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Lymphangitis Workup

  • Author: Raymond D Pitetti, MD, MPH; Chief Editor: Russell W Steele, MD  more...
Updated: Aug 13, 2015

Approach Considerations

In any individual who presents with lymphangitis, a complete blood cell (CBC) count and blood culture should be obtained. In addition, a leading-edge culture or aspiration of pus should be considered. The CBC count and differential often reveal marked leukocytosis.

Incision and drainage

Abscessed areas may require incision and drainage. Cultures and Gram staining of fluid may help in the identification of the causative organism and the selection of appropriate antimicrobial agents.


Plain radiography is unnecessary in routine cases.


Cultures and Gram Staining

Blood cultures may reveal that infection has spread to the bloodstream; however, results are rarely positive.

Culture and Gram staining of aspirate from the primary site of infection may help in identifying the infectious organism and in choosing antimicrobials. Some authors recommend aspiration of the leading edge of the infection; others prefer sampling the area of maximum inflammation.

Aspiration is relatively insensitive for diagnosing causative organisms. The low density of pathogens present in the infected tissue results in the low sensitivity of aspiration. Published data from a small, comparative study appear to suggest that aspiration of the area of maximal inflammation may increase the yield of positive cultures.

The threshold sensitivity of Gram staining is approximately 100,000 microorganisms per milliliter, a concentration rarely found in cellulitis or lymphangitis.

Aspiration of the leading edge of maximal inflammation is not thought to be helpful in the acute management of cases of acute lymphangitis but may be helpful with treatment-resistant cases. Aspiration may identify antibiotic-resistant organisms or unsuspected organisms.


Imaging Studies

A study found that multidetector computed tomography (MDCT) imaging was very useful in determining the morphology (cellulitis with a few small subcutaneous nodules and channels) and the extension of the lesion in a case of nodular lymphangitis caused by Mycobacterium marinum.[5]


Contributor Information and Disclosures

Raymond D Pitetti, MD, MPH Associate Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine; Associate Division Chief, Division of Pediatric Emergency Medicine, Associate Medical Director, Emergency Department, Medical Director, Sedation Services, Medical Director, Express Care, Medical Director, Patient Safety, Consulting Staff, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh Physicians

Raymond D Pitetti, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, Pennsylvania Medical Society, Society for Pediatric Research, Allegheny County Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.


Larry I Lutwick, MD Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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Trypanosomal chancre on shoulder with lymphangitis toward axilla.
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