What is Migratory Thrombophlebitis?
Thrombophlebitis is a condition where a blood clot causes inflammation in a vein. A certain type of this condition, known as migratory thrombophlebitis, first affects one group of veins. Once that group starts to get better, other groups of veins get affected. In some cases, several veins in different areas can get affected at the same time. Thrombophlebitis can affect both veins closer to the skin’s surface and those deeper within the body.
What Causes Migratory Thrombophlebitis?
Superficial migratory thrombophlebitis, a condition where blood clots form in superficial veins and move about under the skin, can be linked with several health issues or conditions. These include high blood pressure, Buerger syndrome (a disease affecting blood vessels in hands and feet), conditions that cause the blood to clot more easily (like deficiencies in proteins C and S, lupus anticoagulant, and factor XII deficiency), inflammatory bowel disease, Behcet disease (a rare disorder causing inflammation in blood vessels), and pancreatic cancer. There have also been instances where it’s related to smoking cannabis and having a type of bacterial infection called Q fever.
Armand Trousseau, a doctor in the 1800s, was the first to notice the association between superficial migratory thrombophlebitis and hidden internal cancers. Today, this association is referred to as Trousseau syndrome-and it is characterized by unexpected blood clots that happen either before the discovery of hidden internal cancers or at the same time as these cancers.
For patients with cancer, not only are the surface veins affected, but also the deep ones. This can sometimes lead to a dangerous condition where a clot breaks free and travels to the lungs, causing what’s known as a pulmonary embolism. Interestingly, these clots tend to occur not just in typical areas such as legs, but in unusual locations like upper arms, chest, and trunk. This happens even without typical risk factors such as old age, obesity, recent surgery, lack of movement, ill health, varicose veins, and earlier trauma to the area.
Risk Factors and Frequency for Migratory Thrombophlebitis
Idiopathic thrombophlebitis migrans, or unexplained migratory vein inflammation, usually happens to people between 25 and 50 years old, with the average age being around 40. Men are affected three times as much as women, and it often occurs in otherwise healthy adults.
This condition is linked to almost all types of cancer. Different studies have noted various frequencies of cancer types associated with migratory thrombophlebitis. Some have reported a high instance in cancer of the body and tail of the pancreas, while others have noted a higher prevalence of lung adenocarcinomas in men and cancers of the reproductive tract in women. Most frequently, it is found in combination with gastrointestinal, including pancreas and stomach, lung, and genital and urinary system cancers.
- Idiopathic thrombophlebitis migrans typically occurs between the ages of 25 and 50.
- The average age of those affected is about 40.
- Men are three times more likely to get it than women.
- Although seen in otherwise healthy adults, it’s significantly linked to various types of cancers.
- Some reports indicate a high incidence in pancreatic body and tail carcinomas.
- Certain studies report a higher incidence of lung adenocarcinomas in males and reproductive tract cancers in females.
- It most commonly accompanies gastrointestinal (pancreas and gastric), lung, and urogenital cancers.
Signs and Symptoms of Migratory Thrombophlebitis
Superficial migratory thrombophlebitis is a condition that’s often connected to other health problems. To identify any underlying conditions, doctors need to ask about your health history. They’re interested in any past high blood pressure, smoking, and cannabis use, your travels, and if you or your family have a history of cancer, blood clotting disorders, or autoimmune diseases. The doctor will also ask if you’ve had previous similar conditions and where they occurred.
People with superficial thrombophlebitis usually have pain, redness, and hardness along a surface vein. Often, they can feel a lumpy cord, which is a blood clot, in the affected vein. Sometimes, they might have a fever. High-risk patients, such as men over 60, those with systemic infections, people with clotting in both surface veins without varicose veins, should be checked for deep vein thrombosis and lung blood clots. Mondor’s disease is a specific type of superficial thrombophlebitis that occurs in the veins of the chest, causing painful, hard, red cords.
It has also been reported in the armpit, penis, and groin area.
Testing for Migratory Thrombophlebitis
Superficial thrombophlebitis is a condition that doctors diagnose based on physical symptoms. Normally, patients with this condition will experience pain and redness in the affected area. When touched, the vein in this area will feel hard and tender. Also, veins that have been affected previously might appear brownish or hyperpigmented due to a substance called hemosiderin. Extensive swelling can occur if the condition has spread deeper into the veins, a situation known as deep venous thrombosis.
There are situations where an imaging test called a Duplex Ultrasound is useful. This is true for patients who feel pain along their vein but don’t have visible symptoms of thrombophlebitis. This is particularly valuable for overweight patients, as their veins are often several centimeters below the skin surface. These patients might have superficial or deep venous thrombosis, and an ultrasound can rule out the latter scenario.
Two particular veins, the great saphenous vein and the small saphenous vein, are more prone to become deep vein thrombosis when superficial venous thrombosis occurs. Duplex ultrasound can help determine how far the clot or “thrombus” has extended in these veins. If a patient has significant swelling in the extremity, an ultrasound can also check for deep vein thrombosis.
There’s a specific type of superficial thrombophlebitis called migratory thrombophlebitis, which is important to diagnose because it can indicate the presence of cancer and other systemic disorders. It may be the first symptom of a hidden or “occult” cancer, which might not manifest until months or even years after the diagnosis of migratory thrombophlebitis.
Doctors will undertake a comprehensive evaluation for such patients. First, they’ll take a detailed health history, examining any symptoms and signs of cancer. They’ll also perform a thorough physical examination. Laboratory tests, including blood tests, liver function tests, and tests evaluating the speed at which your blood cells separate, will be performed. Urine tests, cancer marker tests, and tests examining if the blood is prone to clotting will also be performed. A chest X-ray, as well as a scan of the chest, abdomen, and pelvic region, will be included. Additionally, screenings for specific age-appropriate cancers, such as mammography for breast cancer and the Papanicolaou test for cervical cancer in women, will be performed, along with evaluations of the upper and lower gastrointestinal tract.
Treatment Options for Migratory Thrombophlebitis
The goal in treating superficial thrombophlebitis, or inflammation of a vein just under the skin due to a blood clot, is to ease symptoms and prevent the blood clot from getting bigger. Basic care involves several measures such as elevating the affected limb, taking anti-inflammatory drugs, applying hot or cold packs, wearing compression stockings, and moving more. This type of care is usually recommended for patients with a relatively small blood clot (less than 5 cm), located far from the junctions where major veins meet, and those who have no medical risk factors for more serious blood clot issues. These patients are then checked every 7 to 10 days, or sooner if their symptoms get worse. If symptoms don’t improve, a special type of ultrasound, called a duplex, is performed to check for a deep vein thrombosis, a more serious type of blood clot that forms in a deeper vein.
Patients who are at higher risk, such as those with a blood clot that is getting bigger, a clot that is longer than 5 cm and located near major vein junctions, or who also have a deep vein thrombosis or a pulmonary embolism (a dangerous condition where a blood clot breaks loose and travels to the lungs), are usually given blood thinning medication. It’s still a subject of debate as to which medication and what dose should be used, and for how long. There are various blood thinners that can be used, either by injection or taken by mouth, and they are often recommended for a period of 45 days.
Patients with a deep vein thrombosis and a pulmonary embolism usually need to be on blood thinners for a longer period of time. For patients who can’t take blood thinners, the option could be to tie off the vein at the location of the blood clot.
For patients with Trousseau syndrome, a type of disorder that causes blood clots to form repeatedly, heparin, another type of blood thinner, is often recommended. It works by rendering a component of the clot (thrombin) ineffective, and preventing the activation of other elements that cause clots.
Thrombophlebitis that keeps coming back can be hard to treat with blood thinners in cancer patients, sometimes leading to the clot getting bigger and causing repeated cases of pulmonary embolism. There have been some reports of patients with cancer-causing recurrent thrombophlebitis, where the removal of the cancer not only cured the cancer, but also improved the phlebitis and reduced the occurrence of blood clots.
In patients with Buerger disease, a condition which causes blood vessels to become inflamed, block blood flow, and cause damage to skin tissue, especially in the hands and feet, it’s very important that they quit smoking.
What else can Migratory Thrombophlebitis be?
When a patient presents with certain symptoms, doctors need to consider several different possibilities, or “differential diagnoses,” to determine the cause. For the given symptoms, physicians might rule out the following conditions:
- Cellulitis (an infection of the skin and deep underlying tissues)
- Lymphangitis (inflammation of lymph vessels)
- Erythema nodosum (skin inflammation resulting in red bumps)
- Nodular vasculitis (inflammatory condition affecting the body’s small and medium blood vessels)
- Polyarteritis nodosa (rare and severe blood vessel disease)
- Superficial migratory thrombophlebitis (swelling and inflammation of superficial veins most commonly in legs)
One of the distinguishing features of superficial migratory thrombophlebitis, for instance, includes palpable cord-like nodules and a linear and winding pattern of the purpura (a condition that results in purple-colored spots and patches on the skin).
What to expect with Migratory Thrombophlebitis
The future health of a patient dealing with migratory thrombophlebitis, a condition where clotting occurs in different veins over time, largely depends on its cause. If it’s caused by cancer, unfortunately, the outlook isn’t so good. However, if it’s due to non-cancerous conditions, the chances of recovery are much better, although they may experience lingering symptoms known as post-phlebitic syndrome.
To avoid developing post-phlebitic syndrome, patients will likely need to wear compression stockings for the rest of their lives. Those diagnosed with a blood clot are often treated with anticoagulation therapy, basically medicines to prevent clots, for a period of 3 to 9 months.
If a patient does not seek timely treatment, they can experience a pulmonary embolism—a serious and potentially fatal condition where a blood clot travels to the lungs. So, timely medical assistance is crucial for such cases.
Possible Complications When Diagnosed with Migratory Thrombophlebitis
A common complication is the growth of a blood clot, or thrombus, which can lead to deep vein thrombosis (a blood clot in deep veins, typically in the leg) and pulmonary embolism (a blood clot in the lungs). There is a significant risk, as high as 18%, for these conditions to occur. Unusually, this can even involve veins in the neck and abdominal organs. Other complications can include long-term swelling and long-term venous ulcers, which are wounds that occur from improper functioning of the venous system.
Problems to Look Out For:
- Growth of a blood clot
- Deep vein thrombosis (blood clot in deep veins)
- Pulmonary embolism
- Veins in unusual locations like the neck and abdominal organs involved
- Chronic (long-term) edema (swelling)
- Chronic (long-term) venous ulcers (wounds due to venous system issues)
Preventing Migratory Thrombophlebitis
Patients should be informed that thrombophlebitis, a condition where a blood clot causes inflammation in a vein, can come and go and may occur more than once. It’s important for them to continue follow-up visits to check for other possible related health problems and cancer. This ongoing medical check-up can help catch any potential issues early.
