Lymphoceles
A lymphocele is an accumulation of lymph fluid outside the physiological lymphatic system. A lymphocele most frequently occurs as a result of an operation. However, spontaneous occurrence without a clear cause also occurs.
Lymphocele occurs most frequently in the pelvic area, but can also occur in the abdomen, chest, limbs or neck.
Symptoms
Many lymphoceles are small and cause no symptoms. However, larger lymphoceles can cause pain, swelling and other symptoms, depending on where they are located. They can also lead to infections.
Common symptoms of lymphoceles include, depending on the location:
- Pelvic: pain in the lower abdomen, swelling in the groin or scrotum, frequent or urgent urination, constipation.
- Abdomen: abdominal pain, swelling, nausea, vomiting
- Chest: chest pain, shortness of breath, coughing
- Neck: pain in the neck, swelling in the neck or face
Cause
The most common cause of a lymphocele is due to a surgical procedure. If the lymphatic vessels are damaged during a surgical procedure, lymphatic fluid can leak into the surrounding tissue, resulting in an abnormal accumulation of fluid.
Lymphoceles can also be caused by:
- Trauma: Injury to the lymphatic system can cause lymphoceles to form.
- Radiotherapy: Radiotherapy can damage lymphatic vessels and lead to the formation of lymphoceles.
- Cancer: Cancer can block or damage lymphatic vessels, which can lead to the formation of lymphoceles.
- Infection: An infection can cause inflammation of the lymph vessels, which can lead to the formation of a lymphocele.
Diagnosis
Lymphoceles are usually diagnosed by a physical examination in conjunction with imaging procedures such as ultrasound, lymphoscintigraphy, ICG lymphangiography, computed tomography (CT) or magnetic resonance imaging (MRI).
These examinations allow the size and position of the lymphocele to be precisely determined and other diseases, such as haematomas or abscesses, to be ruled out.
Treatment
Small lymphoceles can resolve on their own without treatment. However, larger lymphoceles that cause symptoms may need to be treated.
Conservative treatments
Compression:
Compression stockings or bandages can help reduce swelling and pain.
Drainage:
A needle or catheter may be inserted into the lymphocele to drain the fluid.
Surgery
In some cases, surgery may be required to remove the lymphocele or repair the damaged lymphatic vessels using a lymphatic venous anastomosis (LVA) or vascularised lymphatic vessel transfer (VLVT).
Lymphatic venous anastomosis (LVA)
Vascularised lymphatic vessel transfer (VLVT)
What are the chances of successful treatment?
The prognosis for lymphoceles is generally good. Most lymphoceles can be successfully treated by drainage or surgery. However, some lymphoceles can recur even after treatment.
