Lymphangiectasia Clinical Presentation
- Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD more...
Patients with lymphangiectasia typically present with numerous fluid-filled vesicles in a chronic lymphedematous area several years after surgery, more commonly due to a malignancy. The cutaneous lesions of lymphangiectasia can range from clear, fluid-filled blisters to smooth, flesh-colored nodules, often appearing along an incisional scar.
Coexisting lymphedema is present in most patients with acquired lymphangioma.
Patients can present with localized wetness or copious drainage of clear or milky fluid from ruptured vesicles. Pain and recurrent cellulitis are complications associated with lymphangiectasia.
Acquired lymphangiectases may be associated upper limb lymphedema secondary to mastectomy, radiotherapy, keloids, chronic lymphedema, or scleroderma.[5, 6] Sometimes, they resolve in weeks without any treatment.
Clinically, lymphangiectasia consists of several clusters of translucent, thick-walled, fluid-filled vesicles. The vesicles typically measure 2-10 mm in diameter. The affected area appears to be speckled by numerous translucent vesicles with normal-appearing skin among the lesions. Some lymphangiectasia lesions may become pedunculated with a hyperkeratotic verrucous surface mimicking a wart.
Conjunctival lymphangiectasis may be evident as intermittent conjunctival swelling and dilated conjunctival vessels on ocular examination.
Although many patients without chronic lymphedema have been reported, it is a common physical finding in patients with acquired lymphangioma. Diffuse infiltration of subcutaneous tissue by lymphangiectasia may produce painless swelling at sites such as the subclavicular fossa.
Acquired lymphangiomas can arise from a large number of external factors that cause structural damage to previously normal deep lymphatics.
Lymphangiectases have been reported following radical mastectomy with or without radiation therapy ; irradiation alone for various malignancies ; metastatic lymph node obstruction; and various scarring processes, such as infections, keloids, scleroderma, and scrofuloderma.
Lymphangiectases have been described in the penis and the scrotum after removal of a sacrococcygeal tumor; they may also arise on the vulva and the inner thigh after surgery for cervical or other pelvic cancers.[17, 18, 19, 20] Pelvic lymphatic obstruction may produce acquired vulvar lymphangiomas.
Acquired lymphangiomas have been reported in the genital region of elderly patients without evidence of lymphatic obstruction.
Garcia-Doval et al reported lymphangiectasis in a patient with cirrhotic ascites.
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