Phlebitis and Thrombophlebitis (cont.)

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What are the symptoms of phlebitis?

Phlebitis, if mild, may or may not cause symptoms. Pain, tenderness, redness (erythema), and bulging of the vein are common symptoms of phlebitis. The redness and tenderness may follow the course of the vein under the skin.

Low grade fever may accompany superficial and deep phlebitis. High fever or drainage of pus from the site of thrombophlebitis may suggest an infection of the thrombophlebitis (referred to as septic thrombophlebitis).

Palpable cords along the course of the vein may be a sign of a superficial clot or superficial thrombophlebitis.

A deep venous thrombosis may present as redness and swelling of the involved limb with pain and tenderness. In the leg, this can cause difficulty walking.

How is phlebitis diagnosed?

The diagnosis of superficial phlebitis can be made based on the physical examination by a physician. Warmth, tenderness, redness, and swelling along the course of the vein is highly suggestive of superficial phlebitis or thrombophlebitis. An ultrasound of the area can help in making the diagnosis of phlebitis or excluding it.

Deep vein thrombosis is more difficult to diagnose on the basis of clinical examination. The strongest clinical indicator is unilateral extremity swelling, which may be associated with pain, warmth, redness, discoloration or other findings. The most commonly used imaging test for diagnosis of deep vein thrombosis is ultrasound. It is less expensive than alternatives and highly reliable. In many settings, however, it is simply not available 24 hours per day.

Other imaging tests of benefit in specific situations include - but are not limited to - CT scan, MRI scan and venography (phlebography).

D-dimer is a useful blood test that can suggest phlebitis. This is a chemical that is released by blood clots when they start to degrade. A normal D-dimer makes the diagnosis of thrombophlebitis unlikely. The limitation of this test is its lack of specificity, meaning that an elevated D-dime level can be seen in other conditions including recent surgery, fall, pregnancy, or an underlying cancer.

Conditions that mimic phlebitis include cellulitis (superficial skin infection), insect bites, or lymphangitis (swelling and inflammation of lymph nodes) and can be distinguished by obtaining a careful medical history and physical examination by a physician. Sometimes, a biopsy of the skin may be required to establish the definite diagnosis.

Medically Reviewed by a Doctor on 12/17/2013

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