Lymphatic obstruction

Definition

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

Lymphatic obstruction is also called lymphedema, which means swelling of the lymph passages.

Alternative Names

Causes

There are many causes of lymphatic obstruction, including:

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

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.

Rare forms of congenital (present from birth) lymphedema may result from problems in the development of the lymphatic vessels.

Symptoms

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 performed:

• Lymphangiography
• Lymphoscintigraphy
• MRI

Treatment

Treatment for lymphedema includes:

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

Manual lymph drainage is a light massage therapy technique that involves moving the skin in particular directions based on the structure of the lymphatic system. This helps encourage drainage of the fluid and waste through the appropriate channels.

Other important aspects of treatment include 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 to encourage drainage without developing swelling from overexertion which could make your condition worse.

Wearing compression stockings on the affected area or using an intermittent pneumatic compression pumps may be helpful. Your doctor and physical therapist will decide which compression methods are best.

Surgery is used in some cases, but success is limited. The surgery must have significant experience with the type of procedures. Physical therapy will still be needed after surgery to reduce lymphedema.

Surgical options include:

• Removal of tissue containing abnormal lymph tissue
• Liposuction
• Transplant of tissue from areas with normal lymphatic tissues to areas with abnormal lymphatic drainage (less common)

Rarely, bypass of abnormal lymph tissue may be done using vein grafts. Such procedures are frequently unsuccessful, and are usually performed on an experimental basis.

Outlook (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.

Possible Complications

In addition to swelling, the most common complications include:

• Skin breakdown
• Chronic wounds and ulcers

Thus, patients must be vigilant about skin care and hygiene. There is also a small risk of developing a lymph tissue-related cancer

When to Contact a Medical Professional

See your doctor if you have ongoing swelling of your arms, legs, or lymph nodes.

Prevention

Sentinel lymph node dissection is a method that some surgeons are using in order to prevent the development of lymphedema following surgery for breast cancer