Symptoms of lymphatic vessel obstruction

Lymph is an important tissue in the body. Normally, there must be no problems with the lymph. Once there is a viral infection or bacterial problem, it will cause lymph blockage, which will cause lymphedema, blockage of the trunk lymphatic ducts, or symptoms of ascites. The most common is the large expansion of the lymphatic vessels, causing local twisting. The patient's chest cavity, abdominal cavity, and urinary tract will have different degrees and different symptoms.

Clinical manifestations

Lymphatic obstruction in the limbs usually manifests as lymphedema, while lymphatic obstruction in the trunk can also lead to clinical signs such as chylous ascites, chyluria, and chylous pleural effusion.

Imaging findings

Lymphangiography can be used to determine whether lymphatic vessel obstruction occurs and to identify the site of obstruction, which is very helpful for clinical diagnosis and treatment. When analyzing the results of lymphangiography, attention must be paid to the number, course, contour, diameter and valve status of the lymphatic vessels. The common X-ray signs of lymphatic vessel obstruction are summarized as follows.

Enlarged lymphatic vessels

The lymphatic vessels were shown to be widened and twisted.

Lymphatic congestion

Iodized oil may remain in the lymphatic vessels for 24 hours or longer after injection.

Lymphatic extravasation

Due to the increased pressure in the lymphatic vessels, the lymphatic vessels rupture. When lymph enters the interstitial space, extravasation of contrast agent can be seen during angiography. Lymph fluid extravasates into the sheaths around blood vessels and nerves, and the contrast agent can depict the outline of the blood vessels. Lymph fluid breaks into the abdominal cavity, intestinal tract, urinary tract, and thoracic cavity, which can show signs of contrast agent entering the abdominal cavity, intestinal tract, urinary tract, and thoracic cavity, respectively.

Decreased or absent number of lymphatic vessels

It is common in limb lymphedema, which is manifested by a decrease in the number of lymphatic vessels, often accompanied by enlargement, distortion and extravasation of the lymphatic vessels.

Lymphatic reflux

It manifests as reverse filling of lymphatic vessels. If retrograde filling of lymphatic vessels around pelvic organs is found, it indicates obstruction of the common iliac lymph nodes or lumbar lymph trunk on that side.

Lymphatic collateral pathways

The emergence of lymphatic collateral pathways is one of the most common signs of lymphatic obstruction and is also the main way the body uses to overcome obstruction. There are two basic forms of lymphatic lateral communication pathways.

① Lymphatic and venous anastomosis: In the area of ​​lymphatic obstruction, contrast agent can be seen in the vein. This proves the existence of lymphovenous anastomosis. Lymphatic angiography often does not allow direct visualization of the pathways.

②Lymphatic and lymphatic anastomosis: It is the most common collateral pathway, similar to the collateral circulation produced after vascular occlusion. For example, when the lumbar lymph nodes are completely blocked, the contrast agent is shunted to the opposite side through the communicating lymphatic vessels at the aortic bifurcation, showing the contralateral lumbar lymph trunk. If the obstruction is located in the groin or subiliac region, extensive subcutaneous collateral lymphatic pathways can be shown in the thigh perineum, external genitalia, and anterior abdominal wall.