Lymphangitis is an acute or chronic inflammation of the lymphatic trunks and capillaries that occurs a second time, against the background of purulent-inflammatory processes. Disease is accompanied by hyperemia and painful swelling along the course of inflamed lymphatic vessels, edema, regional lymphadenitis, high body temperature (39-40 ° C), chills, weakness. Diagnosis is carried out on the basis of ultrasound angioscanning, computer thermal scanning, isolation of the pathogen from the primary purulent focus. Treatment includes sanitation of the primary focus, antibiotic therapy, immobilization of the limb, opening of formed abscesses and phlegmon.
ICD 10
I89.1 Lymphangitis
Meaning
With lymphangitis (lymphangoitis, lymphangiitis), lymphatic vessels of various caliber and depth of localization can be affected. Lymphology and phlebology are more likely to encounter lymphangitis of the extremities, which is due to their frequent microtraumation, an abundance of microbial pathogens and the nature of lymph circulation. Pathology usually occurs with the phenomena of secondary lymphadenitis. The development of lymphangitis indicates the progression of primary pathology and aggravates its course.
Causes
Lymphangitis develops a second time, against the background of an existing superficial or deep purulent-inflammatory focus — an infected abrasion or wound, boil, abscess, carbuncle, phlegmon. The main pathogens in this disease are Staphylococcus aureus, beta-hemolytic streptococcus, less often Escherichia coli and proteus, as well as other aerobic flora in the form of monoculture or in associations. Specific lymphangitis is more often associated with the presence of tuberculosis in the patient.
The probability of developing lymphangitis depends on the localization, the size of the primary infectious focus, the virulence of the microflora, and the peculiarities of lymph circulation in this anatomical zone.
Microbial agents and their toxins enter from the focus of inflammation into the interstitial space, then into the lymphatic capillaries, moving along them in the direction of the lymph flow to larger vessels and lymph nodes. Reactive inflammation of the vascular wall is expressed in swelling of the endothelium, increased permeability, development of exudation, loss of fibrin clots, intravascular thrombosis. These changes lead to disorders of local lymph circulation – lymphostasis. With further progression of inflammation, purulent lymphangitis and purulent melting of blood clots may develop.
If the inflammation spreads to the surrounding tissues, perilymphangitis develops, in which blood vessels, joints, muscles, etc. can be affected. In an ascending way, inflammation can spread to the thoracic lymph duct. In clinical practice, lymphangitis of the lower extremities is more often diagnosed, which occurs as a result of scuffs, microtraumas, combs, trophic ulcers, panaritia.
In andrology, sometimes there is a condition regarded as non-venereal form of the penis: its causes may be injury to the tissues of the penis with frequent masturbation and prolonged sexual intercourse. Specific venereal lymphangitis can develop with primary syphilis, genital herpes, urethritis caused by sexual infection.
Classification
Taking into account the nature and severity of inflammation, disease can be serous (simple) and purulent; according to the clinical course — acute or chronic; according to the depth of the affected vessels — superficial or deep.
Depending on the caliber of inflamed lymphatic vessels, disease is divided into capillary (reticular or mesh) and stem (trunkular). With reticular lymphangitis, many superficial lymphatic capillaries are involved in inflammation; with stem lymphangitis, one or more large vessels become inflamed.
Symptoms
With lymphangoitis, general intoxication is always largely pronounced, accompanying a severe purulent-inflammatory process. There is a high temperature (up to 39-40 ° C), chills, sweating, weakness, headache. Reticular lymphangitis begins with the appearance of pronounced superficial hyperemia around the focus of infection (wound, abscess, etc.) with an enhanced reticular (marble) pattern against the background of intense erythema. According to the clinical picture, mesh lymphangitis resembles erysipelas, but hyperemia has vague boundaries, uncharacteristic of erysipelas.
A local manifestation of stem lymphangitis is the presence of narrow red stripes on the skin along the course of inflamed lymphatic vessels stretching to regional lymph nodes. Swelling, thickening and soreness of the cords, swelling and tension of the surrounding tissues, regional lymphadenitis develop rapidly. Palpation along the course of the vessels reveals painful seals by the type of cord or rosary.
With deep lymphangitis, local hyperemia is not observed, but swelling and pain in the limb quickly increases; with deep palpation, sharp soreness is noted, lymphedema develops early. In the case of perilymphangitis, areas of inflamed surrounding tissues can transform into an abscess or subfascial phlegmon, untimely opening of which is fraught with the development of sepsis.
The symptoms of chronic form are erased and are usually characterized by persistent edema due to blockage of deep lymphatic trunks and lymphostasis. With non-venereal lymphangitis, a painless, compacted weight appears along the trunk or coronal furrow of the penis, which can persist for several hours or days, after which it spontaneously disappears.
Diagnostics
Reticular lymphangitis can be easily diagnosed by a lymphologist already during a visual examination, but it should be differentiated from erysipelas and superficial phlebitis. The identification of the primary inflammatory focus helps in establishing the diagnosis.
Recognition of deep lymphangitis can cause difficulties. In this case, clinical and anamnestic data, the results of instrumental and laboratory studies are taken into account. With lymphangitis, pronounced leukocytosis is observed in the peripheral blood. With ultrasound and duplex scanning, changes in lymphatic vessels are visualized by the type of heterogeneity of the structure, narrowing of the lumen, the presence of a hyperechoic rim around the vessel, reactive changes in the corresponding lymph nodes.
Assessment of the severity, prevalence and depth of lymphangitis is carried out using computer thermography. The complex of studies makes it possible to distinguish deep lymphangitis from soft tissue phlegmon, deep vein thrombophlebitis, osteomyelitis. Determination of the causative agent of lymphangitis is carried out by bacteriological seeding of a purulent wound. With complicated lymphangitis, a blood test for sterility is performed.
Treatment
First of all, in acute lymphangitis, it is necessary to eliminate the primary focus that supports inflammation in the lymphatic vessels. Infected wounds are treated, abscesses, phlegmon, panaritia are opened, drained and sanitized. The affected limb is fixed in an elevated position; motor rest is recommended for the patient. With lymphangitis, massage and self-heating of the inflammation site, rubbing ointments are unacceptable. Medical treatment includes antibiotics (semi-synthetic penicillins, cephalosporins of the 1st-2nd generation, aminoglycosides, lincosamides), anti-inflammatory and antihistamines, infusion therapy, laser or ultraviolet irradiation of blood.
In the case of chronic sluggish lymphangitis, local ointment dressings, semi-alcoholic compresses or with dimethyl sulfoxide, mud treatment, UFOs are prescribed; with a persistent course of inflammation, X-ray therapy is indicated. Treatment of non-venereal penile lymphangitis is not required. With lymphangitis caused by STDs, the main infection is treated.
Prognosis and prevention
Prevention of lymphangitis consists in timely primary surgical treatment of wounds, rehabilitation of pustular diseases, opening of formed purulent foci, adequate antibiotic therapy. Prolonged chronic course of lymphangitis can lead to obliteration of lymphatic vessels, lymph circulation disorder, development of lymphostasis and elephantiasis. In the case of timely initiated therapy, lymphangitis lends itself to a permanent cure.