Thrombophlebitis saltans I82.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 04.11.2022

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Synonym(s)

Phlebitis migrans; Phlebitis saltans; Thrombophlebitis saltans; Trousseau`s syndrome; Trousseau Syndrome

History
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Armand Trousseau, 1865

Definition
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Very rare, strand-like "jumping" superficial thrombophlebitis (see also Mondor's disease), which, among other things, is also considered a monitoring early symptom of an occult visceral tumor (e.g., pancreatic carcinoma - C25.8) (facultative paraneoplastic syndrome). Unlike varicophlebitis, it also affects primary non-varicose veins.

Etiopathogenesis
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Probably hypercoagulatory (allergic-hyperergic), thrombotic vascular reaction.

Most commonly, this segmental inflammatory phlebitis is observed in the setting of thrombangitis obliterans. It may also occur in isolation. Other triggers may include:

  • Chronic bacterial focal infections
  • Carcinomas (especially pancreatic carcinoma; also carcinomas of the lung and prostate; tumors can express cysteine proteinases that directly activate factor X and thus increase thrombin production ) - Note: this constellation seems to be rather rare!
  • Behçet's disease
  • Malignant lymphogranulomatosis and leukoses.

Manifestation
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Occurring mainly in men. Thrombophlebitis saltans is a partial symptom of thrombangiitis obliterans.

Localization
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Especially extensor sides of the lower extremities are affected.

Clinical features
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A "jumping", acute, stranded, well palpable, painful thrombophlebitis is observed, running in phases over different vein sections; the phlebitic strands are 4.0-10.0 cm long. Short-term temperature increases during the thrust are possible. The changes heal spontaneously after 2-3 weeks with slight hyperpigmentation.

Histology
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Thrombotic venous occlusion. Perivenous infiltration with histiocytes and giant cells.

Differential diagnosis
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Therapy
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Cause search and remediation, smoking ban, tumor exclusion.

External therapy
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Possibly compression bandages, heparin ointments.

Internal therapy
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anti-inflammatory drugs (e.g. acetylsalicylic acid 2-3 g/day), possibly corticoids 50-100 mg/day)

Progression/forecast
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Healing of the individual relapses in 2-3 weeks, leaving behind hyperpigmentation.

Note(s)
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A special form of thrombophlebitis saltans is Mondor's disease, which affects the veins on the lateral wall of the throax.

Literature
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  1. Koushk-Jalali B et al (2020) Thrombophlebitis migrans. Dtsch Ärztebl Int 117: 125
  2. Varki A (2007)Trousseau's syndrome: multiple definitions and multiple mechanisms. Blood 110:1723-1729

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 04.11.2022