This is the term often used to describe a more common anatomic-clinical picture of EFSP (see EFSP).
Fig. Device manufactured by VACUMED for cellulite treatment
It is an acute inflammation of the skin, showing the usual semeiotic signs of inflammation: rubor, dolor, calor and tumor. In the majority of cases, it is caused by infection (streptococci), with either mild or even very aggressive clinical pictures. Sometimes, it may even be life-threatening (septic shock).
Fig. Device manufactured by VACUMED for cellulite treatment.
Surgery performed in the past to excise lymphedematous tissues with irreversibly damaged structures. This operation, similarly to other “demolishing” surgical approaches in the treatment of lymphedema (e.g. Servelle’s operation, or total surface lymphangectomy, and Thompson’s buried dermal flap operation) was selected for patients with advance stage lymphedema. More exactly, it featured a skin excision (both of the sub-cutis and the fascia – e.g. a cutolipofasciectomy) in the affected anatomic district. Today, these surgical techniques have been totally replaced by new reconstructive microsurgical techniques, which are commonly applied in lymphology. Another reason for becoming obsolete techniques is that, since they only act on secondary effects of lymphatic failure – e.g. imbibition of suprafascial tissues – they have never yielded any encouraging results, neither in the short term – due to severe surgical invasiveness and serious post-operative complications, nor in the long term, due to extensive scarring and disfigurement caused by the operation itself.
Whitish fluid with a milky look, first described by Gaspare Aselli (1627). Drained by chyliferous vessels, it originates from intestinal villi. Chyle differs from peripheral lymph over its rich content in lipoproteins, which, for their weight and size, cannot enter into blood, but only into lymphatic capillaries. Glycerol, medium and short chain fatty acids, and steroids are drained by the portal venous system. For this reason, many patients who also show a concurrent chylous component – for example those affected by « reflux» disorders – are given a diet without complex fats, while the use of MCT Oil is recommended, that is oil containing only medium chain triglycerides, which are mostly drained through portal circulation.
Intestinal lymphatic collectors. They are named after their function, namely to carry lipids, and chylomicrons in particular, which, because of their size, could not be otherwise transported by the venous portal system.
It is a more or less organized collection of chyle at the level of the mesentery, close to Pecquet cyst (see), or along the course of the thoracic duct. In some cases, it may lead to complications, such as chylomediastinum, chylothorax, or chyloperitoneum.
An abnormal presence of free chyle in the mediastinum. Its main causes are: tumor infiltration of mediastinal lymphatic-lymph node structures, traumas (also iatrogenic ones), or lymphangiodysplasia in the thoracic-mediastinal region.
The presence of effused chyle in the pericardium. In case of conspicuous effusion (> 1500 ml) or of its rapid development (> 200 ml), a heart tamponade may occur, thus requiring immediate drainage. In the majority of cases, a fistular link can be observed between mediastinal lymphatic structures (thoracic duct) and the pericardium. More often, this occurs because of lymphangiodysplasia or after a trauma (even a iatrogenic one).
The presence of effused chyle in the peritoneal cavity. Because of its extent, it is often defined as “chylous ascites” (see). In this case too, there may be very different causes, therefore, accurate clinical investigations also with imaging techniques are essential to design the most suitable medical-surgical therapy. The most common causes are: tumor infiltration of lymphatic structures – visceral lymph nodes – traumas (often of iatrogenic nature, for example during extensive lymphadenectomies in surgical therapy of renal cell cancer), or lymphangiodysplasias.
CHYLORRHEA (or CHYLORRHAGE)
The flow or discharge of chyle. In patients affected by complex lymphangiodysplasias with involvement of chyliferous vessels, with clinical presence of chylous reflux and subsequent lymph-chyledema of external genitalia and lower extremities, chylorrhea may often occur out of lymphostatic warts in the scrotum, in the inguinal-perineal region, or in the lower extremities. It differs from standard lymphorrhoea, because the discharge consists of a milky – not simply serous – fluid. This is an important difference in clinical differential diagnosis, to distinguish a lymphedema proper from a lympho-chyledema, without needing any particular diagnostic procedure, like lymphography.