Mary: For two days, I have a problem with my right calf. He has become sensitive. Still, I don’t remember hitting myself and it doesn’t feel like a cramp either.
Dr Pierrat: So the pain did not appear during an effort?
Mary: Not at all ! Last weekend, I was driving my car when I started feeling this discomfort. I massaged myself gently but without any effect. It does not pass.
Dr Pierrat: Doesn’t that stop you from walking?
Mary: No, not really, but I avoid overdoing it.
Dr Pierrat: Is this the first time you have this problem? You don’t feel out of breath?
Mary: Absolutely not. Besides, apart from this calf story, I feel quite as usual.
Dr Pierrat: Lie down on the examination table, we’ll take a look… Your blood pressure is good but, indeed, there is a problem with this leg. Your calf is a bit hot and I spot a tough cord under the skin. Does it increase the discomfort if I press like that?
Mary: Oh! Yes. It even really hurts me.
Dr Pierrat: I also see that you don’t have good circulation in your legs.
Mary: I know… My gynecologist tells me that every time. She wants me to stop the pill because, in addition, I smoke a little.
Dr Pierrat: Your gynecologist is quite right because, there, I think that you are having phlebitis.
Mary: It’s a circulation problem in the veins, isn’t it? And is it serious?
Dr Pierrat: No, I think it’s just superficial vein thrombosis, also called paraphlebitis. That is to say the obstruction of a small vein under the skin, probably a varicose vein. This creates an inflammatory reaction. That’s why it’s hot and red. But you have to make sure that there is nothing else. I’m going to send you to an angiologist for a Doppler ultrasound.
Mary: Because it can get complicated?
Dr Pierrat: When venous thrombosis is superficial, the clot is small, so it is unlikely to migrate. The danger is when the clot is in a deep vein and is therefore larger. It then risks rising in the circulation and triggering a pulmonary embolism. And that is an emergency! You are not there yet, but you need to do a circulatory assessment, because superficial phlebitis can be associated with deep phlebitis.
Mary: So I have to make an appointment quickly?
Dr Pierrat: Yes, I will give you an address where you will be received quickly. Depending on the results, anticoagulant treatment will be started or not, at preventive doses. And you’re going to put on a restraint. From now on, you will have to take precautions in the event of a long trip by bus, car or plane, by systematically putting on compression stockings. And we must also review this story of the pill…
What you need to know about phlebitis
The risk factors for phlebitis, or deep vein thrombosis, are either transient, linked for example to prolonged bed rest (surgery, cast, etc.), or permanent, such as cancer or genetic background (heredity). A risk that also increases with age. “In young women, the risk is very low, underlines Dr. Jean-Philippe Galanaud, vascular doctor at the University Hospital of Montpellier, including in those who take the pill. Unless they have a personal and family history of thrombosis, which constitutes a contraindication to estrogen-progestogen contraception. In this case, the doctor may suggest microprogestogen contraception or the insertion of an IUD.” Ditto for women who smoke, tobacco being an additional risk factor.
Sudden pain with feeling of heaviness, edema (swelling) in only one leg… it is better to consult without delay. These are the first signs of phlebitis, the diagnosis of which will be confirmed by a venous echo-doppler. In about 20% of cases, it can be complicated by a pulmonary embolism. A risk all the more important as the clot forms high in the leg. It is an emergency whose warning signs must also be known: pain in the chest, rapid pulse and difficulty in breathing most often, more rarely syncope. In this case, only a thoracic scanner or a pulmonary scintigraphy, carried out in an emergency, can make the diagnosis.
OTHER CONSULTATIONS WITH THE MEDICAL ADVISOR
- Doctor, I have a growing mole
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- Doctor, I had blood in my stool
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- Doctor, my ear hurts
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- Doctor, my chest hurts when I walk
- Doctor, I’m running out of breath fast
- Doctor, my fingers are still frozen
- Doctor, I had blood in my urine
- Doctor I have ringing in my ears
- Doctor, I have a lump in my groin
- Doctor, what are these red patches on the neck?
- Doctor, I often feel nauseous
- Doctor, I still have hot flashes
- Doctor, my leg hurts
Read also :
- Phlebitis: 2 out of 3 French people do not know the warning signs
- Infographic: the benefits of spa treatments on venous circulation
- Heavy legs: 10 solutions to relieve them