Pseudothrombophlebitis
Encyclopedia
Pseudothrombophlebitis syndrome is a clinical condition where there are signs and symptoms of phlebitis
in the absence of a thrombophlebitis lesion. Symptoms include pain, swelling, erythema
and tenderness evolving over hours or days. It is often associated with the rupture or dissection of a popliteal cyst otherwise known as a Baker's cyst
, although it can be associated with other disorders such as the arthritides. It may also occur as an orthopaedic surgical complication, secondary to trauma or as a presentation of septic arthritis
. It is crucial to differentiate this condition from deep vein thrombosis
as the treatment for DVT can cause adverse effects in patients with pseudothrombophlebitis.
and warrants further investigation. Pseudothrombophlebitis and deep vein thrombosis are not mutually exclusive conditions, and in rare instances may co-occur.
Pseudothrombophlebitis is clinically indistinguishable from a true thrombophlebitis
such as deep vein thrombosis; the symptoms and history are similar and these conditions cannot be distinguished by clinical examination without radiological or arthroscopic imaging.
It is crucial however to differentiate pseudothrombophlebitis from DVT as the thrombolytic and anticoagulant
treatments usually administered in DVT are not effective in treating pseudothrombophlebitis, and may have adverse effects exacerbating the condition.
.
Pseudothrombophlebitis is not the only possible consequence of a popliteal cyst. The existence of a large popliteal cyst can be a risk factor for deep vein thrombosis
. Furthermore, a ruptured popliteal cyst may cause compartment syndrome
in the calf or even the thigh.
, and the presence of a popliteal cyst is suggestive of pseudothrombophlebitis. The differentiation requires the use of radiological or arthroscopic imaging modalities.
In this condition, imaging modalities often indicated include the use of Doppler and non-Doppler ultrasound
, arthrography, venography
magnetic resonance imaging
(MRI) and computerised axial tomography (CAT scan).
Ultrasound modalities in general are useful for the detection of a ruptured or dissecting popliteal cysts, while Doppler ultrasound has the additional benefit of detecting venous stenosis such as that caused by deep vein thrombosis.
Arthrography and venography using imaging dyes allow for the detection of popliteal cysts and the exclusion of thrombotic lesions but are invasive procedures.
Magnetic resonance imaging and computerised axial tomography scans allow for the detection of a ruptured or dissected popliteal cyst and, if in the same plane as the scan, the detection of a deep vein thrombosis.
other disease masquerades have been excluded, the treatment for pseudothrombophlebitis is supportive. This includes the use of anti-inflammatory medications such as NSAIDs.
Phlebitis
Phlebitis is an inflammation of a vein, usually in the legs.When phlebitis is associated with the formation of blood clots , usually in the deep veins of the legs, the condition is called thrombophlebitis...
in the absence of a thrombophlebitis lesion. Symptoms include pain, swelling, erythema
Erythema
Erythema is redness of the skin, caused by hyperemia of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection, or inflammation...
and tenderness evolving over hours or days. It is often associated with the rupture or dissection of a popliteal cyst otherwise known as a Baker's cyst
Baker's cyst
A Baker's cyst, also known as a popliteal cyst, is a benign swelling of the semimembranous or more rarely some other synovial bursa found behind the knee joint. It is named after the surgeon who first described it, William Morrant Baker...
, although it can be associated with other disorders such as the arthritides. It may also occur as an orthopaedic surgical complication, secondary to trauma or as a presentation of septic arthritis
Septic arthritis
Septic arthritis is the purulent invasion of a joint by an infectious agent which produces arthritis. People with artificial joints are more at risk than the general population but have slightly different symptoms, are infected with different organisms and require different treatment. Septic...
. It is crucial to differentiate this condition from deep vein thrombosis
Deep vein thrombosis
Deep vein thrombosis is the formation of a blood clot in a deep vein. Deep vein thrombosis commonly affects the leg veins or the deep veins of the pelvis. Occasionally the veins of the arm are affected...
as the treatment for DVT can cause adverse effects in patients with pseudothrombophlebitis.
Clinical Features
The symptoms of pseudothrombophlebitis include pain, swelling, erythema and tenderness. It most commonly, but not exclusively, affects the legs. The presence of a popliteal cyst makes this diagnosis more likely. However, the presence of a popliteal cyst does not rule out deep vein thrombosisDeep vein thrombosis
Deep vein thrombosis is the formation of a blood clot in a deep vein. Deep vein thrombosis commonly affects the leg veins or the deep veins of the pelvis. Occasionally the veins of the arm are affected...
and warrants further investigation. Pseudothrombophlebitis and deep vein thrombosis are not mutually exclusive conditions, and in rare instances may co-occur.
Pseudothrombophlebitis is clinically indistinguishable from a true thrombophlebitis
Thrombophlebitis
Thrombophlebitis is phlebitis related to a thrombus . When it occurs repeatedly in different locations, it is known as "Thrombophlebitis migrans" or "migrating thrombophlebitis".-Signs and symptoms:...
such as deep vein thrombosis; the symptoms and history are similar and these conditions cannot be distinguished by clinical examination without radiological or arthroscopic imaging.
It is crucial however to differentiate pseudothrombophlebitis from DVT as the thrombolytic and anticoagulant
Anticoagulant
An anticoagulant is a substance that prevents coagulation of blood. A group of pharmaceuticals called anticoagulants can be used in vivo as a medication for thrombotic disorders. Some anticoagulants are used in medical equipment, such as test tubes, blood transfusion bags, and renal dialysis...
treatments usually administered in DVT are not effective in treating pseudothrombophlebitis, and may have adverse effects exacerbating the condition.
Pathophysiology
Commonly, pseudothrombophlebitis is caused by rupture of a popliteal cyst causing leakage of synovial fluid, leading to inflammatory irritation to the gastrocnemius muscleGastrocnemius muscle
In humans, the gastrocnemius muscle is a very powerful superficial pennate muscle that is in the back part of the lower leg. It runs from its two heads just above the knee to the heel, and is involved in standing, walking, running and jumping. Along with the soleus muscle it forms the calf muscle...
.
Pseudothrombophlebitis is not the only possible consequence of a popliteal cyst. The existence of a large popliteal cyst can be a risk factor for deep vein thrombosis
Deep vein thrombosis
Deep vein thrombosis is the formation of a blood clot in a deep vein. Deep vein thrombosis commonly affects the leg veins or the deep veins of the pelvis. Occasionally the veins of the arm are affected...
. Furthermore, a ruptured popliteal cyst may cause compartment syndrome
Compartment syndrome
Compartment syndrome is a limb threatening and life threatening condition, defined as the compression of nerves, blood vessels, and muscle inside a closed space within the body . This leads to tissue death from lack of oxygenation due to the blood vessels being compressed by the raised pressure...
in the calf or even the thigh.
Investigation
Where pseudothrombophlebitis and thrombophlebitis present as differential diagnoses, DVT is excluded by the absence of a deep vein thrombosisDeep vein thrombosis
Deep vein thrombosis is the formation of a blood clot in a deep vein. Deep vein thrombosis commonly affects the leg veins or the deep veins of the pelvis. Occasionally the veins of the arm are affected...
, and the presence of a popliteal cyst is suggestive of pseudothrombophlebitis. The differentiation requires the use of radiological or arthroscopic imaging modalities.
In this condition, imaging modalities often indicated include the use of Doppler and non-Doppler ultrasound
Ultrasound
Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
, arthrography, venography
Venography
Venography is a procedure in which an x-ray of the veins, a venogram, is taken after a special dye is injected into the bone marrow or veins. The dye has to be injected constantly via a catheter, making it an invasive procedure...
magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
(MRI) and computerised axial tomography (CAT scan).
Ultrasound modalities in general are useful for the detection of a ruptured or dissecting popliteal cysts, while Doppler ultrasound has the additional benefit of detecting venous stenosis such as that caused by deep vein thrombosis.
Arthrography and venography using imaging dyes allow for the detection of popliteal cysts and the exclusion of thrombotic lesions but are invasive procedures.
Magnetic resonance imaging and computerised axial tomography scans allow for the detection of a ruptured or dissected popliteal cyst and, if in the same plane as the scan, the detection of a deep vein thrombosis.
Treatment
Once diagnosed, and after deep vein thrombosisDeep vein thrombosis
Deep vein thrombosis is the formation of a blood clot in a deep vein. Deep vein thrombosis commonly affects the leg veins or the deep veins of the pelvis. Occasionally the veins of the arm are affected...
other disease masquerades have been excluded, the treatment for pseudothrombophlebitis is supportive. This includes the use of anti-inflammatory medications such as NSAIDs.