Lymphatic obstruction

Definition

Lymphatic obstruction is a blockage of the lymph vessels that drain fluid from tissues throughout the body and allow immune cells to travel where they are needed. Lymphatic obstruction may cause lymphedema, which means swelling due to a blockage of the lymph passages.

Alternative Names

Lymphedema

Causes

The most common reason for lymphatic obstruction is the removal or enlargement of the lymph nodes.

Other causes of lymphatic obstruction include:

A common cause of lymphedema is removal of the breast (mastectomy) and underarm lymph tissue for breast cancer. This causes lymphedema of the arm in some people, because the lymphatic drainage of the arm passes through the armpit (axilla).

Rare forms of lymphedema that are present from birth (congenital) may result from problems in the development of the lymphatic vessels.

Symptoms

The main symptom is persistent (chronic) swelling, usually of the arm or leg.

Exams and Tests

The health care provider will perform a physical exam and ask about your medical history.

The following tests may be done:

Treatment

Treatment for lymphedema includes:

Manual lymph drainage is a light massage therapy technique. During massage, the skin is moved in certain directions based on the structure of the lymphatic system. This helps the lymph fluid drain through the proper channels.

Treatment also includes skin care to prevent injuries, infection, and skin breakdown. Light exercise and movement programs may also be prescribed. Wearing compression garments on the affected area or using a pneumatic compression pump may be helpful. Your provider and physical therapist will decide which compression methods are best.

Surgery is used in some cases, but it has limited success. The surgeon must have a lot of experience with this type of procedure. You will still need physical therapy after surgery to reduce lymphedema.

Types of surgery include:

In rare cases, surgery to bypass abnormal lymph tissue using vein grafts is done. These procedures are most effective for early lymphedema and should be performed by a very experienced surgeon.

Outlook (Prognosis)

Lymphedema is a chronic disease that usually requires lifelong management. In some cases, lymphedema improves with time. Some swelling is usually permanent.

Possible Complications

In addition to swelling, the most common complications include:

When to Contact a Medical Professional

See your provider if you have swelling of your arms, legs, or lymph nodes that does not go away.

Prevention

Most surgeons now use a technique called sentinel lymph node sampling to reduce your risk for lymphedema after breast cancer surgery. However, this technique is not always appropriate or effective.

References

Feldman JL, Jackson KA, Armer JM. Lymphedema risk reduction and management. In: Cheng MH, Chang DW, Patel KM, eds. Principles and Practice of Lymphedema Surgery. Philadelphia, PA: Elsevier; 2016:chap 9.

Lee RE, Micali G, Schwartz RA. Lymphedema. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 138.

Strick D. Lymphedema: medical and physical therapy. In: Stanley JC, Veith FJ, Wakefield TW, eds. Current Therapy in Vascular and Endovascular Surgery. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:969-972.