Thrombophlebitis Workup

Updated: Aug 31, 2020
  • Author: Padma Chitnavis, MD; Chief Editor: Dirk M Elston, MD  more...
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Workup

Laboratory Studies

The laboratory evaluation for factor-related hypercoagulability conditions includes measurement and evaluation of the following:

  • Complete blood cell counts, prothrombin time, activated partial thromboplastin time, and serum chemistry values

  • Protein C and APC resistance (factor V Leiden testing if abnormal)

  • Protein S level

  • Antithrombin level

  • Antiphospholipid antibodies panel (lupus anticoagulant, anticardiolipin, anti-beta2-glycoprotein I)

  • Homocysteine level

See Pathophysiology.

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Imaging Studies

Venous duplex ultrasonography, which is mandatory, helps in diagnosing the thrombosis in the vein and details its extent.

Venography, which is rarely necessary, may be used to define the extent and propagation of the thrombosis.

If PE is suspected, appropriate tests such as chest radiography, helical computed tomography scanning, ventilation-perfusion lung scintigraphy, and/or pulmonary venography may be necessary.

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Procedures

If an occult malignancy is suspected, a thorough workup should be performed. A complete medical workup is required in young adults who have thrombophlebitis but no predisposing factors because an occult malignancy is possible.

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Histologic Findings

It is important to differentiate superficial thrombophlebitis from polyarteritis nodosa in biopsy specimens. Attention to the pattern of the muscularis (bundled in veins, nonbundled wreath in artery) and the elastic pattern (surrounding bundles in veins) can help to distinguish the two. [117]

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