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Lymphatic obstruction
Lymphedema
Lymphatic obstruction is a blockage of the lymph vessels that drain fluid from tissues throughout the body and allow immune cells to travel where they are needed. Lymphatic obstruction may cause lymphedema, which means swelling due to a blockage of the lymph passages.
Causes
The most common reason for lymphatic obstruction is the removal or enlargement of the lymph nodes.
Causes of lymphatic obstruction include:
- Infections with parasites such as filariasis
- Injury
-
Radiation therapy
Radiation therapy
Radiation therapy uses high-powered x-rays, particles, or radioactive seeds to kill cancer cells.
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Skin infections such as
cellulitis
(more common in obese patients)
Cellulitis
Cellulitis is a common skin infection caused by bacteria. It affects the middle layer of the skin (dermis) and the tissues below. Sometimes, muscle...
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Tumors
Tumors
A tumor is an abnormal growth of body tissue. Tumors can be cancerous (malignant) or noncancerous (benign).
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A common cause of lymphedema is removal of the breast ( mastectomy ) and underarm lymph tissue for breast cancer. This causes lymphedema of the arm in some patients, because the lymphatic drainage of the arm passes through the armpit (axilla).
Mastectomy
A mastectomy is surgery to remove the entire breast. Most of the time, some of the skin and the nipple are also removed. The surgery is most often ...
Rare forms of lymphedema that are present from birth (congenital) may result from problems in the development of the lymphatic vessels.
Symptoms
The main symptom is persistent (chronic) swelling, usually of the arm or leg.
Exams and Tests
The doctor will perform a physical exam and ask about your medical history.
The following tests may be done:
-
CT
or
MRI
scan
CT
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
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A magnetic resonance imaging (MRI) scan is an imaging test that uses powerful magnets and radio waves to create pictures of the body. It does not us...
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Imaging tests to check the lymph nodes and lymph drainage (
lymphangiography
and lymphoscintigraphy
Lymphangiography
A lymphangiogram is a special x-ray of the lymph nodes and lymph vessels. Lymph nodes produce white blood cells (lymphocytes) that help fight infect...
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Treatment
Treatment for lymphedema includes:
- Compression (usually with wrapping in bandages)
- Manual lymph drainage (MLD)
- Range of motion exercises
Manual lymph drainage is a light massage therapy technique. During massage, the skin is moved in certain directions based on the structure of the lymphatic system. This helps the lymph fluid drain through the proper channels.
Treatment also includes skin care to prevent injuries, infection, and skin breakdown. Light exercise and movement programs may also be prescribed. Wearing compression garments on the affected area or using a pneumatic compression pump may be helpful. Your doctor and physical therapist will decide which compression methods are best.
Surgery is used in some cases, but it has limited success. The surgeon must have a lot of experience with this type of procedure. You will still need physical therapy after surgery to reduce lymphedema.
Types of surgery include:
-
Liposuction
Liposuction
Liposuction is the removal of excess body fat by suction using special surgical equipment. A plastic surgeon typically does the surgery.
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- Transplant of normal lymphatic tissues to areas with abnormal lymphatic drainage (less common)
In rare cases, surgery to bypass abnormal lymph tissue using vein grafts is done. These procedures are not usually successful and are often done experimentally.
Outlook (Prognosis)
Lymphedema is a chronic disease that usually requires lifelong management. In some cases, lymphedema improves with time. Some swelling is usually permanent.
Chronic
Chronic refers to something that continues over an extended period of time. A chronic condition is usually long-lasting and does not easily or quick...
Possible Complications
In addition to swelling, the most common complications include:
-
Chronic wounds and
ulcers
Ulcers
An ulcer is a crater-like sore on the skin or mucous membrane. Ulcers form when the top layers of skin or tissue have been removed. They can occur ...
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- Cancer of the lymph tissue (rare)
When to Contact a Medical Professional
See your doctor if you have swelling of your arms, legs, or lymph nodes that does not go away.
Prevention
Most surgeons now use a technique called sentinel lymph node sampling to reduce your risk of lymphedema after breast cancer surgery. However, this technique is not always appropriate or effective.
References
Kurklinsky AK, Rooke TW. Lymphedema. In: Moore WS, ed. Vascular and Endovascular Surgery . 8th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 53.
Lee RE, Micali G, Schwartz RA. Lymphedema. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies . 4th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 138.
Strick D. Lymphedema. In: Stanley JC, Veith FJ, Wakefield TW, eds. Current Therapy in Vascular and Endovascular Surgery . 5th ed. Philadelphia, PA: Elsevier Saunders; 2014.
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Lymphatic system - illustration
The lymphatic system filters fluid from around cells. It is an important part of the immune system. When people refer to swollen glands in the neck, they are usually referring to swollen lymph nodes. Common areas where lymph nodes can be easily felt, especially if they are enlarged, are: the groin, armpits (axilla), above the clavicle (supraclavicular), in the neck (cervical), and the back of the head just above hairline (occipital).
Lymphatic system
illustration
-
Yellow nail syndrome - illustration
Yellow nail syndrome is characterized by yellow nails that lack a cuticle, grow slowly, and are loose or detached (onycholysis). Yellow nail syndrome is most commonly associated with lung disorders, and with lymphedema.
Yellow nail syndrome
illustration
-
Lymphatic system - illustration
The lymphatic system filters fluid from around cells. It is an important part of the immune system. When people refer to swollen glands in the neck, they are usually referring to swollen lymph nodes. Common areas where lymph nodes can be easily felt, especially if they are enlarged, are: the groin, armpits (axilla), above the clavicle (supraclavicular), in the neck (cervical), and the back of the head just above hairline (occipital).
Lymphatic system
illustration
-
Yellow nail syndrome - illustration
Yellow nail syndrome is characterized by yellow nails that lack a cuticle, grow slowly, and are loose or detached (onycholysis). Yellow nail syndrome is most commonly associated with lung disorders, and with lymphedema.
Yellow nail syndrome
illustration
Review Date: 1/18/2015
Reviewed By: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
