Lymphangiectasia Clinical Presentation

Updated: May 21, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

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. [16, 17] Sometimes, they resolve in weeks without any treatment. [18]

Rarely, lymphangiectasias may occur in pregnancy and spontaneously regress with childbirth. [19] Acquired lymphangiectasia of the glans may also occur after circumcision. [20]

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Physical Examination

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 (see the image below). Some lymphangiectasia lesions may become pedunculated with a hyperkeratotic verrucous surface mimicking a wart. [21]

Lymphangiectasia. Courtesy of DermNet New Zealand Lymphangiectasia. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/doctors/lesions/images/lymphangiectasia1.jpg).

Conjunctival lymphangiectasis may be evident as intermittent conjunctival swelling and dilated conjunctival vessels on ocular examination. [22]

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. [23]

Lymphangiectasia may also be evident on the penis. Benign transient lymphangiectasis of the penis may be evident. [24] Acquired lymphangiectasia of the glans may occur after circumcision. [20]

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Complications

Lymphangiectases are often complicated by pain, copious fluid drainage, and recurrent attacks of cellulitis.

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