Local venous tenderness

Introduction It is a symptom of thrombotic superficial phlebitis, which is a frequently-occurring disease in the clinic. Both men and women can develop the disease, which is more common in young adults. Thrombotic superficial phlebitis can occur in various parts of the body, usually in the limbs, followed by the chest and abdomen wall, and a small number of migratory attacks. The clinical features are sudden redness, burning, pain or tenderness along the superficial vein, and a strip or induration. After the acute phase, the cords become hard and the local skin is pigmented. Local venous tenderness is usually caused by superficial phlebitis caused by chemical drugs, or continuous infusion of the catheter causes direct damage to the vein wall.

Cause

1 superficial phlebitis caused by chemical stimulation, intravenous injection of various irritating solutions, such as: hypertonic glucose solution, various antibiotics, hydrocarbonating agents, organic iodine solution, etc., can be injected into the superficial vein The chemical stimuli cause a rapid formation of thrombosis in a wide range of lesions, followed by a significant inflammatory response.

2 catheter for continuous infusion often causes direct damage to the vein wall to thrombosis, and rapid inflammatory response. It is common in critically ill patients such as extensive burns, severe trauma and major surgery.

3 When the varicose veins of the lower extremities belong to the genus of the saphenous vein or the small saphenous vein, the venous blood stasis lags the skin of the foot. Often due to nutritional changes, chronic infection can cause venous venous inflammation caused by hypoxia and inflammatory damage in varicose veins.

an examination

Related inspection

Deep saphenous vein function test

Lower extremity deep venous thrombosis has the following classification and clinical manifestations:

Deep vein thrombosis of the calf: The patient complained of swelling and pain in the calf and could not walk. Check for pain and tenderness in the lower leg and mild swelling of the calf. The Homans sign is positive. Deep vein thrombosis of the calf is also known as peripheral deep vein thrombosis. Thrombosis originating from the venous plexus of the calf muscle is a good site for deep vein thrombosis after surgery. Because of its small range, it often does not affect blood return, and the degree of inflammatory response is mild, and the clinical manifestation is not obvious, according to Kakkar. About 30% can be automatically dissolved in 72h, 45% will continue to change into mechanization, 25% will spread from the proximal segment, involving the main vein, and there is also a risk of complicated pulmonary embolism.

Differential diagnosis

1, primary iliofemoral vein thrombosis: thrombosis in the iliac vein, the incidence is lower than the calf deep vein thrombosis, more common on the left side, 1-8 times the right side, the reason is left total The venous anatomy was caused by the compression of the right common iliac artery and the structural abnormality in the cavity. In 1965, Cocket et al. first proposed the concept of "complication of iliac vein compression syndrome" after analyzing such lesions. The clinical symptoms of this disease are obvious, and the onset is urgent. There is pain and tenderness. Thrombosis stimulates the inflammatory response in the iliac vein and can cause local pain and tenderness. Some patients in the triangle area of the femur, often can be found in the femoral vein filled with blood clots formed by the cord. Swelling is often very noticeable. Generally, the circumference of the thigh or calf is several centimeters away from the healthy side. Some can see compensatory superficial varices. The body temperature rises but does not exceed 38.5 °C.

2, secondary iliofemoral vein thrombosis: also known as mixed deep vein thrombosis, thrombosis originated in the venous plexus of the calf muscle, spread up, involving the iliac vein. The disease has the following clinical features: the onset of the disease is mostly hidden. Symptoms begin with mild symptoms until the iliac-femoral vein is involved, and typical symptoms appear, so the actual lesion is longer than the symptom period. Nutritional changes in the boot area.

3, femoral bruises: the most serious type, whether it is primary or secondary iliofemoral venous thrombosis, as long as the entire venous system of the affected limb, including the potential collaterals, is almost completely blocked, while causing strong arterial spasm That is, the formation of femoral bruises. Sudden onset, severe systemic reaction, body temperature more than 39 ° C, typical symptoms in the affected limbs showed extensive swelling, skin tension, shiny and purplish color, may be accompanied by vesicle examination found that the limb skin temperature was significantly reduced, The back of the foot and the posterior tibial artery are weakened.

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