LYMPHORRHEA OR LYMPHORRHAGIA
Leak of lymph outside the body. It frequently occurs through surgical wounds, as a complication of lymphadenectomies or lesions of major lymphatic ducts. It may also occur in cases of acute or chronic lymphedemas, where the interstitial pressure increases so much as to make the lymph seep through the skin. Figure: Lymph leak in a case of acute lymphedema with lymphostatic verrucosis.
Diagnostic imaging technique commonly used in lymphology. It features an interdigital injection of Technetium-99m (99mTc) labeled nanocolloids, which, being highly lymphotropic, are only drained through the lymphatic pathways. Then, with the acquisition of serial views from a gamma-camera, the anatomy of lymphatic, both superficial and deep, pathways can be outlined, and their drainage capacity assessed over time. With this simple, moderately invasive examination, requiring only an intradermal subcutaneous or deep injection of radioisotopic tracer, the extent of lymph stasis can be assessed, preferential drainage pathways and lymph node structures detected, and any other parameters defined, that may be useful to begin treatment, as well as for long-term follow-up of applied therapies.
Lymphoscintigraphy of the lower limbs (patient with III Stage secondary lymphedema of the left lower limb).
Typical manifestation of advanced stage chronic lymphedema. The term verrucosis refers to the macroscopic appearance of esophytic lesions, and it has nothing to do with more common dermatologic verrucoid pictures, which, in the majority of cases, are due to viruses (human papilloma virus). Also in lymphostatic verrucosis, skin hyperplasia is present, which, in this case, is caused by increased pressure of interstitial fluid in the derma, promoting the proliferation of epidermal basal layer cells through the compression of their intercellular joints. Lymphostatic verrucosis is often accompanied by lymph leak (lymphorrhea or lymphorrhagia). Figure: Examples of lymphostatic verrucosis of male and female external genitalia