Edema Lymphatic obstruction

Most heroin addicts have lymphadenopathy (Carbone et al. 1998 Tirelli et al. 1986). Vein sclerosis and contaminant-related lymphatic obstruction may cause extremity edema. Ulceration and other dermatologic changes are often present in those who skin pop. ... 

Patients with advanced disease commonly present with back pain and stiffness due to osseous metastases. Untreated spinal cord lesions can lead to cord compression. Lower extremity edema can occur as a result of lymphatic obstruction. Anemia and weight loss are nonspecific signs of advanced disease. 

Post-phlebrtic syndrome, a complication of acute DVT is estimated to occur in approximately 4% of the population (213). This syndrome is characterized by persistent pain, edema, hyperpigmentation, induration of the skin, and stasis ulceration (214). The post-phlebrtic syndrome may be due to venous hypertension as a result of outflow obstruction or damage to the valves and in the cutaneous microcirculation may manifest as tissue hypoxia and lymphatic obstruction. Chronic venous insufficiency may lead to post-phlebetic syndrome. The syndrome may be the result of abnormalities in the superficial, the perforator, or the deep venous system. The diagnosis is purely clinical. The pharmacologic treament of post-phlebetic syndrome is rather limited, with pentoxifylline reported to improve the healing rate of skin ulcers. 

A 59-year-old woman described unilateral upper limb lymphatic obstruction and severe lymphedema after taking sirolimus for 30 months [128]. L)miphatic scintigraphy confirmed poor lymphatic outflow drainage in the left arm, which was consistent with lymphatic obstruction. Sirolimus was replaced by ciclosporin, and there was marked improvement in the swelling and severity of symptoms over 4 weeks. Symmetrical peripheral edema is a well-documented reaction to sirolimus. 

In 17 of 53 cases with obstructive lymphedema there was an increase in Umb volume after lymphangiography with Lipiodol ultrafluid (iodinated poppy seed oil), and 10 cases had features resembling Ijmphangitis. In one patient there was an allergic reaction, with rapid development of edema and an increase in limb volume by 2 liters. Whereas contrast medium virtually disappears from normal Ijmphatics within 8 hours, in cases of obstructive lymphedema Lipiodol remains in the lymphatics for several days and it appears to cause a low grade chemical inflammation with obliteration of the lymphatics (SEDA-7, 454). 

Edema results from the abnormal accumulation of fluid in the interstitial tissue. Edema may be localized, resulting from local changes in vascular permeability or hydrostatic pressure. Systemic edema is associated with changes in protein or electrolyte content of the body fluids. (The causes of allergic and inflammatory edema are discussed in separate sections.) Obstruction of the lumina of the veins or lymphatics induces changes in capillary hydrostatic pressure or prevents lymphatic drainage [52]. 

Clinically, a limb edema is the result of swelling from excessive accumulation of serous fluid in tissue. It depends on two factors. First, excessive liquid is generated in the interstitial space due to obstructive venous diseases presenting as varicose veins or postthrombotic syndrome, heart or kidney failure, metabolic deficits with altered and low protein concentration in the blood, or many other conditions. Second, a lymphatic drainage deficit due to alteration of the lymphatic system can result in water and protein stagnation. Lymphedema frequently occurs in many upper- and lower-limb pathologies. 

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