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 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
- Usually, develops in setting of distal trauma, resulting in distal infection.[3][4]
- Infection, if not locally contained, may spreads through lymphatic channels resulting in lymphangitis.
Chronic Granulomatous Lymphangitis
- Usually, develops in the setting of minor trauma to extremities(e.g., wood splinter or rose bush).[3][4]
- Distal infection through an indolent process, spreads through lymphatic channels, resulting in subcutaneous nodules along the course of lymphatic channels.
- For pathophysiology of Mycobacterium tuberculosis lymphangitis, please refer to Tuberculous enteritis page.
Filarial lymphangitis
- Thread like adult parasite resides in lymphatic channels and lymph nodes, resulting in inflammatory changes to the lymphatics.[3][4]
- Pathophysiology of filarial lymphangitis, is discussed in detailed in Filaria page.
Lymphangitis due to Non-infectious etiology
Lymphangitis carcinomatosa
- Diffuse infiltration of lymphatics of lungs by malignant cells.[5]
- 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.
Sclerosing lymphangitis
- The exact pathophysiology of Sclerosing lymphangitis remains unclear. However, many patients report increase in sexual activity before the appearence of lesion, indicating idiopathic nature of the disease
Light microscopic and electron microscopy examination reveal:
- 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 3.2 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 4.2 lymphanitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016
- ↑ Bruce DM, Heys SD, Eremin O (1996). "Lymphangitis carcinomatosa: a literature review". J R Coll Surg Edinb. 41 (1): 7–13. PMID 8930034.