Thrombophlebitis Clinical Presentation

Updated: Aug 07, 2018
  • Author: Padma Chitnavis, MD; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

Symptoms potentially caused by venous thrombosis are generally nonspecific.

In superficial thrombophlebitis, acute-onset pain and swelling usually occur over a previous varicose vein. At times, this pain and swelling, which is often associated with warm erythema, can appear even without an obvious underlying varicosity. Swelling and pain in an upper extremity are suggestive of thrombosis. Pain associated with SVT is usually localized over the site of thrombosis. Pain associated with DVT is generally more diffuse and more common in the lower extremities than elsewhere.

Recent surgery (especially orthopedic surgery), trauma, immobilization, or prolonged bed rest are factors that can contribute to SVT or DVT.

Inquire about a history or symptoms suggestive of heart disease or congestive heart failure; relevant findings include dizziness, bilateral extremity swelling, and weight gain.

Inquire about a history of previous thrombosis.

Obtain a thorough family history.

Document the patient's age when thrombosis was diagnosed, as well as the type of thrombosis (eg, DVT, SVT, PE, myocardial infarction, stroke).

Obtain an accurate obstetric history in female patients. Recurrent spontaneous abortions may suggest an underlying factor deficiency.

Because hypercoagulability occurs in association with a number of malignancies, a history or symptoms suggestive of malignancy (eg, fever, bone pain, weight loss, bruising, fatigue) should be investigated in individuals without other known risk factors for thrombosis.

Inquire about sickle cell disease.

Risk factors (in the healthy flying population) include factors of immobilization associated with prolonged chair-rest deconditioning, including dehydration, hypovolemia, increased viscosity of the blood, and reduced venous blood flow. [112]

Illicit drug use can be a factor. Cannibis use has been attributed as a cause of SVT in a case report. [113]

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Physical Examination

The classic findings of SVT are a firm, tender, erythematous fibrous cord, usually in the area of a previous varicose or normal-appearing vein.

In cases of DVT, mild-to-moderate edema, erythema, and tenderness prevail. [88] A discrete cord rarely is palpable in persons with DVT, especially DVT in a lower extremity.

Patients with venous thrombosis (or cellulitis) may present with a hot, swollen leg.

See the images below.

Superficial thrombophlebitis. Courtesy of DermNet Superficial thrombophlebitis. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/vascular/thrombophlebitis.jpg).
Deep venous thrombosis. Deep venous thrombosis.
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Complications

The progression of SVT to DVT should be prevented. DVT should be treated at the first sign of its development. Untreated, DVT may result in life-threatening PE.

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