A patient with bronchogenic carcinoma of the left lower lobe develops enlarged nodes at the hilum of the lung. From the lung parenchyma, lymph flows sequentially through which pathway?

• A Hilar nodes, tracheobronchial nodes, bronchomediastinal trunk, thoracic duct ✓
• B Tracheobronchial nodes, hilar nodes, bronchomediastinal trunk, right lymphatic duct
• C Hilar nodes, parasternal nodes, bronchomediastinal trunk, thoracic duct
• D Tracheobronchial nodes, hilar nodes, para-aortic nodes, cisterna chyli

Explanation

Lymph from the lung parenchyma flows centrifugally: from intrapulmonary nodes to hilar (pulmonary) nodes, then to tracheobronchial (carinal and bronchopulmonary) nodes, then into the bronchomediastinal trunk. On the left side, this trunk drains into the thoracic duct at the left venous angle. Parasternal nodes drain the medial breast and anterior thoracic wall, not the lung.

Reference: Gray's Anatomy for Students, 4th ed.

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Written and medically reviewed by the StethoPrep medical team.