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Thermography by Specialty
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Though the vascular system is often thought to be confined to the arteries and veins, the lymphatics or “third vascular system” must also be considered. The lymphatic system is generally invisible or overlooked by thermographers except when disrupted by trauma or surgery, obstructed by parasites such as filariasis, inflamed by infection, or invaded by malignant metastases. A prominent thermal finding is “blood poisoning” – lymphatic inflammation from ascending lymphangitis, usually due to streptococcal bacteria (Figure 11.43). The thermographic appearance of inflamed lymphatics tends to be “wispy,” like cirrus clouds, due to the interweaving network of small lymph vessels, as opposed to the well-defined thermal borders of a warm vein.196 The lymph vessels become more linear and less branched as they progress up the limbs toward the trunk. The presence of visible and warm red streaks extending up a limb indicate possible lymphangitis. Acting as waystations along the lymphatic flow, groups of superficially-located lymph nodes appear thermographically as warm spotty or blotchy areas when reacting to an infection or other invasion. Lymph nodes deep in the body cannot be detected by thermal imaging.
Fungal Infections
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Uwe Wollina, Pietro Nenoff, Shyam Verma, Uta-Christina Hipler
Clinical presentation: Blastomycosis is caused by a dimorphic fungus endemic in soil with a high prevalence in the Midwest of the United States. The asexual form is known as Blastomyces dermatitidis, while the sexual phase is called Ajellomyces dermatitidis. Primary cutaneous blastomycosis is rare, while secondary spread to the skin by pulmonary blastomycosis is seen in up to 30% of patients. North American cutaneous blastomycosis typically evolves from papules that develop into crusted, vegetative plaques often with central clearing or ulceration. Lymphangitis and lymphadenopathy may be present. It occurs also in immunocompetent patients and can be diagnosed by culture, direct visualization of the yeast in affected tissue by silver or periodic acid Schiff (PAS) stains and/or antigen testing.
Acute erythematous rash on the face
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
This is an acute, rapidly spreading rash caused by a Group A beta-haemolytic streptococcus (Strep. pyogenes). The patient is unwell with fever, rigors and general malaise. The rash itself is bright red, well demarcated and may or may not contain large blisters in the centre. There is no associated lymphangitis or lymphadenopathy. It is not usually possible to culture the organism and measurement of the ASO titre is not helpful. Diagnosis is made on the characteristic clinical picture.
Preliminary outcomes of combined surgical approach for lower extremity lymphedema: supraclavicular lymph node transfer and lymphaticovenular anastomosis
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Jae-Ho Chung, Yong-Jae Hwang, Seung-Ha Park, Eul-Sik Yoon
A 41-year-old woman had left LEL after a hysterectomy three years ago (Figure 4). A year before visiting our clinic, she underwent LVA surgery at the ankle and knee levels at another hospital. However, a month after surgery, it had deteriorated and showed a repetitive lymphangitis. For treatment, a simultaneous supraclavicular VLNT and three LVAs were performed (Figure 5). LVAs were conducted at the ankle and the superior edge of the knee. The preoperative circumference diameters were 57 cm and 46.5 cm at 10 cm above and below the patella, and 32 cm at lateral maleollus. The postoperative circumference diameters were improved to 55 cm, 40 cm and 29 cm at 15 months, respectively. The LEL index was improved from 435.0 to 347.6 postoperatively. Also, the symptoms of lymphatic inflammation did not recur after surgery.
Could Penile Mondor’s Disease Worsen Symptoms in Patients with Erectile Dysfunction?
Published in Journal of Investigative Surgery, 2022
PMD may be diagnosed with a medical history and physical examination. Penile Doppler ultrasound may be performed for a definitive diagnosis. Diagnoses using magnetic resonance imaging (MRI) have also been reported [10]. Non-venereal sclerosing penile lymphangitis should also be considered in the differential diagnosis. Upon physical examination, there was a folded, irregular, and light-permeable pathology in lymphangitis, while vein thrombosis was palpable as a flat and pendant string. In addition, it is possible to separate endothelial cells in veins using immunohistochemical methods [11]. In our study, penile Doppler ultrasound was performed on all patients, the thrombosed segment was shown, and PMD was confirmed. None of our patients required additional imaging to make a definitive diagnosis.
A randomized phase-II study of reirradiation and hyperthermia versus reirradiation and hyperthermia plus chemotherapy for locally recurrent breast cancer in previously irradiated area
Published in Acta Oncologica, 2022
Daphne Schouten, Rob van Os, Anneke M. Westermann, Hans Crezee, Geertjan van Tienhoven, M. Willemijn Kolff, Adriaan D. Bins
Between April 2010 and January 2019, 49 patients were randomized, 27 in the standard arm and 22 in the combined arm. Initial accrual was eight patients/year but since 2015 many patients were treated with chemotherapy followed by a resection of the relapse before referral to our department. Hence accrual rate dropped to three patients per year. Therefore, in April 2021, the study was closed. Patient characteristics are listed in Table 1. Baseline characteristics did not vary significantly between the arms. Median age was 60 in the standard arm and 58 in the combined arm (p = 0.72). The standard arm contained more patients with distant metastases (57% vs. 38%), but this was not statistically significant (p = 0.19). Most patients had primarily been operated (93% vs. 100%, p = 0.22) in combination with chemotherapy (71% vs. 76%, p = 0.72). The type of relapse treated in this study was mostly lymphangitis cutis (36% vs. 62%, p = 0.31) and most patients had additional involvement of regional nodes (71% vs. 71%, p = 0.84). Approximately half of the patients had already been unsuccessfully treated for the current relapse with surgery, chemotherapy, hormonal therapy or targeted therapy (i.e., trastuzumab) (43% vs. 52%, p = 0.88).