Thrombotic superficial phlebitis belongs to the categories of blood stasis, pulse depression, swelling and blood stasis in traditional Chinese medicine. At the time of onset, superficial veins are hard cords, which may cause spontaneous pain. Tenderness or traction pain is generally called "pulse arthralgia"; Walking along the superficial vein and its surrounding tissues suddenly turns red, swollen, hot and painful. When the swelling and pain gradually disappear, the hard cord can be touched locally, accompanied by pigmentation, or slight heat pain, which is complicated by varicose veins, often called "evil pulse"; Those who have no history of varicose veins can be called "blood stasis" elbow standby emergency prescription: "evil pulse disease, suddenly red collaterals like vermis." "The meat is swollen, long and narrow, and it hurts."
Due to the differences in etiology, pathology and clinical characteristics, superficial thrombophlebitis of limbs, chest and abdominal wall is also called benign superficial thrombophlebitis. Intermittent and recurrent superficial thrombophlebitis is called wandering superficial thrombophlebitis.
1, benign thrombophlebitis
(1) etiology and pathogenesis
Thrombotic superficial phlebitis of limbs can be caused by different reasons, such as: ① intravenous injection of irritating or hypertonic I solution, such as hypertonic glucose, erythromycin, streptomycin and organic iodine. Can stimulate the intima of superficial vein, cause vein wall injury, rapidly develop into thrombus, and have obvious inflammatory reaction. ② Repeated indwelling catheter in vein for more than 24 hours and continuous infusion can often cause direct damage to the wall of superficial vein, form thrombus and quickly appear inflammatory reaction. (3) When varicose veins of lower limbs occur, due to the serious deformation of vein wall and venous congestion, the skin in the boot area is prone to chronic infection due to nutritional changes, so that varicose veins suffer from hypoxia and inflammatory damage, resulting in thrombotic superficial phlebitis.
Thrombophlebitis of chest and abdomen wall mostly occurs in obese women who lack physical exercise. The cause was once attributed to oral contraceptives, but there was no sufficient evidence. In view of the fact that the upper limbs are often induced by sudden exertion and traction, it is considered that the onset is related to the venous traction injury when the front chest wall and upper abdominal wall are stressed. When the intima of vein is damaged, thrombosis will occur, which will cause inflammatory reaction of blood vessel wall.
(2) Pathological changes
Thrombotic superficial phlebitis is a widespread thrombosis of the whole superficial vein at first, which quickly leads to inflammatory reaction of the whole superficial vein wall, even involving the tissues around the vein, with exudate, so the local manifestations of the affected vein are pain and swelling.
Swelling, relatively flexible texture, with tender cords. After 1 week, with the regression of inflammation and the absorption of exudate, painless hard cord and local pigmentation still exist, indicating that thrombosis has undergone the process of organization and recanalization. In this process, blood circulation under new conditions can be re-established. Sometimes, acute inflammation can be replaced by chronic inflammation, and thrombus veins become fibrotic. Tenderness can exist in and around the affected blood vessels for a long time. There is a tendency of recurrence or multiple attacks, which can cause mild cellulitis around the vein, induration and pigmentation of the skin, and one or more superficial vein branches formed by thrombosis can be palpated around the induration. Thrombophlebitis of chest and abdomen wall mostly involves one side, often invading chest and upper abdominal vein, chest side vein and upper abdominal vein.
(3) Etiology and pathogenesis of TCM
Poor mood, stagnation of liver-qi, damp-heat in the liver and gallbladder, or trauma and poisoning, or meridian trauma and blood stasis, or blood transfusion and vein injury can all lead to poor blood circulation, qi stagnation and blood stasis, and impassable veins.
(4) medical history
Thrombotic superficial phlebitis of limbs often has a recent history of blood transfusion, infusion or venous injury, which is more common in young adults, or has a history of varicose veins of lower limbs, but it has nothing to do with season and sex. The typical history of superficial thrombophlebitis in the chest and abdomen wall is that after being pulled by the right hand or the left hand, one side suddenly feels chest wall pain, with different degrees. Raising your arms, coughing, taking a deep breath, and inadvertently compressing the focus will aggravate the pain.
(5) Clinical manifestations
In the early stage, the patient found that the affected limb had red and hot areas, accompanied by tenderness. When pulling the affected part, the pain gets worse. When the great saphenous vein is involved, it can cause saphenous neuritis and lead to neuralgia in the nerve distribution area. Sometimes, after the venous lesions disappear, neuralgia can still last for a period of time. During examination, a red line with a width of 1cm can be seen in the superficial vein, with different lengths. Local skin temperature rises, and soft cord-like lumps are touched under the skin. The lesion can spread to the proximal vein, even the wave and its branches. Because the deep vein is unobstructed, it rarely causes limb redness and swelling. As the lesion subsided, the skin redness, fever and local tenderness gradually disappeared. But brown pigmentation is left, and the vein can still touch the cord tumor for several weeks, and sometimes it will never go away. Some patients may have chronic inflammation after acute phase, and there is persistent tenderness near the vein. Due to fibrosis, diseased veins are usually difficult to reach. Sometimes recanalization occurs, so the disappearance of local cord can only be judged by the residual pigment, but the pigment can also disappear gradually.
Thrombophlebitis of chest and abdomen wall is mostly unilateral, often involving 1 ~ 2 superficial vein. Typical clinical manifestations are: when the upper limb is lifted and moved, one side of the chest and abdomen wall suddenly feels pain, the affected vein is slightly red and swollen and tender, and the blood vessels become tough, and some of them are silver fork-shaped or bead-shaped. At first, they are soft and gradually harden, with a diameter of about 3 ~ 5 mm Depending on the direction of the affected vein, they are tortuous or straight, and slightly adhered to the skin. When the upper arm is abducted or held high, it can be seen that the skin depression covering the diseased superficial vein is shallow groove-shaped, and the cord is more obvious, which is bow-string-shaped.
The systemic reaction of benign thrombophlebitis is mild, and at most there is an increase in body temperature or a slight increase in white blood cells. The disease is easy to recur, and the recurrent focus can occur in the original vein or other veins, and there are signs of chronic inflammation in the affected area. Lower extremity varicose veins complicated with thrombophlebitis. In some cases, thrombus can spread to the confluence of saphenous vein and femoral vein, which may involve deep vein and complicated with pulmonary embolism, which should be paid attention to.
(6) Diagnostic criteria
Benign thrombophlebitis occurs in lower limbs, and redness, swelling, heat and pain along veins are more common. When the swelling gradually disappears, it appears as a brown band, and the umbilical cord can be felt under it. It is common in the chest and abdomen wall and upper limbs, and it is more common.
Hard objects with stripes can be touched at the painful part. Combined with the history of blood transfusion, infusion, trauma and strain, a diagnosis can be made.
2. Wandering superficial thrombophlebitis
Wandering thrombophlebitis refers to superficial phlebitis that occurs repeatedly all over the body.
(1) Etiology and Pathology
There are many theories about the cause of this disease, but none of them is generally accepted. Some people suggest that infection is the cause of this disease, but bacteria can rarely be cultivated in the diseased vein wall or thrombus, and others suggest that it is related to coagulation, especially the increase of fibrinogen. At present, it is closely related to two diseases in clinic. First, it is often the body surface reappearance of visceral cancer. Moreover, many scholars have realized that this disease is an early manifestation of potential visceral cancer. The site of primary cancer involves stomach, pancreas, gallbladder, prostate and other organs, especially the canceration of pancreatic body and tail. Secondly, it is closely related to thromboangiitis obliterans. According to the current clinical reports, 30% ~ 50% of patients with thromboangiitis obliterans have early wandering superficial phlebitis. In view of the fact that most of the patients with this disease are young and middle-aged men, thromboangiitis obliterans often occurs at first, so it is considered that this disease is a clinical manifestation of thromboangiitis obliterans, which may be related to autoimmune.
Pathogenesis and pathology: the disease mainly invades superficial vein and middle vein, and has the histomorphology of thrombosis and inflammatory reaction of vein wall. Fibroblasts infiltrate under the intima of blood vessels, and the lumen of secondary thrombosis and thromboembolism can be recanalized due to organization. There may be connective tissue hyperplasia and inflammatory infiltration in the vein wall, occasionally giant cells, less inflammatory reaction in the tissues near the diseased blood vessels, and no panniculitis.
(2) Etiology and pathogenesis of TCM
The invasion of damp-heat evil, or stagnation of cold and dampness, leads to stagnation of heat for a long time, leading to poor circulation of qi and blood, and stagnation of damp-heat in the pulse. Or due to seven emotions, qi stagnation and blood stasis, pulse paralysis, depression and pulse stasis.
(3) Clinical manifestations
Superficial thrombophlebitis in legs and feet is more common, and it is less common in thighs and upper limbs.
Look at you, there is no obvious difference between its performance and general thrombophlebitis. Because all the lesions involve small and medium superficial veins, although there is thrombosis and blockage in the lumen, it will not cause venous blood disorder, and swelling of the whole limb is rare. The clinical manifestations are mostly in an area near the superficial veins of limbs or trunk, where scattered red nodules suddenly appear, which are painful and tender and stick to the surrounding inflammatory skin. The shape of the lesion is linear, generally short, and occasionally the venous segment of the lesion can be as long as 30cm. The diseased vein touches the hard cord and can appear in batches, so some of the lesions have just appeared and some have subsided. The characteristic of this disease is that the nodules quickly subside. Most of them only lasted for 7 ~ 18 days, and the cord gradually disappeared, leaving local brown pigmentation, no pus necrosis in the nodule and no edema in the affected limb. The whole body may have low fever, high white blood cells and accelerated erythrocyte sedimentation rate. After each nodule subsides, superficial veins in other parts of the body may react in the same way within weeks or years, and attack repeatedly. After a long illness, the pigmentation and cords left behind can be covered all over the body.
(4) Diagnostic criteria: According to the characteristics of recurrence and wandering of thrombophlebitis, the diagnosis is not difficult.