Dizionario

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Although words like lymphocyte, lymph node, lymph, and lymphatic vessels are common in daily medical activities, Lymphology has always been considered as a sort of younger sister to Angiology or Phlebology. Also, apart from few pioneer physicians, it has never been investigated as a discreet, well identified area of research.

Therefore, the following “Dictionary” aims to be a sort of metaphorical “window” on the extensive and still poorly explored world of lymphatic diseases, as well as to provide some useful, basic information for a correct diagnosis of patients affected by lymphatic-lymph node disorders.

Questo “Dizionario” vuole, quindi, rappresentare una sorta di metaforica “finestra” sul vasto ed ancora poco inesplorato mondo della patologia linfatica e fornire utili elementi di conoscenza di base per una corretta diagnosi e gestione del paziente affetto da alterazioni del sistema linfatico-linfonoidale.

COUMARINS

They belong to the family of alpha-benzopyrones and they can be of natural or synthetic origin. Although they are no alternative to combined decongestion therapy and microsurgery in the treatment of Lymphedema, they are used just like other benzopyrones as adjuvant therapy.

COMPRESSION STOCKINGS / GARMENTS

Compression stockings are one of the most useful and effective ways to treat lymphatic dysfunctions and venous insufficiency. Already Hippocrates, who applied bandages made of simple sponges, had underlined the importance of exerting some external mechanical pressure in those clinical situations in which the limb was suffering from “dysregulation in intra-extravasal fluid exchange”. Later on, in 1650, Richard Wiseman, who was the actual precursor of modern therapies, would recommend the use of gaiters with adjustable leather strings to fight edema of the lower extremities. More recently, new fabric technology and investigations on edema physiopathology have led to current elastic-compression methods, with stockings in different fabrics, that can be adjusted to each type of disorder and customized to each patient. They are key in limb edema control.

COLOR-DOPPLER ULTRASOUND

Today, it is the most commonly applied diagnostic tool for non-invasive anatomic investigations of vascular – venous as well as arterial – structures. It combines the ultrasonographic technique with the physical doppler principle, thus allowing for a good display of the vessels under examination, the identification of their actual anatomy, and the presence of any stenosis or atheromasic plaques. With this imaging technique, bloodstream amount, direction, and velocity can be accurately invesigated. An accurate study of vascular, especially venous, structures, with color-Doppler ultrasound is key for proper lymphatic edema assessment. Indeed, it is necessary to identify any concurrent venous insufficiency, since it could worsen the clinical picture, or the presence of arterial insufficiency, in which case a prolonged application of elastic bandaging should not be recommended.

COLLAGEN

It is the most abundant protein in our body, accounting for almost 1/3 of all our body proteins. Collagen is organized into fibers which, in turn, consist of microfibrils. Practically present everywhere, it forms a support and a basic structure to connective tissues.

COCKETT’S SYNDROME

It is caused by a more or less serrated, in the majority of cases monolateral, stenosis of the iliac vein. It may be due to a congenital anatomic condition or it can be secondary to traumas also of iatrogenic nature. It is the cause of severe homolateral venous stasis and it is often accompanied by lymphatic insufficiency.

CLINICAL STAGING OF LYMPHEDEMA

  • Stage 1
    • IA: No edema, but presence of lymphatic impairment (with lymphatic stasis detected by scintigraphy).
    • IB) Mild edema reversible with limb elevation and night rest.
  • Stage IIA: Persisting edema, with only partial regression with limb elevation and night rest.
  • Stage IIB: Persisting edema (no spontaneous regression with limb elevation) and progressing disease (acute erysipeloid lymphangitis).
  • Stage IIIA: Fibrolymphedema (initial lymphostatic verrucosis) with “column-shaped” limb.
  • Stage IIIB: Elephantiasis with severe deformation of the affected extremity, marked and extended, sclerodermic pachidermitis and lymphostatic verrucosis.

CHYLURIA

Discharge of chyle through urinary excretion pathways. Urine acquires a unique milky, and whitish appearance, due to chyle mixed with urine. In the majority of cases, it is due to fistulas that link the urinary excretion pathways – from the pelvis of the kidney – with the retroperitoneal lymphatic and chyliferous system. It can be caused by traumas – of iatrogenic origin (such as, for example, following extensive para-aortoiliac lymphadenectomies in urologic surgery) -, or it can be correlated with complex dysplasia of intestinal and retroperitoneal chyliferous and lymphatic vessels.

CHYLOUS VAGINAL DISCHARGE

Discharge of chyle through the uterus or the vagina.

CHYLOUS EFFUSION IN A JOINT

Effusion of chyle in a joint cavity.

CISTERNA CHYLI (or RECEPTACULUM CHYLI or CISTERNA OF PECQUET)

It is an ampulla-shaped dilation at the beginning of the thoracic duct; it may be up to one and a half centimeter in diameter, it is normally anterior to the initial lumbar vertebrae, posterior to the aorta, and medial to the right medial pillar of the diaphragm. In some cases, where the origin of the thoracic duct is particularly high – e.g. at the level of the last thoracic vertebrae

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