Migratory superficial vein thrombosis

Introduction Venous thrombosis can occur in the pathogenesis of superficial venous thrombosis, often involving the great saphenous vein or small saphenous vein or its branches, mostly on the basis of varicose veins. The main feature is the pain in the thrombus formation. The superficial vein has a red, low-heat cord, tenderness, and redness around it. The embolus is not easy to fall off and generally does not cause pulmonary embolism. In addition, migratory superficial vein thrombosis is often a suggestive symptom of cancer.

Cause

(1) Causes of the disease

The disease is divided into two types: infectious and non-infective.

Infectious people are more common in acute infection, childbirth, pelvic or abdominal surgery, non-infectious people are caused by blood stasis, and more common in the posterior vein of the calf.

(two) pathogenesis

The calf venous return pressure is reduced due to various reasons, blood viscosity and platelet increase, and blood coagulation is increased. When the blood vessel is slightly damaged, it can cause platelets to adhere to the local thrombus, and then fibrin deposition causes the thrombus to increase, leading to occlusion of the lumen. Even spread to nearby or distant veins.

an examination

Related inspection

Activated partial thromboplastin time (APTT) partial thromboplastin time

According to the different sites of thrombosis, it can be divided into two categories.

1. Superficial vein thrombosis: often involving the great saphenous vein or small saphenous vein or its branches, mostly on the basis of varicose veins. The main feature is the pain in the thrombus formation. The superficial vein has a red, low-heat cord, tenderness, and redness around it. The embolus is not easy to fall off and generally does not cause pulmonary embolism. In addition, migratory superficial vein thrombosis is often a suggestive symptom of cancer.

2. Deep vein thrombosis: According to its location and condition, it can be divided into the following two types.

(1) deep vein thrombosis of the calf: often occurs in the deep veins of the calf, such as the posterior tibial vein and the iliac vein. More common in patients who are less active in bed, often occurs in the second week after surgery. The left lower extremity is the most common. It is characterized by pain and tenderness in the muscles of the calf and ankle. It is severely painful after exercise, and the dorsiflexion of the foot is even worse, and the systemic symptoms are not significant. There may be Homan's sign at the time of examination, that is, the calf is straight, the foot is dorsiflexed, and the vein of the gastrocnemius is pulled by the vein and pain occurs. It can also appear that the circumference of the gastrocnemius muscle is thicker than the healthy side by more than 5 cm.

(2) sputum, femoral vein thrombosis: can be secondary to the calf vein thrombosis, but more than the primary iliac vein. Common in postpartum, rapid onset, severe diffuse edema of the affected limb, elevated skin temperature or slight spasm, superficial vein dilatation, unbearable pain in the inner thigh and significant tenderness along the vein, especially in the trigone. The systemic symptoms are not heavy.

Deep vein thrombosis is due to invasion of the main vein, and can produce peri-venous inflammation, affecting adjacent lymphatic vessels or causing arterial spasm, so the symptoms and signs are heavier. In addition, serious complications can occur, and when the thrombus is extended to the inferior vena cava, it can cause pulmonary embolism, and sometimes it can be the first symptom of the disease. Can be secondary to pulmonary hypertension.

1. Superficial venous thrombosis: very similar to the clinical manifestations of thrombophlebitis, difficult to identify, and clinically superficial thrombotic venous disease is mostly thrombophlebitis rather than venous thrombosis, so the diagnosis of this disease Usually thrombophlebitis.

2. Deep vein thrombosis of the lower leg: According to the pain and tenderness of the calf muscles of the lower leg, the increase of the circumference of the gastrocnemius muscle and the positive Homan sign can confirm the diagnosis.

3. , femoral vein thrombosis: according to lower extremity swelling, pain and tenderness in the triangle, skin temperature reduction, color changes and superficial varices can be diagnosed.

Differential diagnosis

Differential diagnosis of migratory superficial vein thrombosis:

1. Superficial venous thrombosis: very similar to the clinical manifestations of thrombophlebitis, difficult to identify, and clinically superficial thrombotic venous disease is mostly thrombophlebitis rather than venous thrombosis, so the diagnosis of this disease Usually thrombophlebitis.

2. Calf deep vein thrombosis: should be identified with other diseases of the gastrocnemius involvement, such as local soft tissue infection.

3. Sputum and femoral vein thrombosis: Most of the deep vein thrombosis can be characterized by unilateral lower extremity edema, which should be analyzed and differentiated from lymphedema and edema caused by heart, liver and kidney diseases. According to the different sites of thrombosis, it can be divided into two categories.

1. Superficial vein thrombosis: often involving the great saphenous vein or small saphenous vein or its branches, mostly on the basis of varicose veins. The main feature is the pain in the thrombus formation. The superficial vein has a red, low-heat cord, tenderness, and redness around it. The embolus is not easy to fall off and generally does not cause pulmonary embolism. In addition, migratory superficial vein thrombosis is often a suggestive symptom of cancer.

2. Deep vein thrombosis: According to its location and condition, it can be divided into the following two types.

(1) deep vein thrombosis of the calf: often occurs in the deep veins of the calf, such as the posterior tibial vein and the iliac vein. More common in patients who are less active in bed, often occurs in the second week after surgery. The left lower extremity is the most common. It is characterized by pain and tenderness in the muscles of the calf and ankle. It is severely painful after exercise, and the dorsiflexion of the foot is even worse, and the systemic symptoms are not significant. There may be Homan's sign at the time of examination, that is, the calf is straight, the foot is dorsiflexed, and the vein of the gastrocnemius is pulled by the vein and pain occurs. It can also appear that the circumference of the gastrocnemius muscle is thicker than the healthy side by more than 5 cm.

(2) sputum, femoral vein thrombosis: can be secondary to the calf vein thrombosis, but more than the primary iliac vein. Common in postpartum, rapid onset, severe diffuse edema of the affected limb, elevated skin temperature or slight spasm, superficial vein dilatation, unbearable pain in the inner thigh and significant tenderness along the vein, especially in the trigone. The systemic symptoms are not heavy.

Deep vein thrombosis is due to invasion of the main vein, and can produce peri-venous inflammation, affecting adjacent lymphatic vessels or causing arterial spasm, so the symptoms and signs are heavier. In addition, serious complications can occur, and when the thrombus is extended to the inferior vena cava, it can cause pulmonary embolism, and sometimes it can be the first symptom of the disease. Can be secondary to pulmonary hypertension.

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