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Thrombophlebitis/Superficial Vein Thrombosis
Published in Charles Theisler, Adjuvant Medical Care, 2023
Thrombophlebitis is an inflammation of a superficial vein wall causing a clot, or thrombus formation. Most cases of superficial vein thrombosis occur in the legs (e.g., long or short saphenous veins) in association with varicosities. In the upper extremity, the condition can develop after use of an IV line or other trauma to the vein wall. Pain, warmth, swelling, and tenderness are often present over the clot site. Superficial thrombophlebitis is generally a benign and short-term condition. Symptoms typically resolve in one to two weeks.1 Most times, treatment of superficial thrombophlebitis is directed to managing pain and inflammation.2
Thermography by Specialty
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Video thermography of the leg may show the superficial veins rapidly rewarming due to blood flowing “backwards” through incompetent venous valves (venous “insufficiency”). Likewise, the veins of the forearm may appear engorged when the arm is down, but they should drain quickly if the arm is raised (if not, venous thoracic outlet syndrome might be considered along with other possible diagnoses). The superficial veins of the neck including the external jugular vein, may appear engorged thermographically in cases of congestive heart failure. This is best seen with the subject reclined at a 45-degree angle. Similar to arteritis (arterial wall inflammation), the veins may develop phlebitis (venous wall inflammation), usually from infection or autoimmune disease. Arteritis and phlebitis may appear concurrently. Thrombophlebitis refers to clots forming in an inflamed vein. Even with the old infrared scanners of the 1970s, thermography was found useful in the detection of phlebitis.185
Postpartum infections
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
The diagnosis of pelvic thrombophlebitis, in either form, may not be confirmed by radiographic study. Clinical response to heparin may secure the diagnosis in both the acute and the enigmatic syndromes. Full anticoagulation should be instituted along with broad-spectrum antibiotics (Table 2) as microorganisms have been isolated from resected venous specimens and require treatment to promote resolution of the thrombus (73,85). Resolution of the fever does not imply resolution of the clot, so a full course of anticoagulation is necessary. Substitution of low molecular weight for unfractionated heparin seems reasonable, but has not been systematically studied. Primary surgical ligation of ovarian veins and vena cava, employed 50 years ago, decreased mortality from 50% to 10% (86), but is fraught with risks of significant hemorrhage, embolization, and death (74). Today, a surgical approach should be reserved for patients who do not respond to anticoagulation plus antibiotics, who experience pulmonary embolism while on therapeutic anticoagulation, or in whom the diagnosis is uncertain. If pelvic vein thrombosis is found unexpectedly at postpartum laparotomy, closure of the abdomen without vein ligation and institution of medical therapy is probably the treatment of choice. Need for anticoagulation during or after subsequent pregnancy is probably not required.
Pyogenic liver abscess after open hemorrhoidectomy
Published in Acta Chirurgica Belgica, 2023
Maxim Peeters, Xavier De Raeymaeker, Amine Karimi, Martijn van der Pas
Since there was a hemorrhoidectomy in the recent history, the conclusion was made that the small liver abscesses were caused by hematogenic dissemination from the operation site. After resuscitation, the renal function stayed stabile. With the use of the antibiotics, there was a rapid and favorable decline of the inflammatory blood markers. At day 4, antibiotics were changed to amoxicillin/clavulanic acid and the patient was transferred to the department of infectious disease. All blood cultures stayed negative. At day 8, there was mild fever and the inflammatory blood markers showed no further decline. Since there was some concern of the proven ESBL, the antibiotics were changed to Meropenem. Later on, we diagnosed a thrombophlebitis at the right arm. At day 13, we restarted with oral amoxicillin/clavulanic acid. At day 17, the patient was dismissed in good condition. Oral antibiotics for six more weeks were given.
Forget-me-not: Lemierre’s syndrome, a case report
Published in Journal of American College Health, 2023
Benjamin Silverberg, Melinda J Sharon, Devan Makati, Mariah Mott, William D Rose
Symptoms are somewhat nonspecific and include fever, rigors, odynophagia, difficulty swallowing, trismus, neck pain, and/or oropharyngeal swelling. (Of these, rigors and unilateral neck swelling represent red flags that may necessitate admission to the intensive care unit [ICU] and antibiotic coverage for anaerobes.) The tonsils do not necessarily appear exudative or ulcerated.17 Unilateral neck swelling and tenderness from thrombophlebitis of the IJV is often mistaken for cervical lymphadenopathy.16,17 The so-called "cord sign" is actually induration of the IJV under the anterior border of the SCM muscle.14,31 Evidence of thrombophlebitis can also be found with advanced imaging; a CT scan of the neck with contrast is the gold standard, but MRI or even ultrasound may be utilized.4,10,11,16,17,26,27,33 Workup does usually start with a plain chest X-ray, but this can be normal in a minority of cases.32 Myalgias, arthralgias, productive cough, hemoptysis, dyspnea, pleuritic chest pain, and abdominal pain are also possible.23,32
Lemierre’s syndrome in adulthood, a case report and systematic review
Published in Acta Clinica Belgica, 2021
Marco Moretti, Deborah De Geyter, Lode Goethal, Sabine D. Allard
Due to the lack of controlled studies, the role of anticoagulants in the treatment of LS is controversial. Nevertheless, they are generally recommended in the treatment of intracranial thrombophlebitis. Duration of anticoagulation is another matter of debate, with recommendations varying from 3 to 4 weeks, e.g. in cavernous sinus thromboses, to 3 to 12 months, e.g. in case of cranial venous thrombophlebitis [12,18]. The therapeutic rationale behind anticoagulation is to impede the complete blockage of deep and superficial cranial venous system. In the current review, more than half of the patients with LS were anticoagulated, mostly with LMWH. However, of the six patients with intracranial thrombophlebitis, only two were anticoagulated. Nonetheless, only two of the six patients affected by CNI thrombosis had unfavourable outcome. One patient, affected of left vertebral vein thrombosis, was anticoagulated with edoxaban and reported permanent infection-related damages. The other one, presenting with CNI septic emboli, was not anticoagulated and reported permanent neurologic disabilities. Since there are no clear guidelines on this topic, we advise to evaluate each patient on a case-by-case basis and to personalize the therapy.