Lymphatic blockage

Introduction Lymphatic occlusion of the extremities usually manifests as lymphedema, and trunk obstruction of the trunk can still cause clinical signs such as chyle ascites, chyluria, and chylothorax.

Cause

There are many reasons for lymphatic obstruction, which can be divided into primary (unexplained) and secondary. Secondary include inflammation, tumors, post-injury, and post-radiation therapy.

an examination

Related inspection

Lymphatic imaging

Imaging performance:

Lymphatic angiography can be used to determine the presence or absence of lymphatic obstruction and the location of the obstruction, which is of great help to clinical diagnosis and treatment. When analyzing the results of lymphangiography, attention must be paid to the number, diameter, contour, diameter, and valve of the lymphatic vessels. The common X-ray signs of lymphatic obstruction are now combined into the following:

1. Lymphatic enlargement: shows a widening of the lymphatic vessel with distortion.

2, lymphatic stasis: 24 hours after injection or longer, lymphatics still have iodized oil.

3, lymphatic extravasation: due to increased pressure in the lymphatic vessels, lymphatic rupture. Lymph enters the interstitial space. Contrast agent extravasation can be seen during angiography. Lymphatic fluid is extravasated to the blood vessels and peripheral nerve sheath. Contrast agent can depict the contour of the blood vessel; lymph fluid breaks into the abdominal cavity, intestinal tube, urinary tract and chest cavity, which can be displayed separately. The contrast agent enters the abdominal cavity, the intestine, the urinary tract, and the chest.

4, the reduction or disappearance of the number of lymphatic vessels: common in limb lymphedema, manifested as a decrease in the number of lymphatic vessels, often accompanied by lymphatic enlargement, distortion and extravasation.

5, lymphatic vessel countercurrent: manifested as reverse filling of lymphatic vessels. If the lymphatic vessels around the pelvic organs are found to be filled in the opposite direction, it indicates that the lateral common lymph nodes or lumbar lymph nodes are obstructed.

6, lymphatic collateral pathway: the emergence of lymphatic collateral pathway is one of the most common signs of lymphatic obstruction, but also the main way to overcome the obstruction. There are two basic forms of lateral traffic to the lymphatics.

(1) Lymphatic and venous anastomosis: In the area of lymphatic obstruction, a contrast agent is seen intravenously. That is to say, there is a lymphatic anastomosis. Lymphangiography often does not directly see the pathway.

(2) lymphatic and lymphatic anastomosis: it is the most common collateral pathway, similar to the collateral circulation produced by vascular obstruction. For example, when the lumbar lymph is completely blocked, the contrast agent is shunted to the opposite side through the lymphatic vessel at the aortic bifurcation, showing the contralateral lumbar lymph nodes. If the obstruction is located in the groin or underarm area, extensive subcutaneous collateral lymphatic pathways can be seen in the thigh perineum, external genitalia, and anterior abdominal wall.

Differential diagnosis

Sarcoidosis: is a granulomatous inflammatory disease, the cause is unknown, mainly invading the lung parenchyma, and involving multiple organs of the body, such as lymph nodes, skin, joints, liver, kidney and heart, clinically more insidious The patient may be killed by complete atrioventricular block and/or congestive heart failure, even with sudden death as the first symptom.

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