Secondary lymphangiectasia can be caused by increased venous pressure from which condition?

• A. Right-sided CHF, pericarditis, or pericardial effusion
• B. Left-sided CHF
• C. Portal hypertension
• D. Dehydration

Answer: (A)

When venous pressure in the systemic circulation rises, the intestinal lymphatic system can become congested and dilate, leading to secondary lymphangiectasia. This happens most clearly with conditions that raise central venous pressure—such as right-sided heart failure, constrictive pericarditis, or a large pericardial effusion. The elevated venous pressure is transmitted to the mesenteric veins and lymphatics, causing them to enlarge and leak lymph into the gut, which produces loss of protein and immune components (protein-losing enteropathy) and related edema. Left-sided heart failure tends to cause pulmonary congestion rather than systemic venous congestion, so it doesn’t fit the mechanism as directly. Dehydration doesn’t create the back-pressure needed to dilate lymphatics, and while portal hypertension affects venous pressure, the classic direct driver of intestinal lymphatic dilation described here is systemic venous congestion from right-sided disease and similar conditions.