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An imaging evaluation of angiodysplasia syndromes.

Current imaging techniques such as magnetic resonance, magnetic resonance angiography, computer tomography, ultrasound, plain x-rays, and lymphangioscintigraphy have enhanced the ability to define blood and lymph vascular malformations in more precise pathophysiologic terms. Not only can these imaging modalities distinguish arterial anomalies from lymphatic and venous angiodysplasia, but they also readily differentiate edema in the epifascial as opposed to the subfascial peripheral compartments. Moreover, visceral lymphangiectasia (e.g., chylous and non-chylous reflux), bone and muscle overgrowth, agenesis, and fat deposits can also be delineated. Clinical examples are provided including an algorithm for approaching these conditions.

Adolescent↗

Lymphangiectatic fibrolipomatous polyp of the palatine tonsil.

A rare benign polypoid tumor of the right palatine tonsil is described in a 23 year old male. It contained dilated lymphatic channels surrounded by fibrous tissue and foci of mature fat. The features of this lesion add support to the hypothesis that benign tumors of tonsil may be hamartomas of tonsil rather than true neoplasms. The differential diagnosis of polypoid lesions of the tonsil is discussed.

Adipose Tissue↗

Intestinal lymphagiectasia: a reappraisal.

Intestinal lymphangiectasia (IL) may vary widely in its manifestations and severity. Fifteen children seen between 1960 and 1974 with histologically proven IL are analyzed by clinical, laboratory, radiologic, and histologic criteria. Remissions occurred in most patients and none died. Exacerbations occurred in five children. Diarrhea was present in 14 patients and in 13 appeared before the age of 3 years. Vomiting occurred in nine patients and growth retardation in seven. Four children had associated peripheral lymphedema and two of these had a family history of lymphedema, both had affected fathers and one had affected siblings and paternal cousins. Seven had hypoproteinemic edema, and of these, four suffered from hypocalcemic seizures. Chylous effusions were present in five. Hypoproteinemia was present in 12 although five had no hypoalbuminemic edema. Six had lymphopenia which was related to the severity of the disease and was the last abnormality to disappear after clinical remission. Lymphopenia may first appear years after the protein loss begins. Upper gastrointestinal tract series were performed in 13 children and had diagnostic supportive value in seven. Six children had two or more small-intestinal biopsies done. They all showed great variation from one examination to the other, ranging from a normal appearance to severe changes. Lymphatic block may occur at different sites-in the lamina propria only, generalized (lamina propria, submucosa, serosa, and mesentery), or conversely in the mesentery alone with minimal changes in the lamina propria. In three patients intravenous hyperalimentation was necessary. Specific treatment with a high-protein, low-fat diet with added medium-chain triglyceride (MCT) is valuable. Surgical resection was of benefit in one patient, and anastomosis of mesenteric to para-aortic lymph nodes in another.

Adolescent↗

[Cervical lymphangiectasia--case report].

A case-report of a patient with paraesthesia of the left upper extremity caused by a tumor localized in the left supraclavicular area is presented. The patient underwent an operation. Two formations--a lipoma and cyst--were found. Both were removed and histologically examined. The diagnosis of lipoma and neck lymphangiectasia was made. On the third postoperative day the patient was discharged home with no more paraesthetic complaints. A check-up after three months did not reveal any complaints present before operation. In the paper the differential diagnosis of neck tumors with a view to resistance associated with the lymphatic system especially lymphangioma, lymphangiectasia and hygroma coli cysticum is discussed. Lymphangioma is a benign oncogenic affection of lymphatic vessels developing during the postnatal period of life. Lymphangiectasia is a congenital disease without proliferating activity. Hygroma coli cysticum is a congenital extensive multioccular formation localized in the neck area. All three affections are often incorrectly mistaken for each other. Histological examination is decisive for the correct diagnosis.

Adult↗

[Tumoral extension by inversion of the lymphatic flow in colonic cancer].

In a patient with an adenocarcinoma of the ascending colon, the jejunal central villous lymphatics were dilated and contained tumour cells. This case, apparently the only one of its type, demonstrates the proof of a phenomenon sometimes described in connection with malignant diseases, but rarely proven; that of the dissemination of tumour cells by reversal of lymphatic flow.

Adenocarcinoma↗

CO(2) laser therapy of vulval lymphangiectasia and lymphangioma circumscriptum.

BACKGROUND: Lymphangiectasia is a disorder of superficial lymphatics resulting from obstruction of previously normal deep lymphatics, while lymphangioma circumscriptum describes a deep dermal and subcutaneous lymphatic malformation with secondary superficial ectatic changes. Previous case reports have suggested the effectiveness of CO2 laser treatment. OBJECTIVE: To assess CO2 laser therapy for vulval involvement by these lymphatic disorders. METHODS: A retrospective case review at St. John's Institute of Dermatology from 1996 to 1999 identified three women with vulval lymphangiectasia and two with vulval lymphangioma circumscriptum treated with the CO2 laser. RESULTS: Patient tolerance of the procedure was good. Healing was complete within 1 month and occurred without change in skin texture. All patients reported considerable improvement in symptoms (mean follow-up 22 months, median 24 months, range 10-33 months). Focal recurrence and an area of localized persistence were noted in the two patients with lymphangioma circumscriptum. CONCLUSION: CO2 laser therapy of vulval lymphangiectasia and lymphangioma circumscription is effective and well-tolerated; the latter may possibly be more resistant to treatment than the former.

Carbon Dioxide↗

[Transformation in the lymphatic system of the heart and myocardium in congestion with lymph].

Changes in the heart in regional songestion of the lymph were studied both on sectional (26 observations) and experimental (20 dogs) material. It was shown that blocking of the lymphatic ways brought about dilatation and deformation of lymphatic capillaries and vessels, growth of capillaries, formation of lymphatic lacunas, varicosis of the wall of lymphatic vessels, and -- in complete obstruction of the lymph flow -- the appearance of lympho-venous shunts. In the myocardium stroma there were observed oedema, lympho-histiocytic and plasmocellular infiltrations, and in muscle cells -- dystrophic and necrobiotic changes. The degree of manifestation of the disorders depended upon the duration of congestion of the lymph; their outcome is replacing and stromogenous cardiosclerosis.

Animals↗

[Intestinal lymphagiectasis of surgical interest].

Surgical management of a case of intestinal lymphangectasis with unusual features is reported. The view that the picture was one of early segmentary enteritis was supported by some aspects of the course and various anatomopathological features.

Angiography↗

Morphologic and functional changes of the microlymphatic network in patients with advancing stages of primary lymphedema.

Using fluorescent microlymphography, we examined the morphology andfunctional characteristics of the microlymph-vascular network in 36 subjects including 9 patients with "compressible" lymphedema (Group I), 14 with minimally compressible lymphedema (Group II), 9 with noncompressible lymphedema (Group III), and 4 healthy individuals. As lymphedema progressedfrom early to advanced stages (Group I-III), an increasingly greater lymphatic capillary density and diameter were depicted and eventually fibrosis/sclerosis with lymphangiectasia, fragmentation and a gradual decrease in the number of microlymphatics. Concomitantly, there was a prolongation in transport and disappearance of fluorescent dye and a progressive increase in endolymphatic and interstitial hydrostatic pressures.

Adult↗

Intestinal lymphangiectasia: the variability of presentation. A study of five cases.

Five patients with intestinal lymphangiectasia are described. They all had evidence of protein-loss from the gut but this was of a variable degree. In four patients the diagnosis was first suggested by the appearances of jejunal biopsy. The factors influencing presentation are discussed as are the possible co-existence of other gastronitestinal disorders with this congenital abnormality. It seems likely that the condition is commoner than hitherto believed.

Adolescent↗

Yellow nail syndrome or diffuse lymphatic network disease.

We report a man aged 68 years old with pneumothorax and chronic bilateral pleural effusion in association with a history of yellow nails. The diagnosis of yellow nail syndrome based on yellow nails, lymphedema, chronic pleural effusion and intestinal lymphangiectasia.

Aged↗