Some authors recommend aspiration of the leading edge of infection, while others prefer sampling the area of maximal inflammation. One small comparative study seems to suggest that aspiration of the area of maximal inflammation may yield a higher return of positive cultures. Aspiration, however, is relatively insensitive in the diagnosis of causative organisms. The low density of pathogens present in the infected tissue results in the low sensitivity of aspiration. Aspiration of the leading edge of maximal inflammation would not seem to be of benefit in the management of children with acute lymphangitis.
Plain radiographs are unnecessary in routine cases.
Areas of abscess may need to be incised and drained. Culture and Gram stain of fluid may be helpful in identifying the causative organism and in the selection of antimicrobials. Children with lymphangitis should be treated with an appropriate antimicrobial agent. Children who are afebrile, nontoxic-appearing, well hydrated, and in a stable social situation may be treated initially with oral antibiotics. Parenteral antibiotics may need to be used in a patient with signs of systemic illness, such as fever, chills and myalgia, and lymphangitis.