Many diseases of the lymphatic system can be diagnosed by a detailed examination of the patient without further aids. In the case of lymphangitis, the starting point for the infection is always sought in addition to the nearest lymph nodes, which are often painfully swollen as part of the inflammation. Because the inflammation spreads with the lymph from the point of entry toward the center of the body, the site of inflammation can usually be identified by the onset of redness – a skin lesion, a syringe channel, an inflamed IV needle, or an insect bite are common culprits for superficial lymphangitis.
Recognizing lymphedema
Lymphedema can also be recognized with a trained eye. When palpating the affected area of the body, the doughy consistency of the tissue is noticeable, and even with light pressure, palpable dents remain in the tissue for an extended period of time. In lymphedema of the legs, pronounced wrinkles are typically seen above the toes and the skin on the toes cannot be lifted from the subcutaneous tissue (Stemmer’s sign). The toes are also swollen – unlike edema caused by venous outflow obstruction. With lymphography and lymph scintigraphy, two procedures are available to show the lymph drainage conditions in the body more precisely. In lymphography, a contrast medium is injected into or around the lymph vessels of the region to be examined, and the outflow pathways and lymph nodes are then visualized in the X-ray image. Particularly in the case of outflow disorders, it is possible to localize exactly where lymph outflow is obstructed – whether because there are too few lymphatic channels or because the outflow is blocked in the area of a lymph node accumulation.
Lymph nodes: Examination for cancer
The involvement of lymph nodes plays a major role, especially in malignant diseases. To determine the extent to which tumor cells have already spread through the lymphatic channels to the nearest lymph nodes, a lymph scintigraphy is often performed before surgery. In this procedure, some radioactive substance is injected near the tumor and its removal via the lymph is monitored. The substance accumulates in nearby lymph nodes, and the surgeon can remove these lymph nodes during surgery and have them examined for tumor cells. If the nearby lymph nodes are free of cancer cells, it is now known that it is not necessary to remove the other lymph nodes either (sentinel-node method).
Treatment of diseases of the lymphatic system
While lymphangitis can be controlled by appropriate hygiene measures, disinfection, and medical support with antibiotics and antipyretics, in lymphedema the swelling is treated with massage (manual lymphatic drainage), physiotherapy, and special compression stockings or gloves. Excess weight should be reduced and endurance sports such as cycling or hiking boost the metabolism and support venous return. Unfortunately, primary lymphedema will usually not disappear completely even with the use of all treatment options, but the consequences will be reduced.
Secondary lymphedema: treating the causes.
Secondary lymphedema often used to occur after cancer surgery because all the lymph nodes in the tumor area were removed or radiation treatment damaged the small lymph vessels. In addition to the above-mentioned treatment methods, the causative disease is also combated – whether through medication as in the case of inflammatory processes or through the therapy of a cancer disease. A postoperative lymphatic fistula is treated with a sterile pressure dressing. If the injured lymphatic channels do not close after several days, the channels are glued together with tissue adhesive in a new operation. Inflammatory lymph node swellings regress after treatment of the underlying disease. Lymph node swelling due to leukemia or Hodgkin’s disease requires extensive chemotherapy and radiation therapy.
Prevention of diseases of the lymphatic system
Lymph node examination plays an important role, especially in breast cancer screening, because monthly self-palping of the breast should always include palpation of the axillary lymph nodes. Lymphatic drainage also plays a role in the development of cellulite. Regular plucking massages and a little exercise stimulate the outflow of metabolic products – and unsightly dents on the thighs will soon no longer be an issue!
