Skip to main content
SpringerLink
Log in

Septic Thrombophlebitis

Diagnosis and Management

  • Therapy in Practice
  • Published:
American Journal of Cardiovascular Drugs Aims and scope Submit manuscript

Abstract

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 durai 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Tagalakis V, Kahn SR, Libman M, et al. The epidemiology of peripheral vein infusion thrombophlebitis: a critical review. Am J Med 2002; 113(2): 146–51.

    Article  PubMed  Google Scholar 

  2. Chirinos JA, Lichtstein DM, Garcia J, et al. The evolution of Lemierre syndrome: report of 2 cases and review of the literature. Medicine (Baltimore) 2002; 81(6): 458–65.

    Article  Google Scholar 

  3. Drabick JJ, Landry FJ. Supurative pylephlebitis. South Med J 1991; 84: 1396–8.

    Article  PubMed  CAS  Google Scholar 

  4. Clune JP. Septic thrombosis within the cavernous chamber. Am J Ophthalmol 1963; 56: 33–9.

    PubMed  CAS  Google Scholar 

  5. Southwick FS, Richardson EP, Swartz MN. Septic thrombosis of the venous durai sinuses. Medicine (Baltimore) 1986; 65: 82–106.

    CAS  Google Scholar 

  6. Brown CE, Stettier RW, Twickler D, et al. Puerperal septic thrombophlebitis: incidence and response to heparin therapy. Am J Obstet Gynecol 1999; 181: 143–8.

    Article  PubMed  CAS  Google Scholar 

  7. Southwick FS. Septic thrombophlebitis of major durai venous sinuses. Curr Clin Top Infect Dis 1995; 15: 179–203.

    PubMed  CAS  Google Scholar 

  8. Bhatia K, Jones NS. Septic cavernous sinus thrombosis secondary to sinusitis: are anticoagulants indicated? A review of the literature. J Laryngol Otol 2002; 116(9): 667–76.

    Article  PubMed  CAS  Google Scholar 

  9. Karlin RJ, Robinson WA. Septic cavernous sinus thrombosis. Ann Emerg Med 1984; 13(6): 449–55.

    Article  PubMed  CAS  Google Scholar 

  10. Baker J, Winer-Muram HT, Grey SW. Lemierre syndrome. South Med J 1996; 89: 1021–3.

    Article  Google Scholar 

  11. Hagelskjaer Kristensen L, Prag J. Human necrobacillosis, with emphasis on Lemierre’s Syndrome. Clin Infect Dis 2000; 31: 524–532.

    Article  PubMed  CAS  Google Scholar 

  12. Agarwal R, Arunachalam PS, Bosnian DA. Lemierre’s syndrome: a complication of acute oropharyngitis. J Laryngol Otol 2000; 114: 545–7.

    Article  PubMed  CAS  Google Scholar 

  13. Moore-Gillon J, Lee TH, Eykyn S J, et al. Necrobacillosis: a forgotten disease. BMJ (Clin Res Ed) 1984; 288: 1526–7.

    Article  CAS  Google Scholar 

  14. Shetty AK, Begue RE, Coffman K, et al. Lemierre’s syndrome following mastoiditis. Infect Med 1998; 15: 323–32.

    Google Scholar 

  15. Hughes CE, Spear RK, Shinabarger CE, et al. Septic pulmonary emboli complicating mastoiditis: Lemierre’s syndrome revisited. Clin Infect Dis 1994; 18: 633–5.

    Article  PubMed  CAS  Google Scholar 

  16. Lemierre A. On certain septicemias due to anaerobic organisms. Lancet 1936; I: 701–3.

    Article  Google Scholar 

  17. Harar RP, MacDonald A, Pullen D, et al. Lemierre’s syndrome: are we under diagnosing this life-threatening infection? ORL J Otorhinolaryngol Relat Spec 1996; 58: 178–81.

    Article  PubMed  CAS  Google Scholar 

  18. Weesner CL, Cisek JE. Lemierre syndrome: the forgotten disease. Ann Emerg Med 1993; 22: 256–8.

    Article  PubMed  CAS  Google Scholar 

  19. Plemmons RM, Dooley DP, Longfield RN. Septic thrombophlebitis of the portal vein (pylephlebitis): diagnosis and management in the modern era. Clin Infect Dis 1995; 21: 1114–20.

    Article  PubMed  CAS  Google Scholar 

  20. Bleeker-Rovers CP, Jager G, Tack JW, et al. F-18-fluodeoxyglucose positron emission tomography leading to a diagnosis of septic thrombophlebitis of the portal vein: description of a case history and review of the literature. J Intern Med 2004; 255: 419–23.

    Article  PubMed  CAS  Google Scholar 

  21. Pelsang RE, Johlin F, Dhadha R, et al. Management of suppurative pylephlebitis by percutaneous drainage: placing a drainage catheter into the portal vein. Am J Gastroenterol 2001; 96(11): 3192–4.

    Article  PubMed  CAS  Google Scholar 

  22. Vivas I, Bilbao JI, Martinez-Cuesta A, et al. Combination of various percutaneus techniques in the treatment of pylephlebitis. J Vasc Interv Radiol 2000; 11(6): 777–80.

    Article  PubMed  CAS  Google Scholar 

  23. Schwartz W, Honickman S, Ohki S, et al. Percutaneus diagnosis and drainage of pylephlebitis: a case report. Surgery 1987; 10(2): 244–9.

    Google Scholar 

  24. Baddley JW, Singh D, Correa P, et al. Crohn’s disease presenting as septic thrombophlebitis of the portal vein (pylephlebitis): a case report and review of the literature. Am J Gastroenterol 1999; 94(3): 847–9.

    Article  PubMed  CAS  Google Scholar 

  25. Gavilan F, Torre-Cisneros J, Delgado M, et al. Thrombosis of the hepatic artery and portal vein secondary to invasive aspergillosis following liver transplantation. Enferm Infecc Microbiol Clin 1998; 169(3): 127–9.

    Google Scholar 

  26. Hidefumi N, Eiri E, Hideki U. Septic thrombophlebitis of the postal and superior mesenteric veins as a complication of appendicitis: report of a case. Surg Today 2004; 34: 173–6.

    Article  Google Scholar 

  27. Baddour LM, Land MA, Barrett FF, et al. Hepatobiliary abnormalities associated with postanginal sepsis: common manifestations of an uncommon disease. Diagn Micriobiol Infect Dis 1986; 4: 19–28.

    Article  CAS  Google Scholar 

  28. Witte CL, Brewer ML, Witte MH, et al. Protean manifestations of pylethrombosis: a review of thirty-four patients. Ann Surg 1985 Aug; 202(2): 191–202.

    Article  PubMed  CAS  Google Scholar 

  29. Baril N, Wren S, Radin R, et al. The role of anticoagulation in pylephlebitis. Am J Surg 1996; 172(5): 449–52.

    Article  PubMed  CAS  Google Scholar 

  30. Dunnihoo DR, Gallaspy JW, Wise RB, et al. Post partum ovarian vein thrombophlebitis: a review. Obstet Gynecol Surv 1991; 46: 415–27.

    Article  PubMed  CAS  Google Scholar 

  31. Williams JW. Ligation of extension of the pelvic veins in the treatment of puerperal pyemia. Am J Obstet 1909; 59: 758–89.

    Google Scholar 

  32. Allan TR, Miller GC, Wabrek AJ, et al. Postpartum and postabortal ovarian vein thrombophlebitis. Obstet Gynecol 1976; 47: 525–8.

    PubMed  CAS  Google Scholar 

  33. Collins CG, McCallum EA, Nelon E. Suppurative pelvic thrombophlebitis: I. Incidences, pathology, etiology. Surgery 1951; 30: 298–307.

    PubMed  CAS  Google Scholar 

  34. Collins CG. Suppurative pelvic thrombophlebitis: a study of 202 cases in which disease was treated by ligation of the vena cava and ovarian vein. Am J Obstet Gynecol 1970; 108: 681–7.

    PubMed  CAS  Google Scholar 

  35. Brown CEL, Lowe TW, Cunningham FG, et al. Puerpreral septic thrombophlebitis: impact on diagnosis and treatment using x-ray computed tomography and magnetic resonance imaging. Obstet Gynecol 1986; 68: 789–94.

    PubMed  CAS  Google Scholar 

  36. Brown TK, Musick RA. Puerperal ovarian vein thrombophlebitis: a syndrome. Am J Obstet Gynecol 1971; 109: 263–73.

    PubMed  CAS  Google Scholar 

  37. Derrick FC, Turner WR, House EE, et al. Evidence of right ovarian syndrome in pregnant females. Obstet Gynecol 1970; 35: 37–8.

    PubMed  Google Scholar 

  38. Josey WE, Staggers SR. Heparin therapy in pelvic vein thrombophlebitis: a study of 46 cases. Am J Obstet Gynecol 1974; 120: 228–33.

    PubMed  CAS  Google Scholar 

  39. Eschenbach DA. Acute postpartum infections. Emerg Med Clin North Am 1985; 3(1): 87–115.

    PubMed  CAS  Google Scholar 

  40. Maull KI, VanNagell JR, Greenfield LJ. Surgical implications of ovarian vein thrombosis. Am Surg 1978; 44: 727–33.

    PubMed  CAS  Google Scholar 

  41. Angel JL, Knuppel RA. Computed tomography in diagnosis of puerperal ovarian vein thrombosis. Obstet Gynecol 1984; 63: 61–4.

    PubMed  CAS  Google Scholar 

  42. Ross MG, Mintz MC, Tuomala R, et al. The diagnosis of puerperal ovarian vein thrombophlebitis by computer axial tomography scan. Obstet Gynecol 1983; 62: 131–3.

    PubMed  CAS  Google Scholar 

  43. Shaffer PB, Johnson JC, Bryant D, et al. Diagnosis of ovarian vein thrombophlebitis by computed tomography. J Comput Assist Tomogr 1981; 5: 436–9.

    Article  PubMed  CAS  Google Scholar 

  44. Twckler DM, Setiawan AT, Evans RS, et al. Imaging of puerperal septic thrombophlebitis: prospective comparison of MR imaging, CT and sonography. ALR Am J Roentgenol 1997; 169: 1039–43.

    Google Scholar 

  45. Johnson SC, Esclapes M. Sonography of postpartum ovarian vein thrombophlebitis. J Clin Ultrasound 1998; 26: 143–9.

    Article  PubMed  CAS  Google Scholar 

  46. Duff P, Gibbs RS. Pelvic vein thrombophlebitis: diagnostic dilemma and therapeutic challenge. Obstet Gynecol Surv 1983; 38: 365–73.

    Article  PubMed  CAS  Google Scholar 

  47. Munsick RA, Gillanders LA. A review of the syndrome of puerperal ovarian vein thrombophlebitis. Obstet Gynecol Surv 1981; 36: 57–66.

    Article  PubMed  CAS  Google Scholar 

  48. Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas and Bennett’s principles & practice of infectious diseases. 5th ed. New York: Churchill Livingstone Inc., 2000.

    Google Scholar 

  49. Josey WE, Cook CC. Septic pelvic thrombophlebitis: report of 17 patients treated with heparin. Obstet Gynecol 1970; 35: 891–7.

    PubMed  CAS  Google Scholar 

  50. Ledger WJ, Peterson EP. The use of heparin in the management of pelvic thrombophlebitis. Surg Gynecol Obstet 1970; 131: 1115–21.

    PubMed  CAS  Google Scholar 

  51. Schulman H, Zatuchni G. Pelvic thrombophlebitis in the puerperal and post operative gynecologic patient. Am J Obstet Gynecol 1964; 90: 1293–6.

    PubMed  CAS  Google Scholar 

  52. Dunn LJM, Voorhies LWV. Enigmatic fever and pelvic thrombophlebitis-response to anticoagulation. N Engl J Med 1967; 276: 165–8.

    Article  Google Scholar 

  53. Witlin AG, Sibai BM. Postpartum ovarian vein thrombosis after vaginal delivery: a report of 11 cases. Obstet Gynecol 1995; 85: 775–90.

    Article  PubMed  CAS  Google Scholar 

  54. Miller CJ. Ligation or excision of the pelvic veins in the treatment of puerperal pyemia [letter]. Surg Gynecol Obstet 1917; 25: 431.

    Google Scholar 

Download references

Acknowledgments

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, University of Miami School of Medicine, 7135 Collins Avenue #92Y, Miami, Florida, USA

    Julio A. Chirinos & Geraldine Toledo

  2. Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA

    Javier Garcia

  3. Division of General Internal Medicine, Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA

    Maria L. Alcaide & Daniel M. Lichtstein

  4. Division of Infectious Diseases, Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA

    Gio J. Baracco

Authors
  1. Julio A. Chirinos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Javier Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria L. Alcaide
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Geraldine Toledo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gio J. Baracco
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniel M. Lichtstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julio A. Chirinos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chirinos, J.A., Garcia, J., Alcaide, M.L. et al. Septic Thrombophlebitis. Am J Cardiovasc Drugs 6, 9–14 (2006). https://doi.org/10.2165/00129784-200606010-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00129784-200606010-00002

Keywords

Search

Navigation