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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
    • 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 causes lymphedema of the arm in 10 - 15% of patients, because the lymphatic drainage of the arm passes through the armpit (axilla).

    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 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 multilayered 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 lymph fluid drain through the proper 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 your doctor and a physical therapist. It should help drainage without leading to swelling, 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.

    Outlook (Prognosis)

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

    Possible 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.

    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

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

    Davidson N. Breast cancer and benign breast disorders. InGoldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 204.

    Diemert DJ. Tissue nematode infections. In Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 366.

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      A Closer Look

        Tests for Lymphatic obstruction

          Review Date: 9/3/2012

          Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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