Lymphostasis - Causes, Symptoms, Diagnosis And Treatment

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Lymphostasis - Causes, Symptoms, Diagnosis And Treatment
Lymphostasis - Causes, Symptoms, Diagnosis And Treatment

Video: Lymphostasis - Causes, Symptoms, Diagnosis And Treatment

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Video: Lymphedema causes, symptoms, diagnosis, treatment & pathology 2023, February
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Lymphostasis is a disease that is manifested by the proliferation of limbs due to thickening of the skin and subcutaneous tissue.

The content of the article:

  • 1 Lymphostasis - Elephantiasis
  • 2 Interesting facts about elephantiasis
  • 3 Causes of lymphostasis
  • 4 Classification of forms of lymphostasis
  • 5 Symptoms of lymphostasis
  • 6 Diagnosis of elephantiasis

    • 6.1 Which doctor to contact
    • 6.2 Poll
    • 6.3 Examination of the affected area
    • 6.4 Angiography
    • 6.5 Doppler vessels of extremities
    • 6.6 Lymphostasis - Laboratory blood tests
    • 6.7 Additional survey methods
  • 7 Treatment of elephantiasis
  • 8 Prevention and prognosis for lymphostasis

Lymphostasis - Elephantiasis

Lymphostasis
Lymphostasis

Elephantiasis is a relatively rare disease and occurs mainly in young women.

The name of the disease has been preserved since ancient times. And it arose not by chance: painfully changed, thickened legs resemble elephant legs.

Elephantiasis develops due to insufficient function of the lymphatic system: lymph stagnates, disrupting tissue metabolism. Its normal circulation can be disrupted due to many reasons: congenital underdevelopment of lymph nodes and blood vessels, injuries, various diseases, in particular repeated erysipelas;

However, whatever the cause of the disorder of lymph circulation, the essence of the disease is the same: the products of tissue metabolism are not evacuated, which leads to the formation of edema - lymphedema. If you do not take the necessary therapeutic measures, coarse-fibrous connective tissue grows in the subcutaneous tissue and skin. Lymph congestion and the resulting edema can be on the hands and genitals, rarely on the face, mammary gland, but most often on the legs.

The onset of the disease is little noticeable. Indeed, who pays attention to swelling at the back of the foot or around the ankles? It grows by the end of the day and after a long walk, is not accompanied by any pain. Sometimes a person unexpectedly discovers, while trying on shoes, that one foot is thicker than the other, or the shoes that he has worn for a long time suddenly become tight.

Lymphostasis. Puffiness, at first unstable, decreases or disappears after a person lies down, after sleep or a long rest. It is especially significant in summer, in heat, and during menstruation. Over time, the swelling becomes permanent, progressing, and does not disappear after rest.

In the first months of the disease, and often years, the leg is enlarged, but the swelling is mild, no pits remain on the skin when pressed with a finger. For comparison, I note that with edema caused by diseases of the heart or kidneys, such pits necessarily remain.

The disease is often one-sided: one leg becomes noticeably thicker than the other. Young girls are especially acutely experiencing this cosmetic defect. The thickening usually extends to the thigh; for some, the process is limited to the foot and lower leg. Movement in all joints is preserved. Only with advanced forms of the disease does it become difficult to walk.

Interesting facts about elephantiasis

  • Residents of South Asia and Africa are more likely to get sick than Europeans and North Americans. Their disease is caused by a parasite carried by mosquitoes.
  • Ancient doctors mistakenly believed that elephantiasis was transmitted from person to person through the air.
  • Elephantiasis affects not only people, but also animals, especially horses.
  • Elephantiasis occurs mainly in women.

Causes of lymphostasis

Lymphostasis
Lymphostasis

The development of lymphostasis can be caused by a wide range of factors. Violation of lymph circulation with lymph retention in tissues occurs in heart failure, kidney pathology, hypoproteinemia, when the lymphatic highways cannot cope with the outflow of lymph. Lymphostasis can be a consequence of chronic venous insufficiency in decompensated forms of varicose veins, post-thrombophlebitic syndrome, arteriovenous fistulas. Excretion of an excess amount of tissue fluid leads to compensatory expansion of the lymphatic vessels, a decrease in their tone, the development of valve insufficiency and lymphovenous insufficiency.

The causes of lymphostasis can be defects of the lymphatic system, obstruction of the lymphatic vessels in case of damage (mechanical and operational injuries, burns), compression by tumors or inflammatory infiltrates that prevent lymph flow.

With lymphadenitis and lymphangitis, obliteration of some lymphatic vessels leads to expansion and valvular insufficiency of others, which is accompanied by lymph stasis.

In some cases, impaired lymphatic circulation with the development of lymphostasis is observed with recurrent streptococcal lymphangitis (with phlegmon, erysipelas), parasitic infections. In countries with a tropical climate, there is lymphatic filariasis spread by mosquitoes (elephantism, elephantiasis). The infection is manifested by the defeat of the lymph nodes, their enlargement, fever, severe pain, hypertrophy of the legs, arms, chest or genitals.

Classification of forms of lymphostasis

Taking into account the etiofactors, lymphostasis can develop primarily or secondarily. Primary lymphostasis is characterized by insufficiency of the lymphatic system associated with congenital anomalies of the lymphatic tract (hypoplasia, agenesis or obstruction of blood vessels, valve insufficiency, hereditary syndromes). In primary lymphostasis, one or both limbs may be affected; manifestations of lymphedema are already expressed in childhood and increase in adolescence.

Lymphostasis. Secondary lymphostasis is spoken of in the case of injuries or diseases of the initially normally formed lymphatic system. Secondary lymphedema often develops in one limb, usually in the area of ​​the instep of the foot and lower leg, and is more often post-traumatic or inflammatory in nature.

Lymphedema occurs predominantly in women. In 91% of patients, lymphostasis of the lower extremities develops. With the development of lymph edema at the age of 15-30, they talk about juvenile lymphedema, after 30 years - about late lymphedema. In the development of lymphostasis, 3 successive stages are distinguished: 1 - mild transient edema, 2 - irreversible edema; 3 - elephantiasis (irreversible edema, cysts, fibrosis).

Lymphostasis symptoms

Lymphostasis
Lymphostasis

At the mildest stage of lymphostasis, there is a systematic appearance of transient edema of the limb, which is noticeable in the evening and disappears on its own by the morning, after rest. Swelling tends to increase after physical exertion or prolonged limitation of mobility, a long stay on the legs. Irreversible changes and proliferation of connective tissue at this stage are still absent, therefore, a timely visit to a lymphologist and the conducted conservative therapy lead to a stable regression of the disease.

Lymphostasis of moderate severity is characterized by non-disappearing edema, growth of connective tissues, tightening and tightness of the skin, which may be accompanied by pain. Pressing with a finger on the swollen tissue leaves indentation marks that persist for a long time. Persistent lymphatic edema can lead to increased fatigue of the affected limb, convulsions.

In severe lymphedema, irreversible disorders of lymph outflow, the development of fibrocystic changes in tissues and elephantiasis are noted.

Lymphostasis becomes so pronounced that the limb loses its contours and the ability to function normally. At this stage of lymphostasis, the development of contractures and deforming osteoarthritis, trophic ulcers, eczema, and erysipelas can be noted. The extreme outcome of lymphostasis may be the death of the patient from severe sepsis. With lymphostasis, the likelihood of developing lymphosarcoma increases.

Diagnosis of elephantiasis

Which doctor to contact

Lymphostasis
Lymphostasis

If the appearance of elephantiasis is associated with repeated erysipelas, then it is necessary to contact an infectious disease specialist. When infected with filarias, a parasitologist's consultation is required. The surgeon deals with other cases of elephantiasis.

At the first appointment, the doctor will ask about your feelings, conduct an examination and prescribe additional studies.

Interview

To compile a medical history, the doctor will ask a series of questions:

  1. When did the edema appear?
  2. Do they decrease after rest?
  3. Does the edema disappear when the limb is elevated?
  4. Have vein problems or erysipelas?
  5. Have you visited countries where filaria infection is possible?
  6. Is the swelling accompanied by joint pain and impaired mobility?
  7. Are there any diseases of the kidneys, heart, liver?

Examination of the affected area

During the examination of the damaged area, the doctor pays attention to the symptoms confirming elephantiasis. During the course of the disease, three stages are distinguished, each of which has its own characteristics.

Stage I - mild edema (reversible changes). First 6-8 months

  1. Asymmetrical swelling in the limbs
  2. Mild edema - after pressure, a fossa remains
  3. The skin is pale, easily displaced, but difficult to fold
  4. An itchy rash that looks like hives

Stage II - dense edema, begins 2-7 years after the onset of the disease.

  1. Dilated lymphatic vessels are felt under the skin
  2. Swelling extends to the lower leg and thigh
  3. Joint movement is limited, but no pain
  4. The skin is tight, firm and immobile
  5. The skin is very sensitive when pressed, painful sensations occur
  6. The affected limb is significantly increased in size compared to the healthy

Stage III - elephantiasis, 7-15 years after the onset of the first symptoms.

  1. Thickening of the stratum corneum of the epidermis - the skin is rough, thick, keratinous, motionless
  2. Numerous cracks, papillomas, rashes, warts, large trophic ulcers.
  3. Rupture of lymphatic vessels through which lymph flows.
  4. The lymph nodes are enlarged. After 6-8 months, the nodes become inflamed and painful.
  5. The limb is cylindrical. Its surface is deformed - covered with bumps.
  6. The difference in the volume of a sick and healthy limb can exceed 50 cm

In the later stages of the disease, the doctor makes a diagnosis based on external signs. But for clarification, instrumental diagnostics may be required. Modern methods make it possible to distinguish elephantiasis from edema caused by chronic venous insufficiency, heart disease and kidney disease.

Angiography

Lymphostasis
Lymphostasis

For elephantiasis, one of the types of angiography is used - radiopaque lymphography. This research method is quite difficult to perform, besides, the contrast agent damages the lymphatic vessels.

Indications:

  • swelling of the limbs;
  • disorders of lymph flow and blood circulation;
  • anomalies in the development of blood vessels.

A dye is injected into the interdigital space. Methylene blue spreads up the limb, staining the lymphatic vessels. The doctor dissects the skin, exposes a large lymphatic vessel and injects a contrast agent solution with a syringe, which delays the X-rays. After that, a series of X-rays are taken, in which the contours of the lymphatic vessels are visible.

With elephantiasis, the following changes are noticeable:

  • vessels are sharply narrowed or completely blocked;
  • depletion of the vascular pattern - not all lymphatic vessels are visible;
  • areas of vasodilation;
  • thinning of the walls of blood vessels;
  • the release of the contrast agent into the surrounding tissues;
  • reverse course of contrast agent.

Currently, it is not often used due to the widespread use of magnetic resonance angiography.

Limb vessels doppler

Ultrasound examination of the lymphatic vessels is carried out using the method of color Doppler mapping. The device, like a radar, detects the flow of lymph, creating a color image of the lymphatic vessels on the screen. This study is completely painless and safe.

Indications:

  • swollen lymph nodes;
  • varicose veins and thrombophlebitis;
  • lymphatic edema.

Signs of elephantiasis on ultrasound:

  • areas of blockage and narrowing in the lymphatic vessels;
  • enlarged varicose areas, with a slowed down flow of fluid;
  • the presence of blood clots or accumulations of filariae in the lumen of the vessels;
  • defeat of valves in large vessels;
  • an increase in the number of lymphatic capillaries in primary lymphedema;
  • accumulation of connective tissue under the skin and in the intermuscular space.

Lymphostasis - Laboratory blood tests

  1. Lymphostasis
    Lymphostasis

    Serological examination is a study of blood serum, which reveals the presence of specific antibodies to filarias. These antibodies are special protein molecules. They are produced by immune cells to detoxify the waste products of parasites. Antibody detection methods:

    • ring precipitation reaction;
    • indirect hemagglutination reaction;
    • enzyme immunoassay reaction.
  2. A general blood test is a laboratory blood test, which includes counting all types of blood cells, determining their characteristics and relationships among themselves.

    • the level of eosinophils is several times increased> 0.4 * 10 9 / l
    • the albumin level is reduced, less than 35 grams / liter;
    • increased blood clotting.
  3. Blood microscopy - the study of blood under a microscope. A thick blood smear is made on a glass slide and stained with aniline dyes according to the Gram method. When examined under a microscope, microfilariae are found. They look like thin purple filaments. The larvae of filariae enter the peripheral blood at night. Therefore, a blood test from peripheral vessels is taken at night.
  4. Diethylcarbamazine provocation test

    A person is given 50 mg of Diethylcarbamazine. An hour later, a blood test is done from a vein or from a finger. The drug stimulates the release of larvae into the peripheral blood capillaries and they are easily detected by microscopic examination of blood.

The occurrence of allergic reactions on the skin also proves filarial infection.

Additional examination methods

  1. Lymphostasis
    Lymphostasis

    Thermography is a method of studying infrared radiation that comes from the human body. X-rays of the extremities. X-ray does not allow visualization of changes in soft tissues. But the picture shows the following symptoms of elephantiasis:

    • thickening of the bone with 3 degrees of elephantiasis;
    • signs of osteoporosis;
    • smooth or wavy layers at the surface of the bone;
    • deposits of calcium in the place of death of parasites.
  2. Thermography is a method of studying infrared radiation that emanates from the human body. This method is not stand alone. It is used in conjunction with X-rays to clarify and conduct scientific statistical research. Symptoms:

    • a decrease in the temperature of the affected limb compared to a healthy one by 1.5 degrees, which indicates a violation of blood circulation;
    • decrease in the temperature of the affected limb after exercise;
    • local temperature rise in the foci of inflammation;
  3. Magnetic resonance imaging. The method of layer-by-layer visualization of slices of a diseased limb. It is based on the excitation of hydrogen atoms in cells under the influence of electromagnetic waves. Its advantage over computed tomography and angiography is that there is no need to inject contrast agents into the vessels.

    • places of narrowing or complete blockage of the lymphatic and blood vessels;
    • tangles of filariae in the lumen of the vessel;
    • areas of deposition of calcium salts on the walls of blood vessels;
    • varicose expansion of lymphatic capillaries and their rupture;
    • uniform border between the muscle layer and subcutaneous fat;
    • at the initial stages, the density of subcutaneous adipose tissue is reduced, and in the later stages, signs of germination by fibrous fibers are noticeable;
    • proliferation of coarse connective tissue fibers.
  4. Lymphoscintigraphy - the introduction into the lymphatic vessels of the drug Lymphocyis, which contains small doses of a radioactive substance. Isotopes penetrate the capillaries, where a special chamber captures their presence. In this procedure, skin incision is not required. The following changes confirm the disease:

    • Slowing down the rate of spread of the drug - from the toes to the lower leg for more than 12 minutes, to the thigh for more than 18 minutes.
    • Slowing down the resorption of the drug in the tissues.
  5. Blister test McClure - Aldrich. In the epidermis of the diseased and healthy legs, 0.2 ml of saline is injected. Small blisters form in the skin. With elephantiasis, the blister on the sore leg disappears in 5-10 minutes, which is associated with the increased ability of the edematous tissue to absorb fluid. A blister on a healthy leg resolves after 40-50 minutes.

Treatment for elephantiasis

Treatment of elephantiasis, both conservative and operative, is quite effective. I say this to dispel the misconception that elephantiasis is incurable.

The purpose of conservative treatment is to suspend the progression of the process, to prevent relapses of erysipelas, which significantly aggravates the course of the disease. Clever! Sewing the swelling helps to constantly wear an elastic stocking or bandage or both! together. You should bandage your leg or put on a medical elastic band every day any time of the year, continuously, without interruption!

It is necessary to bandage the leg in fasting in the same way as it is done in case of varicose veins (® "Health" No. 9 for 1976 mountains Remove the medical elastic stocking or unband the leg only in the lying position before going to bed.

Lymphostasis
Lymphostasis

However, remember another thing: foot massage with elephantiasis can be done only as directed by a doctor, when there is no chronic venous insufficiency, thrombophlebitis. Experts recommend it with caution to those who have frequent relapses of erysipelas.

Daily rubbing of the body with water at room temperature is very useful. But all kinds of thermal procedures - mud, ozokerite, hot foot baths are completely unacceptable. Physical activity, physical exercise are not contraindicated, swimming, in particular, is useful.

I want to warn those suffering from elephantiasis from the passion for diuretics: some patients take them at their own peril and risk. The effect is short-lived, and even then in cases where the patient has mild edema. At the end of the medication, the swelling reaches its original size within two to three days. Long-term use of diuretics is associated with the elimination of very important trace elements from the body, including potassium. And with the so-called dense edema, the use of diuretics is generally useless.

Lymphostasis. Advances in microsurgery now make it possible to perform an operation for elephantiasis even in the stage of mild edema. The purpose of the operation is to restore the disturbed lymph outflow by creating anastomosis between the lymphatic vessels and veins. But such operations are not shown to all patients.

With a long course of the disease, when the leg is significantly deformed, the removal of the altered subcutaneous fat and skin with subsequent skin grafting brings success. Many years of experience show that this operation has a lasting positive effect, the leg functions normally.

Prevention and prognosis for lymphostasis

Refusal to treat lymphedema contributes to even greater lymphatic edema of the tissues, impaired limb mobility, and the development of chronic infection. Regardless of the stage at which lymphostasis was diagnosed, patients need to be monitored by an angiosurgeon. Course maintenance therapy for lymphostasis should be carried out for life.

Thorough care of the skin of the hands and feet, timely treatment of any wounds and prevention of their infection can prevent impaired lymph circulation in the extremities. Treatment of diseases of the kidneys, heart, venous vessels should be carried out in order to avoid decompensation of pathology.

To prevent the development of postoperative lymphedema, in recent years, mammology has abandoned total lymph node dissection during radical mastectomy and is limited to the removal of sentinel lymph nodes.

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