Which physical findings are characteristic of septic thrombophlebitis?

Updated: Oct 05, 2021
  • Author: JE Robyn Hanna, MD, MS; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Local signs of phlebitis include the traditional cardinal signs of inflammation: calor, dolor, rubor, and tumor (heat, pain, redness, and swelling). Simple phlebitis may produce a painful cord, blanching erythema, and streaking along the venous channel. Septic thrombophlebitis presents with the same symptoms plus fever. [30]

According to Baker et al, in a review of 100 patients with peripheral septic phlebitis, fever was found in 63% patients, erythema and edema were seen in 62% of patients, abscess in 43%, a palpable cord in 20%, and lymphadenopathy in 13%. [4] Suppurative phlebitis is recognized when any amount of purulent material can be expressed from within or around the lumen of a vessel.

In contrast, central line–associated deep vein phlebitis is often clinically occult, because the infected thrombus is located in the region of the catheter tip. Occasionally, erythema, purulence, or surrounding cellulitis at the insertion site is present and should alert the clinician to the possibility of septic thrombophlebitis in the deep vein. [7] If deep system blood flow is obstructed, extremity pain and edema may develop. Verghese et al reported a small series in which 66% of patients with central venous occlusion had corresponding extremity swelling. [7]

Nonspecific findings in pelvic phlebitis, ovarian phlebitis, and pyelophlebitis include fever, abdominal tenderness, and vomiting. Patients often appear clinically ill, with sepsis sometimes apparent on presentation. Helpful, but less common, findings of pyelophlebitis include hepatomegaly and jaundice, [16] while cervical motion tenderness and purulent cervical discharge are often discovered in patients with pelvic and ovarian vein disease.

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