n cancers are known to increase the risk of clot formation (referred to as a hyper-coagulable state) by causing abnormalities in the normal clotting system (coagulation pathway). Some cancers with hypercoagulable state cause phlebitis or thrombophlebitis.
- Inherited (primary) or acquired (secondary) hypercoagulable states are associated with an increased risk of phlebitis and thrombosis. Some, but not all, of these states can be identified by appropriate laboratory testing.
- Recent surgery of any type can be associated with the conditions. The highest risk seems to come with major orthopedic procedures and procedures for cancers.
What are the symptoms of phlebitis?
Phlebitis, if mild, may or may not cause symptoms. Pain, tenderness, redness (erythema), and bulging of the vein are common symptoms of phlebitis. The redness and tenderness may follow the course of the vein under the skin.
Low grade fever may accompany superficial and deep phlebitis. High fever or drainage of pus from the site of thrombophlebitis may suggest an infection of the thrombophlebitis (referred to as septic thrombophlebitis).
Palpable cords along the course of the vein may be a sign of a superficial clot or superficial thrombophlebitis.
A deep venous thrombosis may present as redness and swelling of the involved limb with pain and tenderness. In the leg, this can cause difficulty walking.
How is phlebitis diagnosed?
The diagnosis of superficial phlebitis can be made based on the physical examination by a physician. Warmth, tenderness, redness, and swelling along the course of the vein is highly suggestive of superficial phlebitis or thrombophlebitis. An ultrasound of the area can help in making the diagnosis of phlebitis or excluding it.
Deep vein thrombosis is more difficult to diagnose on the basis of clinical examination. The strongest clinical indicator is unilateral extremity swelling, which may be associated with pain, warmth, redness, discoloration or other findings. The most commonly used imaging test for diagnosis of deep vein thrombosis is ultrasound. It is less expensive than alternatives and highly reliable. In many settings, however, it is simply not available 24 hours per day.
D-dimer is a useful blood test that can suggest phlebitis. This is a chemical that is released by blood clots when they start to degrade. A normal D-dimer makes the diagnosis of thrombophlebitis unlikely. The limitation of this test is its lack of specificity, meaning that an elevated D-dime level can be seen in other conditions including recent surgery, fall, pregnancy, or an underlying cancer.
Conditions that mimic phlebitis include cellulitis (superficial skin infection), insect bites, or lymphangitis (swelling and inflammation of lymph nodes) and can be distinguished by obtaining a careful medical history and physical examination by a physician. Sometimes, a biopsy of the skin may be required to establish the definite diagnosis.
How is phlebitis treated?
Treatment of phlebitis may depend on the location, extent, symptoms, and underlying medical conditions.
In general, superficial phlebitis of the upper and lower extremities can be treated by applying warm compresses, elevation of the involved extremity, encouraging ambulation (walking), and oral anti-inflammatory medications (ibuprofen [Motrin, Advil], diclofenac [Voltaren, Cataflam, Voltaren-XR], etc.). Topical anti-inflammatory medications may also be beneficial, such as diclofenac gel. External compression with fitted stockings is also a recommended for patients with superficial phlebitis of the lower extremities.
If an intravenous catheter is the cause, then it should be removed. If the phlebitis is infected, then antibiotics are used. In severe cases of infected thrombophlebitis, surgical exploration may be necessary.
Superficial thrombophlebitis (blood clots) is evaluated by an ultrasound to exclude deep venous thrombophlebitis, especially those involving the saphenous vein. If deep venous thrombophlebitis is suspected or diagnosed, or if its risk of developing is considerable, then anti-coagulation (