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Description: Thrombophlebitis is an inflammatory condition of the veins with secondary thrombosis. This may occur in two forms: aseptic or suppurative (septic). The vessels may be either superficial or deep. Risk factors may be present, or the onset may be idiopathic. Risk varies with the location and cause.
Prevalence: Two million cases per year in the United States; 10% of nosocomial infections, intravascular (venous or arterial) catheter-related—88/100,000, 1/1600 during pregnancy. Pulmonary embolism is the seventh leading cause of maternal mortality, accounting for 9% of maternal deaths.
Predominant Age: Septic—childhood; aseptic—ages 20–30 years; superficial—older than 40 years. Average age for women: 58 years.
Genetics: Uncommon—antithrombin III, proteins C and S, and factor XII deficiencies (autosomal dominant with variable penetrance), factor V Leiden or prothrombin C-20210-a genes.
Causes: Sepsis ( Staphylococcus aureus [65%–75%], multiple organisms [14%]), hypercoagulable states (congenital deficiencies, malignancy, pregnancy, high-dose oral contraceptives, Behçet syndrome, Buerger disease, factor V Leiden deficiency), venous stasis (varicose veins), injury to vessel wall. Septic thrombophlebitis may be caused by Candida albicans in unusual cases. (Virchow triad: intimal damage [trauma, infection, or inflammation], stasis, or changes in the blood constituents [changes in coagulability].)
Risk Factors: Trauma (general or vascular), prolonged immobility (hospitalization, prolonged air travel), advanced age, obesity, pregnancy or puerperium (higher in multiple gestations), recent surgery, intravascular catheters or drug abuse, steroid or high-dose estrogen therapy (high-dose oral contraceptives), body mass index (BMI) ≥30 kg/m 2 , inflammatory bowel disease, high altitude, hemoglobinopathies, malignancy, nephrotic syndrome, urinary tract infection, homocystinuria, congenital abnormality or heritable thrombophilia.
Asymptomatic
Generalized limb pain or swelling
Swelling, tenderness, redness along the course of the vein
Fever (70% of patients with septic thrombophlebitis)
Warmth, erythema, tenderness, or lymphangitis (32%)
Systemic sepsis (84% in suppurative cases)
Red, tender cord
Swelling of collateral veins
Cellulitis
Erythema nodosa
Cutaneous polyarteritis nodosa
Sarcoid
Kaposi sarcoma
Ruptured synovial cyst (Baker cyst)
Lymphedema
Muscle tear, sprain, strain
Venous obstruction (secondary to tumor, lymph node enlargement)
Associated Conditions: Pulmonary embolism, Budd-Chiari syndrome (hepatic vein thrombosis), renal vein thrombosis, homocystinuria, hypercoagulability states (antiphospholipid antibody syndrome), Behçet syndrome, and varicose veins.
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