1.  Thrombophlebitis Kyle Christakos, David Cohee, Wade Dowling, Paul James, Levi Street, Stanton Urling

2. Pathophysiology  Thrombophlebitis involves the formation of a blood clot in the presence of venous inflammation or injury. Many innate conditions may predispose patients to thrombophlebitis by means of a variety of hypercoagulopathy syndromes. Traumatic events can also initiate a thrombophlebitic reaction. In addition, the persistence of significant reflux into a vein that has been treated with a sclerosing agent can lead to phlebitis. More commonly, phlebitis occurs if perforated veins in the region of sclerotherapy are not diagnosed and treated

3. Lemierre’s Syndrome  Lemierre’s Syndrome is an infective thrombophlebitis of the neck veins secondary to an andaerobic infection in the oropharyngeal region with disseminated septic emboli. May present acutely as a painful neck  May develop secondary to:  Trauma  Carcinoma  Infection  Central venous catheters

4. Risk Factors  DVT  Cancer  Genetics/family history  Sedentary  Birth control pills or hormone replacement therapy.  Pregnancy or immediate post-partum.  Pacemaker  Stroke causing paralysis of extremities

5. Signs and Symptoms  Superficial thrombophlebitis:  Inflammation over the affected area  Pain  Skin redness  Warmth and tenderness over the vein.

6. Tests and Measures  Frequently check: pulse, BP, temperature, skin condition, circulation.  Blood coagulation studies  Doppler ultrasound  Venography

7. How to Proceed  Refer to physician for necessary diagnostic tests to determine state of the condition and candidacy for Physical Therapy.  If previously and currently diagnosed with condition treat as needed avoiding any and all contraindications as well as close monitoring of the patients signs and symptoms.

8. References  Thomas JH. Edgar J Poth lecture. Pathogenesis, diagnosis, and treatment of thrombosis. Am J Surg. 1990 Dec. 160(6):547-51  Chattopadhyay D, Mostafa M, Carr M. Acute neck pain referred to the surgeon: Lemierre’s syndrome as a differential diagnosis. Annals of The Royal College of Surgeons of England. 2012;94(3):e132-e133. doi:10.1308/003588412X13171221589414.