Lymphatic obstruction

Definition

Lymphatic obstruction is a blockage of the lymph nodes -- vessels that drain fluid from tissues throughout the body and allow immune cells to travel where they are needed.

Lymphatic obstruction is also called lymphedema, which means swelling of the lymph passages. Lymph nodes may be enlarged for any reason.

Alternative Names

Lymphedema

Causes, incidence, and risk factors

There are many causes of lymphatic obstruction, including:

• Infections with parasites such as filariasis
• Injury (trauma)
• Radiation therapy
• Skin infections such as cellulitis (more common in obese patients)
• Surgery
• Tumors

In Western societies, one of the most common causes of lymphedema is removal of the breast (mastectomy) 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 armpit (axilla), and tissue in the axilla is removed during mastectomy.

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.

Signs and tests

The doctor will perform a physical exam and ask questions about your medical history.

The following tests may be done:

• CT or MRI scan
• Lymphangiography
• Lymphoscintigraphy

Treatment

Treatment for lymphedema includes:

• Compression (usually with multi-layered bandages)
• Manual lymph drainage (MLD)
• Range-of-motion exercises

Manual lymph drainage is a light massage therapy technique in which the skin is moved in certain directions based on the structure of the lymphatic system. This helps the fluid and waste drain through the right channels.

Treatment also includes skin care to prevent injuries, infection, and skin breakdown, as well as light exercise and movement programs. Exercise should be carefully designed by a physical therapist. It should help drainage without leading to swelling from overexertion, which could make your condition worse.

Wearing compression stockings on the affected area or using a pneumatic compression pump on and off 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
• Removal of abnormal lymphatic tissue
• Transplant of normal lymphatic tissues to areas with abnormal lymphatic drainage (less common)

Rarely, the surgeon will bypass abnormal lymph tissue using vein grafts. These procedures are not usually successful, and are often done experimentally.

Expectations (prognosis)

Lymphedema is a chronic disease that usually requires lifelong management. In some cases, lymphedema improves with time. However, some swelling is usually permanent.

Complications

In addition to swelling, the most common complications include:

• Chronic wounds and ulcers
• Skin breakdown

You must be vigilant about skin care and hygiene. There is also a small risk of developing a lymph-tissue type of cancer.

Calling your health care provider

See your doctor if you have swelling of your arms, legs, or lymph nodes that does not go away.

Prevention

Some surgeons are using a technique called sentinel lymph node dissection to prevent lymphedema from developing after surgery for breast cancer. However, this technique is not always appropriate or effective.

References

Kerchner K, Fleischer A, Yosipovitch G. Lower extremity lymphedema update: pathophysiology, diagnosis, and treatment guidelines. J Am Acad Dermatol. 2008;59:324-331.

Freedman DO. Filariasis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 379.

Muss HB. Breast Cancer and Differential Diagnosis of Benign Lesions. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 208.