Lymphangitis pathophysiology: Difference between revisions
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==Overview== | ==Overview== | ||
Lymphangitis is [[inflammation]] of the lymphatic system, a system that is comprised of small vessels of the immune system that carry lymphatic fluid. The fluid is filtered in the [[lymph nodes]] and [[spleen]], drained into the [[subclavian veins]] and finally returned back to the circulatory system. | Lymphangitis is [[inflammation]] of the lymphatic system, a system that is comprised of small vessels of the immune system that carry lymphatic fluid. The fluid is filtered in the [[lymph nodes]] and [[spleen]], drained into the [[subclavian veins]] through thoracic duct and finally returned back to the circulatory system. Depending on the etiologies, lymhangitis has a spectrum of pathophysiology. | ||
==Pathophysiology== | ==Pathophysiology== | ||
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*Normal Lymphatic vessels:- Invasion of microorganisms either from traumatized skin, or from a distal site of infection into the lymphatic vessels that leads to inflammation of the vessel. | *Normal Lymphatic vessels:- Invasion of microorganisms either from traumatized skin, or from a distal site of infection into the lymphatic vessels that leads to inflammation of the vessel. | ||
*Anatomical abnormalities resulting in obstruction of lymphatic channels or damage to the lymphatic vessels, as seen in setting of surgery, malignancy, and trauma.<ref name="pmid1364813">{{cite journal| author=Simon MS, Cody RL| title=Cellulitis after axillary lymph node dissection for carcinoma of the breast. | journal=Am J Med | year= 1992 | volume= 93 | issue= 5 | pages= 543-8 | pmid=1364813 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1364813 }} </ref> | *Anatomical abnormalities resulting in obstruction of lymphatic channels or damage to the lymphatic vessels, as seen in setting of surgery, malignancy, and trauma.<ref name="pmid1364813">{{cite journal| author=Simon MS, Cody RL| title=Cellulitis after axillary lymph node dissection for carcinoma of the breast. | journal=Am J Med | year= 1992 | volume= 93 | issue= 5 | pages= 543-8 | pmid=1364813 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1364813 }} </ref> | ||
Depending on etiologies lymphangitis has spectrum of pathophysiology: | Depending on etiologies, lymphangitis has spectrum of pathophysiology: | ||
===Lymphangitis due to infectious etiology=== | ===Lymphangitis due to infectious etiology=== | ||
====Acute lymphangitis==== | ====Acute lymphangitis==== | ||
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====Chronic Granulomatous Lymphangitis==== | ====Chronic Granulomatous Lymphangitis==== | ||
Chronic granulomatous lymphangitis, develops in the setting of minor trauma to extremities (e.g., wood splinter or rose bush). Distal infection | Chronic granulomatous lymphangitis, develops in the setting of minor trauma to extremities (e.g., wood splinter or rose bush). Distal infection spreads through an indolent process, spreads through lymphatic channels, resulting in subcutaneous nodules along the course of lymphatic channels.<ref name="harrison" /><ref name="lymphangitis" /> | ||
====Filarial lymphangitis==== | ====Filarial lymphangitis==== | ||
Filarial lymphangitis develops when thread like [[Wuchereria bancrofti|adult filarial worms]] resides in lymphatic channels and lymph nodes, resulting in | [[Filariases|Filarial lymphangitis]] develops when thread like [[Wuchereria bancrofti|adult filarial worms]] resides in lymphatic channels and lymph nodes, resulting in inflammatory changes to the lymphatics.<ref name="pmid11121854">{{cite journal| author=Dreyer G, Norões J, Figueredo-Silva J, Piessens WF| title=Pathogenesis of lymphatic disease in bancroftian filariasis: a clinical perspective. | journal=Parasitol Today | year= 2000 | volume= 16 | issue= 12 | pages= 544-8 | pmid=11121854 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11121854 }}</ref> | ||
===Lymphangitis due to Non-infectious etiology=== | ===Lymphangitis due to Non-infectious etiology=== | ||
Revision as of 22:51, 2 January 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2]Vishal Devarkonda, M.B.B.S[3]
Overview
Lymphangitis is inflammation of the lymphatic system, a system that is comprised of small vessels of the immune system that carry lymphatic fluid. The fluid is filtered in the lymph nodes and spleen, drained into the subclavian veins through thoracic duct and finally returned back to the circulatory system. Depending on the etiologies, lymhangitis has a spectrum of pathophysiology.
Pathophysiology
- Lymphatic vessels are thin walled, valved structures situated in deep dermis and sub-dermis tissues.[1]
- Lymph follows the following pattern of drainage.
- Lymph from tissues drain into the regional lymph nodes via afferent lymphatics, then to right lymphatic duct and thoracic duct via efferent lymphatics, and finally into venous circulation via one of the subclavian veins.
Settings involved in pathogenesis of disease are:
- Normal Lymphatic vessels:- Invasion of microorganisms either from traumatized skin, or from a distal site of infection into the lymphatic vessels that leads to inflammation of the vessel.
- Anatomical abnormalities resulting in obstruction of lymphatic channels or damage to the lymphatic vessels, as seen in setting of surgery, malignancy, and trauma.[2]
Depending on etiologies, lymphangitis has spectrum of pathophysiology:
Lymphangitis due to infectious etiology
Acute lymphangitis
Acute lymphangitis, develops in setting of distal trauma, resulting in infection. Infection, if not contained locally, may spread through lymphatic channels resulting in lymphangitis.[3][4]
Chronic Granulomatous Lymphangitis
Chronic granulomatous lymphangitis, develops in the setting of minor trauma to extremities (e.g., wood splinter or rose bush). Distal infection spreads through an indolent process, spreads through lymphatic channels, resulting in subcutaneous nodules along the course of lymphatic channels.[3][4]
Filarial lymphangitis
Filarial lymphangitis develops when thread like adult filarial worms resides in lymphatic channels and lymph nodes, resulting in inflammatory changes to the lymphatics.[5]
Lymphangitis due to Non-infectious etiology
Lymphangitis carcinomatosa
Lymphangits carcinomatosa is a dreadful condition, that develops due to extensive lymphatic permeation and embolization of lymphatic capillary by tumor cells.[6][7]
Sclerosing lymphangitis
- The exact pathophysiology of Sclerosing lymphangitis remains unclear. However, many patients report increase in sexual activity before the appearance of lesion, indicating idiopathic nature of the disease.[8]
Light microscopic and electron microscopy examination reveal:[8][9]
- Sclerosis and hypertrophy of lymphatic vessels along with mild perilymphatic round cell infiltrate.
- Marked edema and thickening of lymphatic vessels both with and without thrombus formation.
References
- ↑ Suami H, Taylor GI, Pan WR (2007). "The lymphatic territories of the upper limb: anatomical study and clinical implications". Plast Reconstr Surg. 119 (6): 1813–22. doi:10.1097/01.prs.0000246516.64780.61. PMID 17440362.
- ↑ Simon MS, Cody RL (1992). "Cellulitis after axillary lymph node dissection for carcinoma of the breast". Am J Med. 93 (5): 543–8. PMID 1364813.
- ↑ 3.0 3.1 lymphanitis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on October 12,2016
- ↑ 4.0 4.1 lymphanitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016
- ↑ Dreyer G, Norões J, Figueredo-Silva J, Piessens WF (2000). "Pathogenesis of lymphatic disease in bancroftian filariasis: a clinical perspective". Parasitol Today. 16 (12): 544–8. PMID 11121854.
- ↑ Bruce DM, Heys SD, Eremin O (1996). "Lymphangitis carcinomatosa: a literature review". J R Coll Surg Edinb. 41 (1): 7–13. PMID 8930034.
- ↑ Damstra RJ, Jagtman EA, Steijlen PM (2010). "Cancer-related secondary lymphoedema due to cutaneous lymphangitis carcinomatosa: clinical presentations and review of literature". Eur J Cancer Care (Engl). 19 (5): 669–75. doi:10.1111/j.1365-2354.2009.01102.x. PMID 20030691.
- ↑ 8.0 8.1 Papeš D, Altarac S, Antabak A, Savić I (2015). "Nonvenereal sclerosing lymphangitis of the penis". Acta Dermatovenerol Croat. 23 (2): 150–1. PMID 26228831.
- ↑