Lymphangitis pathophysiology
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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 and finally returned back to the circulatory system.
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 a 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
- Develops in the setting of trauma resulting in distal infection or overlying infection(cellulitis)
- Infection, if not locally contained, may spreads through lymphatic channels resulting in lymphangitis.
Chronic Granulomatous Lymphangitis
- Develops in the setting of minor trauma to extremities(e.g., wood splinter or rose bush)
- Distal infection through an indolent process spreads through the lymphatic channels, resulting in subcutaneous nodules along the course of lymphatic channels.
Filarial lymphangitis
- Threadlike adult parasite resides in lymphatic channels and lymph nodes, resulting in inflammatory changes to the lymphatics
Lymphangitis due to Non-infectious etiology
====Lymphangitis carcinomatosa====[3][4]
- Diffuse infiltration of lymphatics of lungs by malignant cells
- It could be the only manifestation of occult malignancy
- Extensive lymphatic permeation and embolization of lymph capillary by tumor cells, results in progressive respiratory failure and right heart failure
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.
- ↑ Funakoshi T, Yasui H, Boku N, Fukutomi A, Yamazaki K, Machida N; et al. (2014). "Clinicopathological features and outcomes of gastric cancer patients with pulmonary lymphangitis carcinomatosa". Jpn J Clin Oncol. 44 (9): 792–8. doi:10.1093/jjco/hyu091. PMID 25057093.
- ↑ Merzon KA, Belakovskiĭ MS (1988). "[Plasma 25-hydroxyvitamin D3 level in patients with chronic cardiac insufficiency]". Kardiologiia. 28 (12): 108–9. PMID 3244248.