Symptoms of phlebitis
Inflammation is characterised by four main properties. These are:
- redness (“rubor”)
- pain (“dolor”)
- swelling (“tumor”)
- heat (“calor”)
As phlebitis is usually inflammation of one vein, or a single network of veins, it is easy to understand the symptoms and signs of phlebitis (or superficial venous thrombophlebitis).
The associated area, usually on the leg but occasionally on the arm or elsewhere, goes hot, red and becomes tender and painful. There may be some localised swelling noted. As it is caused by a vein which usually has a clot in it, the vein will be felt as a hard tubular structure, tender to the touch just under the skin, provided the vein is superficial enough.
Unfortunately, a lot of doctors, nurses and other healthcare professionals get very confused about phlebitis and call almost every condition of the lower leg “phlebitis”. It is quite common to see people who have got; red patches around the ankles or the lower legs (venous eczema), brown stains around ankles or lower legs (haemosiderin deposition), tenderness and swelling of the whole of the lower leg or indeed the whole of the leg (that may be deep vein thrombosis) or even a red hot infected area of skin (cellulitis) being incorrectly told that they have “phlebitis”.
As such, phlebitis (superficial venous thrombophlebitis) should only be diagnosed if the affected area is localised to one area, running in the same direction of the veins of the legs. Therefore classically, thrombophlebitis should present as a patch on the leg of variable length that is hot and red and tender and, if near the surface, the hard thrombotic vein may be felt.
It is very important not to mistake one of the other conditions in the leg for phlebitis (superficial venous thrombophlebitis). As we are seeing from the recent research and recommendations, phlebitis or superficial venous thrombophlebitis can be associated with the dangerous deep vein thrombosis (DVT) or even more worrying pulmonary embolism (PE). As such, if a medic suggests a diagnosis of phlebitis (superficial venous thrombophlebitis) of the leg, an urgent ultrasound scan is needed to find out how severe it is, whether DVT has already formed, and to plan what treatment is required.
Other conditions of the leg that are often misdiagnosed as phlebitis rarely need this urgency of investigation and treatment. Hence if the condition is clearly not phlebitis, it saves a lot of anxiety if the correct diagnosis is made in the first place.