Septic thrombophlebitis: diagnosis and management.
Septic thrombophlebitis, as a result of invasion from adjacent nonvascular infections, includes conditions such as Lemierre syndrome (internal jugular vein septic thrombophlebitis), pylephlebitis (portal vein septic thrombophlebitis), and septic thrombophlebitis of the dural sinuses and the pelvic veins. All of these conditions are associated with a very high mortality if untreated. Appropriate antibacterial therapy dramatically improves the outcome of these infections and results in a low mortality rate, with the notable exception of septic thrombophlebitis of the dural sinuses. The endovascular nature of these infections results in secondary metastatic disease, including pneumonia, endocarditis, and arthritis due to septic embolization and/or hematogenous bacterial spread. The appropriate diagnosis and management of these infections depends on a high degree of clinical suspicion, the use of imaging studies, and early initiation of empiric antibacterial therapy. In this article, we review the diagnosis and management of septic thrombophlebitis, focusing on Lemierre syndrome, pylephlebitis, and septic thrombophlebitis of the pelvic veins.
Division of Cardiology, Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA. jchirinos@med.miami.edu
Julio A
JA
Chirinos
Javier
J
Garcia
Maria L
ML
Alcaide
Geraldine
G
Toledo
Gio J
GJ
Baracco
Daniel M
DM
Lichtstein
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007601:Jugular Veins / Q000473:pathology; D010388:Pelvis / Q000098:blood supply / Q000473:pathology; D011169:Portal Vein / Q000473:pathology; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D013924:Thrombophlebitis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology
D000900:Anti-Bacterial Agents