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# Lymphangitis and lymphoedema

- Lesion

Lymph vessels can become infected (red streaks up the limb) or blocked (a swollen, firm limb that does not go away).

Updated Nov 12, 2026

## Key points

- Lymphangitis: red, tender subcutaneous streaks with enlarged painful nodes; usually β-hemolytic streptococci; may lead to cellulitis or sepsis.
- Secondary lymphoedema is far more common than primary; cancer treatment and filariasis lead the causes.
- Lymphatic filariasis (Wuchereria bancrofti, Brugia): massive lymphoedema of legs and genitals (elephantiasis) with skin thickening.
- Peau d'orange: tumour blocks dermal lymphatics of the breast; the skin dimples around hair follicles (inflammatory breast carcinoma).
- Chronic lymphoedema causes fibrosis, skin thickening and recurrent infection, and rarely lymphangiosarcoma (Stewart–Treves).

## What it is

Lymphangitis is acute inflammation of lymphatic vessels as bacteria spread from an infection, most often group A streptococci, producing painful red streaks toward the regional nodes. Lymphoedema is swelling from blocked or absent lymphatic drainage. Primary lymphoedema is congenital or developmental (for example Milroy disease or Turner syndrome); secondary lymphoedema follows obstruction by tumour, surgery or radiation (axillary dissection for breast cancer), infection (filariasis) or scarring.

## Structure

- Lymphangitis: dilated lymphatics filled with neutrophils and monocytes that extend into the surrounding tissue.
- Chronic lymphoedema: dilated dermal lymphatics, interstitial fibrosis, thickened skin with hyperkeratosis and papillomatous change.
- Chylous effusions (chylothorax, chylous ascites) occur when obstructed lymphatics rupture.

## Causes of lymphoedema

| Type | Examples | Notes |
| --- | --- | --- |
| Primary (developmental) | Milroy disease, lymphoedema praecox, Turner syndrome | Absent or underdeveloped lymphatics; appears in infancy or youth |
| [Secondary, infectious](https://durgical.com/en/conditions/lymphatic-filariasis/) | Lymphatic filariasis | Endemic in parts of the tropics; elephantiasis |
| [Secondary, cancer and its treatment](https://durgical.com/en/conditions/breast-cancer/) | Axillary dissection and radiation, tumour in lymphatics | Arm lymphoedema after breast cancer; peau d'orange |
| Secondary, other | Recurrent lymphangitis, trauma, scarring | Progressive fibrosis with each infection |

## Clinical notes

- Every episode of cellulitis damages lymphatics further, so prevention of infection is central in chronic lymphoedema.
- Global programmes of mass drug administration have greatly reduced filariasis in the Americas.

## Memory aid

Red streaks mean germs in the lymph; a swollen, hard limb means the drain is shut, by birth, by worm or by the surgeon.

## Test yourself

Think of the answer, then tap the question to see it.

## Which organism usually causes acute lymphangitis?

Group A β-hemolytic streptococci (Streptococcus pyogenes).

## What produces peau d'orange skin in breast cancer?

Obstruction of dermal lymphatics by tumour emboli, so the swollen skin dimples at the hair follicles.

## Which rare malignant tumour can arise in long-standing lymphoedema?

Lymphangiosarcoma (angiosarcoma), the Stewart–Treves syndrome.

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## Elsewhere in DurgiPedia

- [Lymphatic vessels](https://durgical.com/en/histology/lymphatic-vessels/)
- [How the lymphatic system works](https://durgical.com/en/physiology/how-the-lymphatic-system-works/)

## Connections

## Related 3

- [Edema and effusions: the four mechanisms](https://durgical.com/en/general-pathology/edema-and-effusions-the-four-mechanisms/)
- [Haemangioendothelioma and angiosarcoma](https://durgical.com/en/general-pathology/haemangioendothelioma-and-angiosarcoma/)
- [Benign vascular tumours](https://durgical.com/en/general-pathology/benign-vascular-tumours/)

## Related conditions 5

- [Lymphoedema](https://durgical.com/en/conditions/lymphoedema/)
- [Cellulitis of the leg](https://durgical.com/en/conditions/cellulitis-of-the-leg/)
- [Lymphatic filariasis](https://durgical.com/en/conditions/lymphatic-filariasis/)
- [Breast cancer](https://durgical.com/en/conditions/breast-cancer/)
- [Turner syndrome](https://durgical.com/en/conditions/turner-syndrome/)

## Microorganisms 2

- [Wuchereria bancrofti / Brugia malayi](https://durgical.com/en/microbiology/wuchereria-bancrofti-brugia-malayi/)
- [Streptococcus pyogenes](https://durgical.com/en/microbiology/streptococcus-pyogenes/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Lymphedema](https://www.ncbi.nlm.nih.gov/books/NBK537239/) (StatPearls (NCBI Bookshelf), 2025); [Lymphatic filariasis](https://www.who.int/news-room/fact-sheets/detail/lymphatic-filariasis) (World Health Organization, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/lymphangitis-and-lymphoedema/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/lymphangitis-and-lymphoedema/