Lymphangiectasia

LYMPHANGIECTASIA (from Greek lympha—water, angeion—vessel, and ektasis—dilation), lymphangiectasis, is the dilation of lymphatic vessels. It is usually observed in the skin of the lower extremities in the form of soft, easily compressible nodules or vesicles that are easily injured. Lymphangiectasia can also develop in other locations: in the serous membranes of organs, in the mesentery, on the labia, etc. When lymphangiectasia is damaged, persistent leakage of lymph (lymphorrhagia) occurs externally and into serous cavities. The fluid flowing into the latter may not be transparent lymph, but rather a milky-turbid fluid due to the admixture of a fat emulsion (ascites chylosus). Lesions and ruptures of lymphangiectasia are often complicated by tissue infection with pyogenic microbes, which then leads to the development of acute lymphangitis, erysipelas, and phlegmon. Dilation of lymphatic vessels sometimes affects all the lymphatic vessels of an extremity, due to which its volume increases significantly, to a greater or lesser degree. If a recurrent infection is added to such chronic stasis of lymph in the dilated lymphatic vessels, the skin and the subcutaneous and intermuscular connective tissue of the extremity may hypertrophy and harden, and then elephantiasis (pachydermia lymphangiectatica, elephantiasis) is added to the lymphangiectasia. The etiology of lymphangiectasia is diverse; it has been linked to cicatricial changes in lymph nodes, obliteration of large lymphatic trunks, and even the thoracic duct; all such processes create obstacles to the outflow of lymph from an organ (most often from the lower extremity) and thereby contribute to the stretching of its lymphatic vessels. Metastases of cancers in lymph nodes can have the same effect when tumor masses fill the sinuses and impede the outflow of lymph. Surgical removal of entire clusters of lymph nodes, for example, axillary nodes in cases of breast cancer, can result in chronic edema of the extremity with subsequent lymphangiectasia, especially when all the loose fatty tissue surrounding them is removed along with the lymph nodes, creating major obstacles to lymph outflow. Other researchers have seen the cause of lymphatic vessel dilation in the insufficiency of their valvular apparatus, although the latter may be not a cause, but a consequence of lymphangiectasia. Limited lymphangiectasias are very similar to simple lymphangiomas (lymphangioma simplex), but differ from them in that they are always an acquired condition based on obstacles to the outflow of lymph.

F. CHISTOVICH. Lymphangiectatic dilation appears analogous to varicose dilation of veins. Lymphangiectasia of the skin is prone to inflammation. In the presence of lymphangiectasia in deeper tissues, the corresponding area of the body appears swollen over a greater or lesser extent (often in the region of the lower extremities), with a doughy consistency and without sharp boundaries. Sometimes thick, dilated lymphatic vessels are visible. Upon pressure with a finger, the fluid, as in ordinary edema, is displaced into the surrounding tissues, so that a slowly disappearing pit remains; rupture of a dilated lymphatic vessel with subsequent lymphorrhea occurs easily. Lymphangiectasia is particularly clearly expressed in the region of the vulva, scrotum, and penis. The course of the disease is chronic. Treatment is conservative and surgical. Conservative treatment involves elevating the extremities, compression with an elastic bandage, dry-air baths, and massage. Surgical treatment includes: excision of small ectasias in the skin and subcutaneous tissue, wedge-shaped excision of the skin with subcutaneous tissue (Mikulicz-Schmidt), and “lymphangioplasty” according to Handley, operations by Kondoleon, and others (see Elephantiasis). These methods of treatment in most cases provide long-term improvement; complete recovery occurs rarely.