Lymphatic obstruction is a blockage of the lymph vessels that drain fluid from tissues throughout the body and allow immune cells to travel where they are needed. Lymphatic obstruction may cause lymphedema, which means swelling due to a blockage of the lymph passages.
Causes, incidence, and risk factors
The most common reason for lymphatic obstruction is the removal or enlargement of the lymph nodes.
In Western societies, one of the most common causes of lymphedema is removal of the breast (mastectomy) and underarm lymph tissue for breast cancer. This causes lymphedema of the arm in 10 - 15% of patients, because the lymphatic drainage of the arm passes through the armpit (axilla).
Rare forms of lymphedema that are present from birth (congenital) may result from problems in the development of the lymphatic vessels.
The main symptom is persistent (chronic) swelling, usually of the arm or leg.
Signs and tests
The doctor will perform a physical exam and ask questions about your medical history.
Manual lymph drainage is a light massage therapy technique in which the skin is moved in certain directions based on the structure of the lymphatic system. This helps the lymph fluid drain through the proper channels.
Treatment also includes skin care to prevent injuries, infection, and skin breakdown, as well as light exercise and movement programs. Exercise should be carefully designed by a physical therapist. It should help drainage without leading to swelling, which could make your condition worse.
Wearing compression stockings on the affected area or using a pneumatic compression pump on and off may be helpful. Your doctor and physical therapist will decide which compression methods are best.
Surgery is used in some cases, but it has limited success. The surgeon must have a lot of experience with this type of procedure. You will still need physical therapy after surgery to reduce lymphedema.
You must be vigilant about skin care and hygiene. There is also a small risk of developing a lymph-tissue type of cancer.
Calling your health care provider
See your doctor if you have swelling of your arms, legs, or lymph nodes that does not go away.
Some surgeons are using a technique called sentinel lymph node dissection to prevent lymphedema from developing after surgery for breast cancer. However, this technique is not always appropriate or effective.
Kerchner K, Fleischer A, Yosipovitch G. Lower extremity lymphedema update: pathophysiology, diagnosis, and treatment guidelines. J Am Acad Dermatol. 2008;59:324-331.
Muss HB. Breast cancer and differential diagnosis of benign lesions. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 208.
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.