Thrombophlebitis Migrans

THROMBOPHLEBITIS MIGRANS, wandering phlebitis, characterized by a wandering type of inflammatory phenomena. T. t. was first described in 1903 by Neisser. Subsequently, several other cases were described. In 1910, L. Buerger reported 11 cases of T. t., accompanied by obliterative thromboangiitis of the extremities, which subsequently led to amputation. A special form of chronic wandering phlebitis was described in 1927 by Chlumsky. The etiology of T. t. is unclear in some cases, while in others, the cause of the condition is considered to be cancerous cachexia, syphilis, tuberculosis, rheumatism, gout, sepsis, idiosyncrasy, acromegaly. Chlumsky considered insect bites (mosquitoes) as the cause of the condition in his cases. However, such a variety of predispositions in T. t. is only apparent. It should be assumed that in all these cases, there are significant changes in the blood itself, i.e., a factor that can, by itself, determine the question of thrombus formation. As for the localization of thrombi, it is associated with local conditions of venous blood circulation, blood flow rate, etc. T. t. is localized mainly in the superficial veins of the upper and lower extremities. The process manifests itself in the formation of painful nodules. The latter have the appearance of spindle-shaped thickenings 2-4 cm long and 1-2 cm wide. The skin over the affected area is inflamed in some cases, unchanged in others. The inflammatory process is localized in the outer or middle layer of the blood vessel, but can also affect the inner layer. Damage to the inner layer leads to thrombosis. When the process is localized in superficial veins, the limb does not swell; deep lesions are accompanied by phlegmasia phenomena. The form of T. t. described by Chlumsky is characterized by the formation of small swellings resembling insect bites. The disease begins with the hands and feet. For the T. t. described by Buerger, the combination of venous and arterial lesions is characteristic, and this author emphasizes that the process of thrombosis in deep vessels also has a migratory nature. Buerger believes that T. t. and deep thromboangiitis are not always localized in the same limb. The pathological-anatomical changes in the cases described by Briggs consisted of sclerosis of the veins with simultaneous arteriolar-capillary fibrosis, affecting not only superficial veins but also deeper ones, including those of the mesentery, lung, and heart. Path-anat. changes in Buerger's disease depend on the stage of the lesion. In the early stage, polymorphonuclear infiltration is noted in all layers of the vascular wall, and thrombotic clots in the lumen. Subsequently, miliary granulomas develop with the participation of giant cells; the latter usually lie in the thickness of the proliferating intima. In the future, the lumen is filled with connective tissue penetrated by capillaries and cavernous cavities. All these changes are combined with periphlebitis. In the late stage, all phenomena of obliterative thromboangiitis with organization and significant periphlebitis are usually noted. The clinical picture in cases of T. t. of unknown origin described by Briggs, Murged, and Abrahamson manifested as a slight increase in temperature, redness, and mild swelling. The process was accompanied by embolism symptoms (hemoptysis). The course was prolonged but not severe and ended in recovery. The cases described by Chlumsky manifested as the appearance of small itchy swellings resembling insect bites. Subsequently, the veins became swollen, and temperature increased. The condition lasted for a long time. Young people are affected, mainly in summer and autumn. Serious complications included pulmonary embolism and gangrene of the extremities. The T. t. described by Buerger can often occur without subjective symptoms. The process is only revealed upon examination of the amputated limb. Buerger noted that in developed ischemia, lowering the limb is accompanied by the appearance of a special redness. This redness, unlike in Raynaud's disease and erythromelalgia, he proposes to call erythromelia. Buerger believes that the disease of superficial veins, characterized by the formation of painful swellings, should arouse suspicion of the simultaneous presence of thromboangiitis. The process in superficial veins occurs without sharply expressed phenomena. The spread of the process to deeper vessels causes more serious disorders. Treatment of T. t. is conservative. Where the process occurs on the basis of any general disease, it is necessary to treat the underlying disease. Conservative treatment for T. t. described by Buerger is not successful (see Gangrene).