T Thrombophlebitis Superficial Thrombophlebitis: Risk Factors, Symptoms, and Diagnosis
May 15, Author: See Etiology and Workup. Although superficial thrombophlebitis usually occurs in the lower extremities, it also has been described in the penis and the breast Mondor disease. Superficial thrombophlebitis can also develop anywhere that medical interventions occur, such as in the arm or neck external jugular vein when intravenous IV catheters are used. See Etiology, Presentation, and Workup, t Thrombophlebitis. Thrombosis and thrombophlebitis of the superficial venous system receive little attention in medical and surgical textbooks.
However, thrombophlebitis is encountered frequently and, although it is usually a benign, self-limiting disease, it can be recurrent and tenaciously t Thrombophlebitis, at times causing significant incapacitation. See Epidemiology and Prognosis. When affecting the great saphenous vein also referred to as the greater or long saphenous veinthrombophlebitis will sometimes progress into the deep venous system, t Thrombophlebitis. Damage to deep venous valves leads to chronic deep venous insufficiency often referred to as t Thrombophlebitis syndromeas well as to recurrent pulmonary embolism PE and an increased risk of death.
Superficial thrombophlebitis can occur spontaneously, especially in the lower extremities in the great saphenous vein, or as t Thrombophlebitis complication of medical or surgical interventions. Although the etiology is frequently obscure, superficial venous thrombosis is most often associated with one of the components of the Virchow triad; ie, intimal damage which can result from trauma, infection, or inflammationstasis or turbulent flow, t Thrombophlebitis, or changes in blood constituents presumably causing increased coagulability.
In each type of superficial thrombophlebitis, the condition presents as redness and tenderness along the course of the vein, t Thrombophlebitis, usually accompanied by swelling. Bleeding also can occur at the site of a varicose vein. Although unusual, superficial thrombophlebitis may occur in the lesser saphenous vein, which empties into the popliteal vein. Superficial thrombophlebitis can also occur in the external jugular vein, t Thrombophlebitis, if it has been used for an infusion site.
Superficial thrombophlebitis of the upper extremities usually occurs at infusion sites or sites of trauma. Superficial thrombophlebitis is a clinical diagnosis in which the clinician identifies tender and inflamed superficial veins. However, ruling out DVT in the clinical setting is difficult; further testing is often required to evaluate for this condition. See Presentation and Workup. Treatment for superficial thrombophlebitis is aimed at patient comfort and at preventing superficial phlebitis from involving the deep veins.
See Treatment and Medication, t Thrombophlebitis. Superficial phlebitis with infection, such as phlebitis originating at an IV catheter site, is referred to as septic thrombophlebitisa clinical entity requiring diagnostic and therapeutic approaches that are different from those applied to sterile phlebitis. Microscopic thrombosis is a normal part of the dynamic balance of hemostasis, t Thrombophlebitis.
Inthe German pathologist Virchow recognized that if this dynamic balance were altered by venous stasis or turbulence, abnormal coagulability, or vessel wall injuries, then microthrombi could propagate to form macroscopic thrombi. In the absence of a triggering event, t Thrombophlebitis, neither venous stasis nor abnormal coagulability alone causes clinically important thrombosis, t Thrombophlebitis, but vascular endothelial injury does reliably result in thrombus formation.
The initiating injury triggers an inflammatory response that results in Krampfbecken platelet adhesion at the injury site. Further platelet aggregation is mediated by thromboxane A2 TxA2 and by thrombin, t Thrombophlebitis. A more detailed visual of the coagulation pathway can be t Thrombophlebitis in the image below.
Platelet aggregation due to TxA2 is inhibited irreversibly by aspirin and reversibly by other nonsteroidal anti-inflammatory t Thrombophlebitis NSAIDs ; thrombin-mediated platelet aggregation, on the other hand, t Thrombophlebitis, is not affected by NSAIDs, including aspirin. This is why aspirin and t Thrombophlebitis NSAIDs are somewhat effective in preventing arterial thrombosis, where platelet aggregation is mediated via TxA2, as seen in patients with stroke and myocardial infarction, but are not very effective in preventing venous thrombophlebitis, where it is believed that clot formation is more of a result of thrombin activation.
The most important clinically identifiable risk factors for thrombophlebitis are a prior history of superficial phlebitis, DVT, and PE. Some common risk markers include recent surgery or pregnancy, t Thrombophlebitis, prolonged immobilization, and underlying malignancy.
Phlebitis also occurs in diseases associated with vasculitis, such as polyarteritis nodosa periarteritis nodosa and Buerger disease thromboangiitis obliterans. The increased likelihood of developing thrombophlebitis occurs through most of pregnancy and for approximately 6 weeks after delivery, t Thrombophlebitis.
This is partly due to increased platelet stickiness and partly due to reduced fibrinolytic activity, t Thrombophlebitis. The association between t Thrombophlebitis and thrombophlebitis is of particular concern to women who carry the factor V Leiden or prothrombin Ca gene, because they already have a predisposition to clotting, which would also be exacerbated by pregnancy.
High-dose estrogen therapy is another risk factor. Case-controlled and cohort studies based on clinical signs and symptoms of thrombosis suggest t Thrombophlebitis by taking high-estrogen oral contraceptives, a woman may increase her risk of thrombosis by a factor of times, though the absolute risk remains low.
Newer low-dose oral contraceptives are associated with a much lower risk of thrombophlebitis, though the absolute risk has not been well quantified. Superficial venous thrombosis following an injury usually occurs in an extremity, manifesting as a tender cord along the course of a vein juxtaposing the area of trauma.
Ecchymosis may be present early in the disease, indicating extravasation of blood associated with injury to the vein; this may turn to brownish pigmentation over the vein as the inflammation resolves. Thrombophlebitis frequently occurs at the site of an IV infusion and is the result of irritating drugs, hypertonic solutions, or the intraluminal catheter or cannula itself.
This is by far the most common type of thrombophlebitis encountered. Usually, redness and pain signal its presence while the infusion is being given, but thrombosis may manifest as a small lump days or weeks after the infusion apparatus has been removed. It may take months to completely resolve. The features of iatrogenic form of traumatic chemical phlebitis may be deliberately produced by sclerotherapy during the treatment of varicose veins.
Superficial thrombophlebitis frequently occurs in varicose veins. It may extend up and down the saphenous vein or may remain confined to a cluster of tributary varicosities away from the t Thrombophlebitis saphenous vein. Although thrombophlebitis may follow trauma to a varix, it often occurs in varicose veins without an antecedent cause.
Thrombophlebitis in a varicose vein develops as a tender, hard knot and is frequently surrounded by erythema. At times, bleeding may occur as the reaction extends through the vein wall. It frequently is observed in varicose veins surrounding venous stasis ulcers. Superficial thrombophlebitis along the course of the great saphenous vein is observed more often to progress to the deep system, t Thrombophlebitis.
Infection-related thrombophlebitis is associated with several different conditions, including a serious complication of intravascular cannulation and can be suspected in patients who have persistent bacteremia in the setting of appropriate antibiotic therapy. It also frequently is associated with septicemia, t Thrombophlebitis. InDeTakats suggested that dormant infection in varicose veins was a factor in the development of thrombophlebitis occurring following operations or after injection treatments, trauma, or exposure to radiation therapy, t Thrombophlebitis.
Altemeier et Heile Dich selbst Varizen suggested that the presence of L-forms and t Thrombophlebitis atypical bacterial forms in the blood may play an important t Thrombophlebitis role in the disease and recommended administration of tetracycline.
Jadioux described migratory thrombophlebitis indetermining it to be an entity characterized by repeated thromboses developing in superficial veins at varying sites but occurring most commonly in the lower extremity. Although numerous etiologic factors have been proposed for t Thrombophlebitis condition, none have been confirmed. The association of carcinoma with migratory thrombophlebitis was first reported by Trousseau, t Thrombophlebitis, in Sproul noted migratory thrombophlebitis to be especially prevalent with carcinoma of the tail of the pancreas.
Mondor disease is a rare condition. Thrombophlebitis is usually located in the anterolateral aspect of the upper portion of the breast or in the region extending from the lower portion of the breast across the submammary fold toward the costal margin and the epigastrium.
A characteristic finding is a tender, cordlike structure that may be best demonstrated by tensing the skin via elevation of the arm. The cause of Mondor disease is unknown, but a search for malignancy is indicated.
Mondor disease is more likely to occur after breast surgery, with the use of oral contraceptives, and with protein C deficiency. Thrombophlebitis of the dorsal vein of the penis, generally caused by trauma or repetitive injury, is also referred to as Mondor disease.
In the author's experience, superficial thrombophlebitis most frequently occurs in the age group ranging from young adulthood to middle age, t Thrombophlebitis. However, Markovic et al reported that a common risk factor is age older than 60 years, though fewer complications occur in this age group.
As previously mentioned, pregnancy, puerperium, and high-dose estrogen therapy are recognized risk factors for phlebitis. However, there are no intrinsic, sex-linked risks for the disease.
The prognosis in superficial thrombophlebitis is usually good. Superficial phlebitis is rarely associated with PE, t Thrombophlebitis, although it can occur, particularly if t Thrombophlebitis process extends into a deep vein. However, t Thrombophlebitis, individuals with t Thrombophlebitis venous thrombosis do not seem to have a great tendency to develop DVT.
In contrast, patients with DVT are frequently found to have superficial venous thrombosis. The patient should be told to expect the disease process to persist for weeks or longer. If it occurs in the lower extremity in association with varicose t Thrombophlebitis, it has a high likelihood of recurrence unless excision is performed. Because thrombophlebitis tends to recur if the vein has not been excised, instructing the patient in ways to prevent stasis in the vein is usually advisable.
The use of elastic stockings may be indicated, especially if the patient plans to stand in an upright position for long periods, t Thrombophlebitis. Slight elevation of the foot of the bed, avoidance of long periods of standing in an upright position, and avoidance of prolonged inactivity is recommended. An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh. The veins in thromboangiitis obliterans: With particular reference to arteriovenous anastomosis as a cure for the condition.
Pathology, Diagnosis and Treatment. University of Nagoya Press; Best Pract Res Clin Rheumatol. Vasculopathy related to cocaine adulterated with levamisole: A review of the literature. Oral contraceptives, hormone replacement therapy and thrombosis. Skin necrosis and venous thrombosis from subcutaneous injection of charcoal lighter fluid naptha.
Am J Emerg Med. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: Am J Med Sci. Acute and recurrent thromboembolic disease: Carcinoma and venous thrombosis: Frequency of association of carcinoma in body or tail of pancreas with multiple venous thrombosis. Nazir SS, Khan M. Thrombosis of the dorsal vein of the penis Mondor's Disease:
Superficial Thrombophlebitis: Background, Pathophysiology, Etiology
Thrombophlebitis is a phlebitis inflammation of a vein related to a thrombus blood clot. When it occurs repeatedly in different locations, it is known as thrombophlebitis migransmigrating thrombophlebitis. The following symptoms or signs are often associated with thrombophlebitis, t Thrombophlebitis, although thrombophlebitis is not restricted to the veins of the legs, t Thrombophlebitis.
Thrombophlebitis causes include disorders related to increased tendency for blood clotting and reduced speed of blood in the veins such as prolonged immobility; prolonged traveling sitting may promote a blood clot leading to thrombophlebitis but this occurs relatively less.
High estrogen states such as pregnancy, estrogen replacement therapyor oral contraceptives are associated with an increased risk of thrombophlebitis. Thrombophlebitis migrans can be a sign of malignancy - Trousseau sign of Varizen Volksmedizinmann. In terms of complications, one of the most serious occurs Krampfadern der Hoden und Samenstrang the superficial blood clot is associated with a deeper venous thrombosis; this can then dislodge, traveling through the heart and occluding the dense capillary network of the lungs This is a pulmonary embolism which can be life-threatening to the affected individual.
The diagnosis for thrombophlebitis is primarily based on the appearance of the affected area, t Thrombophlebitis. Frequent checks of the pulset Thrombophlebitis, blood pressureand temperature may be required. If the cause t Thrombophlebitis not readily identifiable, tests may be performed to determine the cause, including the following: Prevention consists of walking, drinking fluids and if currently hospitalized, changing of IV lines.
In terms of treatment for this condition the individual may be advised to do the following: In certain circumstances drainage of the clot might be an option. In general, treatment may include the following: Thrombophlebitis occurs almost t Thrombophlebitis between women and men, though males do have a slightly higher possibility. The average age of developing thrombophlebitis, based on analyzed incidents, is 54 for men and 58 for women.
From Wikipedia, the free encyclopedia, t Thrombophlebitis. Thrombophlebitis Ultrasonographic image showing thrombosis of the great saphenous vein. Specialty cardiology [ edit on Wikidata ]. Retrieved 23 September History, Physical Examination, t Thrombophlebitis, Causes". Retrieved 23 October Journal of General Internal Medicine, t Thrombophlebitis.
Reference Module in Biomedical Sciences. Diseases of the Human Body. Cardiovascular disease vessels I70—I99— Arteritis Aortitis Buerger's disease. Carotid artery stenosis Renal artery stenosis. Aortoiliac occlusive disease T Thrombophlebitis disease Erythromelalgia Fibromuscular dysplasia Raynaud's phenomenon.
Arteriovenous fistula Arteriovenous Krampfadern und Beinübung Telangiectasia Hereditary hemorrhagic telangiectasia. Cherry hemangioma Halo nevus Spider angioma. Chronic t Thrombophlebitis insufficiency T Thrombophlebitis cerebrospinal venous insufficiency Superior vena cava syndrome Inferior vena cava syndrome Venous ulcer.
Hypertensive heart disease Hypertensive emergency Hypertensive nephropathy Essential hypertension Secondary hypertension Renovascular hypertension Benign hypertension Pulmonary hypertension Systolic hypertension White coat hypertension. Gynaecology Gynecologic oncology Maternal—fetal medicine Obstetrics Reproductive endocrinology and infertility Urogynecology, t Thrombophlebitis.
Radiology Interventional radiology Nuclear medicine Pathology Anatomical pathology Clinical pathology Clinical chemistry Clinical immunology Cytopathology Medical microbiology Transfusion medicine.
Hypertension Hypertensive heart disease Hypertensive emergency Hypertensive nephropathy Essential hypertension Secondary hypertension Renovascular hypertension Benign hypertension Pulmonary hypertension Systolic hypertension White t Thrombophlebitis hypertension.
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