Manual of Surgery Volume First: General Surgery. Sixth Edition.

by Alexis Thomson; Alexander Miles

The clinical features resemble those of other pyogenic infections, and there are wavy red lines running from the source of infection towards the nearest lymph glands. These correspond to the inflamed vessels, and are the seat of burning pain and tenderness. The associated glands are enlarged and painful. In severe cases the symptoms merge into those of septicæmia. When the deep lymph vessels alone are involved, the superficial red lines are absent, but the limb becomes greatly swollen and pits on pressure.

In cases of extensive lymphangitis, especially when there are repeated attacks, the vessels are obliterated by the formation of new connective tissue and a persistent solid œdema results, culminating in one form of elephantiasis.

Treatment.—The primary source of infection is dealt with on the usual lines. If the lymphangitis affects an extremity, Bier's elastic bandage is applied, and if suppuration occurs, the pus is let out through one or more small incisions; in other parts of the body Klapp's suction bells are employed. An autogenous vaccine may be prepared and injected. When the condition has subsided, the limb is massaged and evenly bandaged to promote the disappearance of œdema.

Tuberculous Lymphangitis.—Although lymph vessels play an important rôle in the spread of tuberculosis, the clinical recognition of the disease in them is exceptional. The infection spreads upwards along the superficial lymphatics, which become nodularly thickened; at one or more points, larger, peri-lymphangitic nodules may form and break down into abscesses and ulcers; the nearest group of glands become infected at an early stage. When the disease is widely distributed throughout the lymphatics of the limb, it becomes swollen and hard—a condition illustrated by lupus elephantiasis.

Syphilitic lymphangitis is observed in cases of primary syphilis, in which the vessels of the dorsum of the penis can be felt as indurated cords.

In addition to acting as channels for the conveyance of bacterial infection, lymph vessels frequently convey the cells of malignant tumours, and especially cancer, from the seat of the primary disease to the nearest lymph glands, and they may themselves become the seat of cancerous growth forming nodular cords. The permeation of cancer by way of the lymphatics, described by Sampson Handley, has already been referred to.

Lymphangiectasis is a dilated or varicose condition of lymph vessels. It is met with as a congenital affection in the tongue and lips, or it may be acquired as the result of any condition which is attended with extensive obliteration or blocking of the main lymph trunks. An interesting type of lymphangiectasis is that which results from the presence of the filaria Bancrofti in the vessels, and is observed chiefly in the groin, spermatic cord, and scrotum of persons who have lived in the tropics.

Filarial disease in the lymphatics of the groin appears as a soft, doughy swelling, varying in size from a walnut to a cocoa-nut; it may partly disappear on pressure and when the patient lies down.

The patient gives a history of feverish attacks of the nature of lymphangitis during which the swelling becomes painful and tender. These attacks may show a remarkable periodicity, and each may be followed by an increase in the size of the swelling, which may extend along the inguinal canal into the abdomen, or down the spermatic cord into the scrotum. On dissection, the swelling is found to be made up of dilated, tortuous, and thickened lymph vessels in which the parent worm is sometimes found, and of greatly enlarged lymph glands which have undergone fibrosis, with giant-cell formation and eosinophile aggregations. The fluid in the dilated vessels is either clear or turbid, in the latter case resembling chyle. The affection is frequently bilateral, and may be associated with lymph scrotum, with elephantiasis, and with chyluria.

The diagnosis is to be made from such other swellings in the groin as hernia, lipoma, or cystic pouching of the great saphenous vein. It is confirmed by finding the recently dead or dying worms in the inflamed lymph glands.