Lymphangitis

Causes and mechanism of development

Lymphangitis never occurs as an independent disease. It is a secondary process that complicates the course of other purulent foci. In clinical practice, it most commonly accompanies furuncles, carbuncles, abscesses, phlegmon, felon (panaritium), or suppurating wounds.

The main pathogen is staphylococcus, although other pyogenic bacteria can also be encountered. The mechanism of development is associated with the penetration of microorganisms into the interstitial spaces and then directly into the lymphatic vessels. It is worth noting that microbes enter the lymphatic bed in any inflammation, but the vivid clinical picture of lymphangitis unfolds only when pronounced structural changes of the vessels themselves occur.

During the pathomorphological process, both superficial and deep lymphatic vessels are affected. Their walls and surrounding tissues become edematous, and lymphocyte infiltration occurs. Phenomena of perilymphangitis—inflammation of the tissues surrounding the affected vessel—frequently join the process.

General symptoms

The appearance of signs of acute lymphangitis is an ominous signal indicating the progression of the primary purulent-inflammatory disease. Pronounced intoxication syndrome comes to the forefront.

Patients complain of:

• Body temperature elevation up to 39–40 °C;
• Severe chills and profuse sweating;
• Headache;
• General progressive weakness.

Laboratory-wise, this process is confirmed by a sharp increase in the white blood cell count in the blood (high leukocytosis).

Clinical forms of lymphangitis

Depending on the caliber and location of the affected lymphatic pathways, three main forms of the disease are distinguished. Each of them has specific local manifestations.

1. Reticular lymphangitis

The smallest lymphatic capillaries forming a network in the skin are affected. Visually, this is manifested by pronounced skin hyperemia (redness). A characteristic reticular pattern appears in the zone of intense redness. Outwardly, the picture may resemble erysipelas, but the main difference is the absence of clear boundaries in the hyperemic spot.

2. Truncular (nodular/trunk) lymphangitis

Larger lymphatic vessels (trunks) are involved in the process.

• Skin manifestations: Hyperemia looks like separate red streaks extending from the primary focus of inflammation toward the regional lymph nodes (for example, to the axillary fossa or inguinal fold). The skin over them becomes edematous.
• Palpation: Painful indurations resembling cords or strings are palpable along the course of the inflamed vessels.
• Lymph nodes: Regional nodes react by enlarging; they become dense and painful.

3. Deep lymphangitis

In this form, lymphatic vessels passing through the deep layers of tissues become inflamed. Its main feature is the complete absence of hyperemia on the skin. The development of deep lymphangitis can be suspected by the appearance of pain in the affected limb, increasing edema, and pronounced tenderness upon deep palpation. The earliest diagnostic sign of this form is the appearance of lymphadenitis (inflammation of regional lymph nodes).

When surrounding tissues are involved, perilymphangitis develops, in which clear areas of tissue induration are determined along the course of the lymphatic pathways.

Class and exam questions

What else to study on this topic

• Mechanisms of infection penetration into lymphatic pathways
• Pathomorphological picture: edema, infiltration, vascular wall involvement
• Differential diagnosis of reticular lymphangitis and erysipelas
• The connection between truncular lymphangitis and lymphadenitis
• Features of intoxication syndrome in purulent complications

Other topics from the section "CHAPTER 11. SURGICAL INFECTION (PURULENT-INFLAMMATORY DISEASES)"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.