Subcutaneous veins show reticular engorgement
Introduction
Introduction The subcutaneous vein with reticular engorgement is one of the clinical symptoms of thrombophlebitis. The disease is a venous disease characterized by acute non-suppurative inflammation of the vein wall and intraluminal thrombosis. Slow blood flow and eddy current formation, increased blood coagulation and endometrial damage are the main causes. Clinically, it is divided into superficial thrombophlebitis and deep vein thrombosis. Need to be differentiated from venous edema and lymphedema. Limiting thrombosis and inflammation; eliminating swelling and restoring venous function as much as possible; preventing the development of fatal pulmonary embolism is the main purpose of treating this disease.
Cause
Cause
(1) Causes of the disease
The three basic factors of thrombosis are slow blood flow and eddy current formation, increased blood coagulation and endometrial damage, which are also the main causes of this disease.
(two) pathogenesis
Thrombosis can occur in both the vein and the arterial lumen, while the former is mainly caused by increased blood coagulation, and the latter is necessary for endometrial damage.
1. Slow blood flow and eddy formation: an important condition for thrombosis. Such as long-term bed rest, heart failure, tumor compression, varicose veins and venous tumors, elevated abdominal and pelvic pressure during pregnancy, weakness of lower limb muscle contraction, etc., can cause slow blood flow and promote thrombosis. The reason is that the slow blood flow makes the axial flow wide, which is beneficial to the edge and agglutination of the platelets, and increases the contact with the endometrium and the chance of adhesion; at the same time, the platelets adhered and a small amount of coagulation active substances already present locally, because The blood flow is slow and cannot be diluted and removed, and is concentrated in the local area to reach the necessary concentration of blood coagulation; when the blood flow is slow, the vascular endothelial cells are susceptible to damage, collagen exposure occurs, and thrombus is easily formed. In addition, after the formation of varicose veins and venous tumors, the local blood flow state changes, creating a vortex, causing platelets to precipitate, precipitate and adhere from the bloodstream, and is also prone to thrombosis.
2. Increased blood coagulation: increased platelet or coagulation factor, decreased fibrinolytic activity, increased blood coagulability and thrombosis. Dehydration and blood loss caused by various reasons, resulting in blood concentration; increased platelet count and viscosity; increased fibrinogen, prothrombin and other coagulation factors; advanced cancer such as pancreatic cancer and lung malignant tumor due to tumor necrosis Release of coagulation-like enzyme-like substances that activate the exogenous coagulation system; certain allergic diseases, which may cause destruction of platelets and red blood cells, release of platelet factor 3 and erythrotoxin, and activation of prothrombin, are beneficial to Thrombosis.
3. Intimal injury: various causes such as trauma (intravenous sclerotherapy, hypertonic solution, anticancer drugs, contrast agents, intravenous cannula), hypoxia, chemicals (smoking, hypercholesterolemia), infection ( Bacterial toxins) Invasion of tumor cells can cause damage to vascular endothelial cells, leading to the exposure of rough subendothelial collagen fibers and promoting platelet aggregation. Adherent platelets and endothelial cells release ADP and thromboxane A2, which further promote platelet aggregation. At the same time, exposed collagen fibers activate blood factor XII, which activates the endogenous coagulation system and damages the tissue released by the intima. The factor initiates an exogenous coagulation system, which causes blood to clot and promote thrombosis.
Venous thrombosis can occur in all parts of the body. The most common are the saphenous vein and its branches. The rare ones are veins, subclavian veins, cephalic veins, expensive veins, and chest and abdominal wall veins. After the superficial vein thrombosis of the lower extremity or upper limb, due to extensive anastomotic branch, it is not easy to cause circulatory disorder and tissue edema; on the contrary, larger deep veins, such as iliac vein, iliac vein and superior and inferior vena cava, etc. Due to stenosis or occlusion of the lumen, obstructing blood return, and due to the development of the external end of the thrombus, the venous pressure is increased, so that the capillaries and venules are congested, the tissue is hypoxic, and the capillary osmotic pressure is increased, resulting in tissue edema. When the lymphatics are compressed, the edema is more pronounced. If new blood vessels are formed or recanalized and the collateral circulation is established, the blood circulation of the affected area can be maintained. If these newly formed structures are sound, the venous return can be improved (it is more difficult to recover when the venous valve is damaged); otherwise, it leads to Chronic venous insufficiency, post-phlebitis syndrome or a part of the thrombus shedding becomes an embolus.
The difference between venous thrombosis and thrombophlebitis is that the former has a major role in slow blood flow and increased blood coagulation. The change in the vein wall is not obvious; the latter is a thrombus on the basis of inflammation of the vein wall. In the pathological anatomy, there was a thrombus in the venous cavity, and there was no clinical manifestation of thrombophlebitis before birth; on the contrary, the vascular wall showed different degrees of inflammatory reaction within a few hours after thrombus formation. Therefore, it is difficult to distinguish the two clearly in the clinic, so they can be collectively referred to as thrombophlebitis.
Fresh blood clots in large veins are usually mixed. A typical thrombus is divided into three parts: the head, the body, and the tail. On the venous venous intima, sticky white platelets and mixed white blood cells form grayish white thrombus as the head; then white blood clots are attached with more white blood cells and fibrin and a large number of red blood cells to form a mixed thrombus. Body; when the formed thrombus further develops to fill the lumen, local blood flow stops, the blood rapidly solidifies, forming a dark red red thrombus as a tail. The length of the thrombus is usually stopped at the point of an effective blood vessel branch. After thrombosis, it dissolves due to the action of plasmin and neutrophil proteolytic enzymes. Fibroblasts invade within 5 days after thrombus formation, forming new granulation tissue, which is then machined and new blood vessels are formed and recanalized. In the case of connective tissue hyperplasia and scar formation, the diseased vein becomes a sclerosing cord-like lesion.
The histopathology of thrombophlebitis caused by different causes is not completely the same, such as suppurative phlebitis, the wall inflammation is significant, and neutrophil infiltration is the main; chemical phlebitis is more obvious intimal hyperplasia; In phlebitis caused by tumor and heart failure, the inflammation of the wall is relatively mild; in migratory thrombophlebitis, the fibroblasts in the wall and surrounding tissues are more severe.
Examine
an examination
Related inspection
Doppler echocardiography plasma thrombin detection
Can be divided into the following types of diseases.
1. Superficial thrombophlebitis: It is often divided into superficial benign thrombophlebitis and migratory thrombophlebitis. The main difference is that in addition to the cause, the former involves a vein and continues to develop upwards; while the latter does not have a certain form, often one or several veins are involved at the same time or successively, and repeatedly occur one after another.
(1) superficial benign thrombophlebitis: superficial benign thrombophlebitis, according to the cause of the disease; intravenous sclerotherapy, hypertonic solution, anticancer drugs, etc., cause chemical stimulation on the inner membrane It causes extensive damage, produces phlebitis and causes thrombosis, called chemical phlebitis. Localized phlebitis caused by mechanical injury such as intravenous injection, long-term insertion of plastic tube, blow, sprain, etc. is called traumatic phlebitis.
Superficial benign thrombophlebitis is more common in the saphenous veins of the lower extremities and their branches and veins of the upper extremities, often limited to one vein, and develops to the proximal end and its large branches in severe cases. A subcutaneous hard cord that can be painful and tender along the diseased vein during an acute attack. Or a segmental distribution of oval nodules. Peripheral inflammation occurs when the surrounding tissue is involved, so that the adjacent skin is red and swollen and the temperature rises, and it can move with the skin. There may be mild systemic symptoms after onset, but white blood cells are generally not elevated. When healed, the pain is relieved, the redness and swelling subsides, leaving a pigmentation spot or a subcutaneous hard cord. When the collateral circulation is established and re-opened, the hard cable may gradually disappear. Due to superficial venous lesions, blood reflux is generally unaffected. Therefore, it does not cause edema of the extremities. If deep venous lesions or venous valves are involved, severe tissue edema and chronic venous insufficiency may occur.
(2) migratory thrombophlebitis: mainly involves superficial veins, and deep veins such as brain, liver, kidney, mesentery and lungs can also occur, but the lower limbs, hips and abdominal wall are common. It is characterized by a segmental subcutaneous hard cord or induration with pain and tenderness. Adjacent skin is red and swollen, subsides after 2 to 4 weeks, leaving pigmentation spots, and new damage occurs in the other vein or another vein. Then part of it subsided, and some of it was new, so that there were damages in different parts in different parts. The cause of the disease is unknown, but it is closely related to the two diseases:
1 It is often an early manifestation of latent visceral cancer. Primary visceral cancer involves the stomach, lung, pancreas and gallbladder, and is most closely related to pancreatic and pancreatic cancer.
2 is closely related to thromboangiitis obliterans, is a clinical manifestation of its early manifestations or a whole stage of the disease, thrombosis phlebitis of Behcet disease may also belong to this type of disease, the difference is that the latter is deep and shallow Different diameters and veins can occur, while the former mainly invades the superficial small and medium veins.
2. Deep vein thrombosis can be divided into the following two types according to their location and condition:
(1) deep vein thrombosis of the calf: often occurs in the deep veins of the calf, such as the posterior tibial vein and the iliac vein. Organized thrombosis may cause local venous obstruction and inflammatory response. Because the thrombus is generally small, inflammation is mild, and blood return is not large. The symptoms are generally not obvious. Usually, after exercise, the muscles of the ankle are heavy and painful, and in severe cases, there is pain. A small number of patients will have obvious symptoms when the thrombus spreads to the proximal vein, such as obvious tissue edema, local symptoms and fever. The characteristic manifestation is pain and tenderness at the gastrocnemius. During the examination, the calf was straightened, the foot was dorsiflexed, and the vein of the gastrocnemius was pulled by the vein to cause pain, which was called Homan's sign. Homan's sign positive, deep gastrocnemius tenderness (Neuhof sign) and passive foot extension or toe dorsiflexion caused pain in the lower leg, all contribute to the diagnosis of deep venous thrombosis of the lower leg. In addition, the circumference of the gastrocnemius muscle is more than 5 cm larger than the healthy side, and mild edema of the ankle with superficial venous engorgement may also be a manifestation of deep vein thrombosis. Although deep vein thrombosis of the lower leg can occur on both sides, it is not necessarily symmetrical, and can be distinguished from tissue edema caused by diseases such as heart, liver and kidney.
(2) sputum, femoral thrombophlebitis: typical performance is:
1 diffuse edema of the lower extremities; 2 subcutaneous vein engorgement and skin bruising;
3 strands of triangle pain. Often have fever, tachycardia and increased white blood cell count. Diffuse edema causes skin tension, paleness, depression and depression; subcutaneous veins are reticular anger; there are intolerable pain and tenderness along the vein, especially in the trigone. This phenomenon is called phlegmasia alba dolens. If venous thrombosis develops not only in the main vein to extensive or deep muscle tissue, but capillary pressure and tissue pressure exceed arterial pressure, severe tissue edema can occur. The local temperature is lowered, diffuse bruising occurs in the calf and the back of the foot, and the femoral artery spasm and arterial pulsation may disappear, and finally the tissue dystrophy and even the gangrene of the vein occur. This condition is called phlegmasia cerulea dolens or blue thrombophlebitis. Because the above lesions are mainly thrombosis in the main vein, occlusion of the lumen, a greater impact on blood circulation, and can produce peri-venous inflammation, affecting adjacent lymphatic vessels or causing arterial spasm, so the symptoms and signs are more serious (Figure 1) .
1. Superficial thrombophlebitis: The diagnosis is based on the subcutaneous hard cord along the superficial vein. If it is a small vein, it may be a nodule, but it is not spherical, and the adjacent skin is red, swollen, painful and tender.
2. Calf deep vein thrombosis: The diagnosis is based on pain and tenderness of the gastrocnemius muscle, as well as the increase in the circumference of the calf and the positive Homan sign.
3. , femoral vein thrombosis: swelling of the lower extremities, pain and tenderness along the femoral vein, especially in the trigone, skin temperature reduction, color change and superficial venous engorgement.
Diagnosis
Differential diagnosis
Several abnormal conditions of the vein:
Varicose ulcer is one of the complications of varicose veins. The varicose veins, commonly known as "fried ribs", are the most common diseases of the venous system. The main reason for the formation is that the congenital vascular wall membrane is weak or maintains the same posture for a long time. Change, the blood accumulates in the lower limbs, and the venous pressure is destroyed by rupturing the venous valve in the case of accumulation of time, which is a symptom of the blood vessel protruding from the surface of the skin. Varicose veins occur in the lower extremities, and other scrotal spermatic cords, abdominal veins, and gastric esophageal veins may also develop varicose veins.
Venous collapse is a symptom in which the abnormal shrinkage of the vein becomes distorted and dents. Blood volume reduction, shock, dehydration, high heat sweating, foam hardener, etc. can cause venous collapse.
Varicose veins: a symptom in which abnormal expansion of the vein becomes distorted and swollen, and about half of the population over forty years old has a ricket rate. Especially women, about 2/3 of them have different degrees of varicose veins. This type of deformed and sometimes painful disease usually occurs in the legs, due to the pressure on your leg veins due to your upright posture. Varicose veins usually do not have serious consequences, but may have the pore veins under the dual influence of gravity and valve failure, so that the blood supply to the tissue is greatly reduced, resulting in malnutrition and skin ulcers.
Can be divided into the following types of diseases.
1. Superficial thrombophlebitis: It is often divided into superficial benign thrombophlebitis and migratory thrombophlebitis. The main difference is that in addition to the cause, the former involves a vein and continues to develop upwards; while the latter does not have a certain form, often one or several veins are involved at the same time or successively, and repeatedly occur one after another.
(1) superficial benign thrombophlebitis: superficial benign thrombophlebitis, according to the cause of the disease; intravenous sclerotherapy, hypertonic solution, anticancer drugs, etc., cause chemical stimulation on the inner membrane It causes extensive damage, produces phlebitis and causes thrombosis, called chemical phlebitis. Localized phlebitis caused by mechanical injury such as intravenous injection, long-term insertion of plastic tube, blow, sprain, etc. is called traumatic phlebitis.
Superficial benign thrombophlebitis is more common in the saphenous veins of the lower extremities and their branches and veins of the upper extremities, often limited to one vein, and develops to the proximal end and its large branches in severe cases. A subcutaneous hard cord that can be painful and tender along the diseased vein during an acute attack. Or a segmental distribution of oval nodules. Peripheral inflammation occurs when the surrounding tissue is involved, so that the adjacent skin is red and swollen and the temperature rises, and it can move with the skin. There may be mild systemic symptoms after onset, but white blood cells are generally not elevated. When healed, the pain is relieved, the redness and swelling subsides, leaving a pigmentation spot or a subcutaneous hard cord. When the collateral circulation is established and re-opened, the hard cable may gradually disappear. Due to superficial venous lesions, blood reflux is generally unaffected. Therefore, it does not cause edema of the extremities. If deep venous lesions or venous valves are involved, severe tissue edema and chronic venous insufficiency may occur.
(2) migratory thrombophlebitis: mainly involves superficial veins, and deep veins such as brain, liver, kidney, mesentery and lungs can also occur, but the lower limbs, hips and abdominal wall are common. It is characterized by a segmental subcutaneous hard cord or induration with pain and tenderness. Adjacent skin is red and swollen, subsides after 2 to 4 weeks, leaving pigmentation spots, and new damage occurs in the other vein or another vein. Then part of it subsided, and some of it was new, so that there were damages in different parts in different parts. The cause of the disease is unknown, but it is closely related to the two diseases:
1 It is often an early manifestation of latent visceral cancer. Primary visceral cancer involves the stomach, lung, pancreas and gallbladder, and is most closely related to pancreatic and pancreatic cancer.
2 is closely related to thromboangiitis obliterans, is a clinical manifestation of its early manifestations or a whole stage of the disease, thrombosis phlebitis of Behcet disease may also belong to this type of disease, the difference is that the latter is deep and shallow Different diameters and veins can occur, while the former mainly invades the superficial small and medium veins.
2. Deep vein thrombosis: According to its location and condition, it can be divided into the following two types:
(1) deep vein thrombosis of the calf: often occurs in the deep veins of the calf, such as the posterior tibial vein and the iliac vein. Organized thrombosis may cause local venous obstruction and inflammatory response. Because the thrombus is generally small, inflammation is mild, and blood return is not large. The symptoms are generally not obvious. Usually, after exercise, the muscles of the ankle are heavy and painful, and in severe cases, there is pain. A small number of patients will have obvious symptoms when the thrombus spreads to the proximal vein, such as obvious tissue edema, local symptoms and fever. The characteristic manifestation is pain and tenderness at the gastrocnemius. During the examination, the calf was straightened, the foot was dorsiflexed, and the vein of the gastrocnemius was pulled by the vein to cause pain, which was called Homan's sign. Homan's sign positive, deep gastrocnemius tenderness (Neuhof sign) and passive foot extension or toe dorsiflexion caused pain in the lower leg, all contribute to the diagnosis of deep venous thrombosis of the lower leg. In addition, the circumference of the gastrocnemius muscle is more than 5 cm larger than the healthy side, and mild edema of the ankle with superficial venous engorgement may also be a manifestation of deep vein thrombosis. Although deep vein thrombosis of the lower leg can occur on both sides, it is not necessarily symmetrical, and can be distinguished from tissue edema caused by diseases such as heart, liver and kidney.
(2) sputum, femoral thrombophlebitis: typical manifestations are: 1 diffuse edema of the lower extremities; 2 subcutaneous vein engorgement and skin bruising; 3 triangles tenderness. Often have fever, tachycardia and increased white blood cell count. Diffuse edema causes skin tension, paleness, depression and depression; subcutaneous veins are reticular anger; there are intolerable pain and tenderness along the vein, especially in the trigone. This phenomenon is called phlegmasia alba dolens. If venous thrombosis develops not only in the main vein to extensive or deep muscle tissue, but capillary pressure and tissue pressure exceed arterial pressure, severe tissue edema can occur. The local temperature is lowered, diffuse bruising occurs in the calf and the back of the foot, and the femoral artery spasm and arterial pulsation may disappear, and finally the tissue dystrophy and even the gangrene of the vein occur. This condition is called phlegmasia cerulea dolens or blue thrombophlebitis. Because the above lesions are mainly thrombosis in the main vein, occlusion of the lumen, a greater impact on blood circulation, and can produce peri-venous inflammation, affecting adjacent lymphatic vessels or causing arterial spasm, so the symptoms and signs are more serious.
1. Superficial thrombophlebitis: The diagnosis is based on the subcutaneous hard cord along the superficial vein. If it is a small vein, it may be a nodule, but it is not spherical, and the adjacent skin is red, swollen, painful and tender.
2. Calf deep vein thrombosis: The diagnosis is based on pain and tenderness of the gastrocnemius muscle, as well as the increase in the circumference of the calf and the positive Homan sign.
3. , femoral vein thrombosis: swelling of the lower extremities, pain and tenderness along the femoral vein, especially in the trigone, skin temperature reduction, color change and superficial venous engorgement.
