murphy’s sign gallbladder gallbladder fossa thickened linear lacy thickening gall stones calculi calculous multiple small stones stones dependant position shadowing multiple small stones cholelithiasis cholecystitis acute cholecystitis acute calculous cholecystitis USscan ultrasound Courtesy Ashley Davidoff MD copyright 2008 |
48008c01 gallbladder thick wall non distended dx hepatitis USscan Davidoff MD |
calcified metastasis in gallbladder fossa edema of the wall lymphatics contracted gallbladder CTscan copyright 2008 Courtesy Ashley Davidoff MD gallbladder liver portal triad 82313c01.8s |
11949bs gallbadder carcinoma grosspathology Courtesy Barbara Banner MD |