Lymphangitis

LYMPHANGITIS, lymphangitis, angioleucitis, inflammation of lymphatic vessels. It is usually caused by the penetration of various bacteria and their toxins, foreign particles (metallic, chemical, coal dust), and tumor cells into the lymphatic channel and the vessel wall through often insignificant injuries of the skin or mucous membranes. Lymphangitis is most frequently observed in industrial workers, food handlers, people engaged in field work and dealing with purulent foci and corpses: during work they receive small injuries to the fingers of the extremities and contaminate them. Pathological anatomy. Acute and chronic forms of lymphangitis are distinguished. In the first form, the process may involve only the capillary lymphatic network or large lymphatic trunks. In either case, the inflammatory process involves the vascular wall and the surrounding tissue. The endothelium swells, multiplies, desquamates, the vascular wall is infiltrated and thickened, especially in the adventitia; the surrounding tissue is injected and infiltrated (peri- and paralymphangitis). The lymph often coagulates and thrombi form (thrombolymphangitis). The process may stop at this point and undergo regression or pass into suppuration. Then, in addition to purulent infiltration of the vascular wall, an abundant accumulation of pus and purulent-fibrinous masses, which occlude it, is found in the lumen of the vessel. The inflammation often spreads to the surrounding tissue, where limited abscesses, often multiple and arranged in cords, are formed; a gangrenous process is observed less frequently. Chronic lymphangitis arises from frequently repeated acute or from prolonged inflammatory processes associated with the absorption of infectious agents, for example in tuberculosis, syphilis, ulcers, eczema, etc. Patho-anatomical picture consists in thickening of the vascular wall and abundant proliferation of connective tissue both in the thickness of the wall and around it, as a result of which the lumen of the vessel narrows and sometimes obliterated (lymphangitis fibrosa obliterans). In the capillaries, there is abundant proliferation of the endothelium, which gradually fills the entire lumen (lymphangitis productiva). The clinical picture of superficial lymphangitis is very characteristic. Shortly after the contaminated injury of the skin or mucous membrane near the wound, redness, severe itching, and burning appear. Within a few hours, red stripes appear along the lymphatic trunks, which disappear in the nearest lymph nodes or, passing through them, go to the glands of the next stage. Within a day, along these stripes, dense, sharply painful cords can be palpated; the skin is usually swollen and somewhat tense. These phenomena in mild infection may regress within 1–2 days, or this form may pass into the purulent form, and then the formation of one or several abscesses along the cords is observed. In the inflammation of deep lymphatic trunks, no changes are observed on the skin in the first days; patients note dull pains along the vessels, and only after several days the entire limb becomes severely swollen and enlarged and painful lymph nodes can be palpated (see Lymphadenitis). In the purulent form, one has to deal with subfascial or intermuscular phlegmon. In addition to local phenomena, general phenomena are observed in acute lymphangitis, which are expressed in fever, sometimes shaking chills, headache, and general malaise. The severity of these phenomena depends on the severity of the infection and the living and working conditions of the patient. Muscular movements and any physical work worsen the course of the process and contribute to the appearance of complications in the form of metastatic abscesses and septicopyemia. Lymphangitis is most frequently observed on the upper and lower extremities, and in venous diseases on the genital organs (for example, in acute gonorrhea, a wide painful cord runs along the back of the penis to the pubic arch, and short cords are observed on the prepuce; usually gonococcal lymphangitis does not suppurate). In primary sclerosing chancre, painless lymphangitis is palpated on the side where the chancre is located and drains into the nearest dense and enlarged lymph nodes. A special form is carcinomatous lymphangitis. Cancer cells, entering the lymphatic vessels, multiply rapidly and fill the entire lumen of the vessel. In these cases, since only the lymphatic vessels are involved in the growth of cancer, it is incorrect to speak of lymphangitis; but with the breakdown of the tumor and the penetration of infection, inflammatory phenomena may be observed in the vessel wall itself. Tumor cells may grow into the lymphatic spaces surrounding the nerves. Penetrating into the endoneurium, and then into the perineurium and rapidly proliferating, they cause severe shooting pains along the nerves, which often leads to diagnostic errors. The diagnosis of superficial lymphangitis does not present difficulties, although sometimes it can be confused with phlebitis and erysipelas. Deep lymphangitis is more difficult to diagnose; here one can think of osteomyelitis. With proper treatment, the prognosis for acute lymphangitis is favorable. Lymphangitis proceeds more severely in old, exhausted people, diabetics, alcoholics, and arteriosclerotics, sometimes taking a gangrenous form in them. Prevention consists in observing hygienic requirements in general and in keeping the resulting injuries clean. In any injury, timely seeking of medical help is necessary. Treatment should be directed primarily at the portals of entry of the infection to cut off its further ingress. Abscesses and paronychia must be opened; especially careful care is required for contaminated wounds (see Wounds, injuries). The diseased limb must be given complete rest and a raised position, which are achieved by immobilizing bandages, and sometimes by bed rest. It is useful to apply moist dressings with hypertonic solutions and heat. Some propose compresses of alcohol mixed with water or indifferent ointment dressings. Nosske and Lexer recommend transverse incisions down to the fascia closer to the trunk. If abscesses form, they must be opened in time. Massage, rubbing, and any muscular movements are contraindicated, as they promote the generalization of the process. Lit.-see literature to the article Lymphatic system.

E. Prilezhaeva. Lymphatism (a fairly common term), increase of the lymphatic apparatus of various character. Leukemias, neoplasms (lymphosarcomas) and inflammatory-granulomatous forms are usually separated from general lymphatism. In former times, various forms of chronic increase of the lymphatic apparatus, partly of tumor, partly of inflammatory character, were united under the name lymphoma. At present, from this group of lymphomas, all diseases of glands of inflammatory character, of truly tumor character, and chronic hyperplasia in various diseases are distinguished as sui generis processes. As long as lymphadenitis remains local, one speaks only of lymphadenitis. If, however, there is a widespread massive increase of the lymphatic apparatus, including increase of follicles