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Lymphangitis

Lymphangitis is an inflammation of the lymphatic vessels. Causes of acute lymphangitis are the same as in acute lymphadenitis (see). Superficial acute lymphangitis can most often be observed on the extremities. There are two forms of lymphangitis: reticular (reticular), that is, inflammation of many small lymphatic vessels, and truncular (stem) inflammation of one or several larger vessels. When reticular lymphangitis in the area of ​​the source of infection ( furuncle , purulent wound or abrasion, etc.) appears bright red - solid or spotty (marble). Unlike faces (see), it has no sharp boundaries. Narrow red stripes, which extend from the source of infection toward the regional lymph nodes, are characteristic of a truncular lymphangitis. In the course of these strips, a painful induration in the form of a cord or a rosary is sometimes felt. Feverish condition, in severe cases with chills, pains are slight (burning sensation). Regional lymph nodes almost always swell up (acute lymphadenitis often develops).

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With an unfavorable course of lymphangitis goes into suppuration with the formation of several abscesses or subcutaneous phlegmon in the course of the vessel. In severe cases, sepsis is possible (see).

lymphangitis

The diagnosis of reticular lymphangitis is not difficult; the stranular lymphangitis (especially on the tibia) needs to be differentiated with superficial thrombophlebitis (see): with the latter, the induration along the vein is more pronounced and appears earlier than the reddening of the skin.

Treatment : first of all, treatment of the source of infection (as with lymphadenitis), rest. Massage is not allowed. Heat (half-alcohol warming compresses, warm heater), antibiotics - as prescribed by the doctor. When suppuration - cuts. Constant monitoring of the state of regional lymph nodes. Deep acute lymphangitis may have different localization - from limb to the intestinal mesentery. Even on the limbs it is difficult to recognize (similar to deep thrombophlebitis). Treatment - in a surgical hospital.

Chronic lymphangitis may be associated with erysipelas, varicose ulcers of the lower leg (see Varicose veins), or has a tuberculosis etiology. Leads to significant violations of lymph outflow, the formation of persistent edema, sometimes to elephantiasis (see). Patients with signs of chronic lymphatic stagnation should be referred to a surgeon.

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Lymphangitis (lymphangitis; lymph + Greek. Angeion - vessel) - inflammation of the lymphatic vessels. Lymphangitis occurs most often as a result of penetration of various bacteria through the damaged skin or mucous membranes. There are acute and chronic lymphangitis.

Acute lymphangitis . In acute lymphangitis, either the capillary lymphatic network or large lymphatic vessels are involved in the inflammatory process. In accordance with this distinguish mesh and stem lymphangitis.

Pathogens (often streptococci and staphylococci) and their toxins with lymph flow penetrate into the interstitial crevices or, through multiple anastomoses, into deeper segments of the vessels. The inflammatory process captures the entire wall of the lymphatic vessel, sometimes goes to the surrounding tissues - skin, subcutaneous tissue, etc.

The pathological anatomy of the lymphangitis is determined by the inflammatory process of the walls of the lymphatic vessels, swelling and an increase in permeability occur in them, leukocyte infiltration of cellulose along the lymphatic vessel (perilymphangitis). As a result of coagulation of lymph fibrin in the lumen of blood vessels, blood clots form, there is an extensive lymphatic thrombosis with persistent lymphostasis.

In case of reticular lymphangitis, the inflammatory process begins in the superficial network of the smallest lymphatic vessels, redness, soreness appear around the infected focus (wound, furuncle, etc.), then narrow intermittent red stripes going towards the regional lymph nodes. The temperature rises to 39 °, chills and intoxication appear (coated tongue, headaches, etc.).

The clinical picture of reticular lymphangitis resembles erysipelas, but hyperemia has no pronounced boundaries characteristic of erysipelas.

Stem lymphangitis is characterized by the appearance on the skin of bright red stripes running from the primary focus to the regional lymph nodes. In the first days, only dull pain is observed along the lymphatic vessels. Then there is a seal in the area of ​​these bands, they become more painful, swelling and tension of the surrounding tissues occur. With the transition of the inflammatory process to the surrounding tissue redness increases, it becomes solid.

In acute lymphangitis of deep lymphatic vessels, swelling, pain and early appearance of lymphadenitis are observed (see). Deep lymphatic pathways are affected simultaneously or after the development of superficial lymphangitis. Inflammation either subsides, or there is suppuration, one or more ulcers appear along the lymphatic vessels, and deep subfascial cellulitis may develop. With delayed and inadequate treatment may develop sepsis.

The diagnosis of superficial lymphangitis is not difficult. Sometimes it can be mixed with erysipelas or phlebitis, and in case of diffuse swelling of the skin integument with phlegmon. With deep lymphangitis, you can mistakenly diagnose thrombophlebitis.

Treatment of lymphangitis should be aimed at eliminating the primary focus in order to stop the flow of infection into the lymphatic vessels. Abscesses should be opened, wounds should be treated accordingly. It is necessary to create rest and improve the blood supply to the diseased limb. To this end, limb immobilization, bed rest, thermal procedures, warming compresses, and ointment dressings are shown. With the formation of abscesses along the lymphatic vessels - timely incisions. Any movement, massage is contraindicated. With common phenomena, in addition to bed rest, a general strengthening treatment, sulfonamides, antibiotics is indicated. Formed abscesses, phlegmon are treated by the general rules.

Chronic lymphangitis is usually caused by weakly virulent pathogens. Specific lymphangitis are more often of tubercular origin. They are characterized by blockage of deep lymphatic vessels due to lymphatic stasis, lymphatic thrombosis with the formation of edema.

Treatment. In chronic lymphangitis, physiotherapy, mud therapy, and radiotherapy are indicated. Patients with lymphangitis are subject to outpatient treatment, and with the development of severe lymphangitis with common phenomena - hospitalization.

Prevention of lymphangitis is reduced to the timely treatment of small traumatic foci, pustular skin diseases, abscesses, etc.