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Lymphatic obstruction |
| Definition: |
| Lymphatic obstruction involves blockage of the lymph vessels, which drain fluid from tissues throughout the body and allow immune cells to travel where they are needed. |
| Alternative Names: |
| Lymphedema |
| Causes, incidence, and risk factors: |
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There are many causes of lymphatic obstruction, which is also known as lymphedema (swelling of the lymph passages). These include certain infections ( for example, chronic cellulitis or parasitic infections such as filariasis), trauma, tumors, certain surgeries, and radiation therapy. In addition, there are rare forms of congenital (present from birth) lymphedema which probably result from abnormalities in the development of the lymphatic vessels. In Western societies, one of the most common causes of lymphedema is mastectomy with axillary dissection (removal of the breast and underarm lymph tissue for breast cancer). This can cause lymphedema of the arm in 10-15% of patients. This occurs because the lymphatic drainage of the arm passes through the axilla (armpit), and tissue in the axilla has been removed during mastectomy. Recurrent cellulitis, or infection of the skin, can damage lymphatic vessels and lead to lymphedema of the affected area. This is more commonly seen in obese patients. |
| Symptoms: |
| Chronic swelling, usually of the arm or leg, is the clinical hallmark of lymphatic obstruction. |
| Signs and tests: |
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Physical exam and history are most important for diagnosis. In some cases, lymphangiography may be performed. This involves injection of dye into lymphatic vessels followed by X-rays of the area. Lymphangiography requires surgical isolation of the lymph vessels to be injected and is therefore a difficult procedure. Lymphoscintigraphy is an alternative technique in which a radioactive substance that concentrates in the lymphatic vessels is injected into the affected tissue and mapped using a gamma camera, which images the location of the radioactive tracer. Lymphoscintigraphy is less invasive and more easily performed and is often used as a substitute for lymphangiography. MRI is being explored as a means to image lymphatic vessels. |
| Treatment: |
| The vast majority of patients with lymphedema will not need surgery. Non-surgical management includes use of compression stockings applied to the affected arm or leg, intermittent pneumatic compression pumps, elevation of the the limb and meticulous skin care to prevent injuries and skin breakdown. Your health care provider will recommend the appropriate treatment for you.
Surgical therapy is used in some cases, but has met with limited success and requires significant experience and technical expertise. Surgical therapy includes removal of tissue containing abnormal lymphatics, and less commonly, transplant of tissue from areas with normal lymphatic tissues to areas with abnormal lymphatic drainage. Rarely, bypass of abnormal lymphatic tissue is attempted, in some cases using vein grafts. Such procedures are frequently unsuccessful and often performed only under experimental protocols. |
| Expectations (prognosis): |
| Lymphedema is a chronic disease that usually requires lifelong management. In some cases, lymphedema improves with time, but some degree of swelling usually persists for years after onset. |
| Complications: |
| In addition to swelling of the affected limb, skin breakdown and formation of chronic wounds and ulcers are the primary complications of chronic lymphedema in severe cases. Thus, patients must be vigilant about skin care and hygiene. There is also a small risk of developing a lymph tissue-related cancer |
| Calling your health care provider: |
| See your doctor if you have ongoing swelling of your arms, legs, or lymph nodes. |
Reviewed By: James P. Dolan, M.D., Department of Surgery, University of California, San Francisco, San Francisco, CA. Review provided by VeriMed Healthcare Network.
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