Clinical presentation depends on type of vessel and organ involved and associated embolism. Cases of deep venous thrombosis (DVT) present with swelling of leg, discoloration of leg and pain. Cases of pulmonary embolism often are secondary to deep venous thrombosis and present with acute chest pain, dyspnea, cough, and hemoptysis.

Embolus in internal carotids, vertebral arteries and circle of Willis presents with recurrent dizziness, confusion, limb weakness, sensory dysfunction, speech disorders, facial asymmetry, bladder dysfunction and abnormal gait. Thromboembolic complications in the heart presents with severe chest pain, sweating, palpitation, anxiety and syncope. Portal vein thrombosis may cause adnominal distension, pain in abdomen and breathing difficulty. Jugular vein thrombosis causes fever, neck swelling, and cervical pain [6].

• Splenomegaly

  This increased pressure (called portal hypertension ) causes the spleen to enlarge (splenomegaly). It also results in dilated, twisted (varicose) veins in the esophagus (called esophageal varices ) and often in the stomach (called gastric varices). [merckmanuals.com]

• Pain

  Jugular vein thrombosis causes fever, neck swelling, and cervical pain. [symptoma.com]

  If you still have pain you can take paracetamol or ibuprofen. As well, try not to load your foot a lot until discomfort has disappeared. [trombo.info]

  Pain and swelling in the leg are common symptoms. Post-thrombotic syndrome may also happen following deep vein thrombosis of a leg vein. It is a long-term problem with pain, swelling, and redness. [saintlukeskc.org]

  This report describes a case of spontaneous IJV thrombosis leading to neck pain and swelling as a primary manifestation of antiphospholipid (Hughes) syndrome. [ncbi.nlm.nih.gov]

• Leg Swelling

  However, they are sometimes considered in people with massive leg clots to prevent long-term leg swelling and pain (called post-phlebitis syndrome). [health.harvard.edu]

  Symptoms and Signs of Deep Vein Thrombosis (Blood Clot in Leg) Swelling, usually in one leg Leg pain or tenderness Reddish or bluish skin discoloration Leg warm to touch The symptoms of a blood clot may feel similar to a pulled muscle or a “Charlie horse [stoptheclot.org]

  Wear elastic compression stockings: If you have a history of blood clots or leg swelling, elastic stockings reduce leg swelling and the chance of blood clots. The stockings must be worn snugly to offer support while ensuring adequate circulation. [lifebridgehealth.org]

  This condition is characterized by pooling of blood, chronic leg swelling, increased pressure, increased pigmentation or discoloration of the skin, and leg ulcers known as venous stasis ulcers. [my.clevelandclinic.org]

• Surgical Procedure

  Minimally Invasive Procedures for Deep Vein Thrombosis Minimally invasive surgical procedures may help resolve deep vein thrombosis. [nyulangone.org]

  Thrombosis can happen for no apparent reason, but it is often associated with an inherited predisposition to blood clots, surgical procedures, immobility, oral contraceptive use or underlying medical conditions. [ucsfhealth.org]

  procedures Guided transition of care for adolescents with bleeding and clotting disorders into young adulthood in close partnership with the hemophilia/thrombosis program at Rady Children's Hospital San Diego Rapid bleed detection through point of care [health.ucsd.edu]

  Having a recent major surgical procedure, especially hip and knee orthopedic surgeries or one that requires prolonged bed rest, predispose the blood to clotting. [vascularcures.org]

• Asymptomatic

  While generally asymptomatic and discovered as incidental findings, there is a small number that can cause intracranial haemorrhage, usually attributed to associated cavernomas; however, venous thrombosis of the draining vein is a rare cause. [ncbi.nlm.nih.gov]

  646.5 bacteriuria, asymptomatic 646.5 bariatric surgery status 649.2 bicornis or bicornuate uterus 654.0 biliary problems 646.8 bone and joint disorders (conditions classifiable to 720 - 724 or conditions affecting lower limbs classifiable to 711 - 719 [icd9data.com]

  Even if asymptomatic thrombosis is excluded however, the incidence of symptomatic thrombosis and thromboembolism was high, at 5%. Predisposition to spontaneous thrombosis of the pulmonary vasculature might be a real possibility. [dictionary.cambridge.org]

• Gangrene

  Examinations after death have shown that thrombosis exists for some distance around the gangrenous mass. Thrombosis of the subclavian and axillary veins is much less frequent. [thesaurus.com]

  Venous gangrene may result. Infection rarely develops in venous clots. [merckmanuals.com]

  Gas gangrene. Investigations [ 6 ] Ultrasound (compression with either Doppler or colour Doppler) is recommended as the investigation of choice. [patient.info]

  Can also get microangiopathic hemolytic anemias like TTP/HUS, HELLP, and in Catastrophic APS (see below) Skin manifestations are common and include splinter hemorrhages, livedo reticularis, skin necrosis/infarction and digital gangrene. [errolozdalga.com]

  Endovascular treatment of phlegmasia cerulea dolens with impending venous gangrene: manual aspiration thrombectomy as the first-line thrombus removal method. Cardiovasc Intervent Radiol 2011;34:1214-21. Kahn SR. [acc.org]

• Cough

  The warning signs and symptoms of a pulmonary embolism include: Sudden shortness of breath Chest pain or discomfort that worsens when you take a deep breath or when you cough Feeling lightheaded or dizzy, or fainting Rapid pulse Coughing up blood Causes [mayoclinic.org]

  Symptoms may include: Chest pain Trouble breathing or sudden shortness of breath Coughing (may cough up blood) Fainting Fast heartbeat Sweating You may have bleeding if you take medicine to help prevent blood clots. [saintlukeskc.org]

  […] or movement Pain in the back Cough (sometimes with bloody sputum/phlegm) Sweating more than normal Fast heartbeat Feeling dizzy or fainting Some people do not know they have a DVT until the clot moves from their leg or arm and travels to their lung. [my.clevelandclinic.org]

  […] dizzy, or fainting Fast heartbeat or rapid pulse Coughing up blood Finally, there are some preventative measures if you feel you are at risk. [gendermed.org]

• Tachypnea

  […] chest pain, chest tightness, shortness of breath, palpitation, or coughing up blood; dizziness or lightheadedness may occur with a massive PE.5 Symptoms may be confused with those of myocardial infarction or pneumonia.5 The patient may present with tachypnea [uspharmacist.com]

  […] with acute pulmonary embolism (PE) may present with pleuritic chest pain, shortness of breath, fatigue, back pain, syncope or even death if severe (e.g., PE associated with hemodynamic instability or right heart strain).[11] Signs include tachycardia, tachypnea [ncbi.nlm.nih.gov]

• Abdominal Pain

  This is a case of a 14-year old female presented with complaints of shortness of breath, palpitation and abdominal pain whose laboratory test results were consistent with Coomb's test negative haemolytic anaemia. [ncbi.nlm.nih.gov]

  This form of thrombosis presents with abdominal pain, ascites and enlarged liver. Treatment varies between therapy and surgical intervention by the use of shunts. [en.wikipedia.org]

• Thrombosis

  […] convert 453.2 to ICD-10-CM 453.3 Other venous embolism and thrombosis of renal vein convert 453.3 to ICD-10-CM 453.4 Acute venous embolism and thrombosis of deep vessels of lower extremity 453.40 Acute venous embolism and thrombosis of unspecified deep [icd9data.com]

  Deep vein thrombosis is further described in three types: Type 1: distal thrombosis, extending in proximal direction (most frequent). [flexikon.doccheck.com]

  Thrombosis " search on: [curlie.org]

  […] the risk of arterial thrombosis. [en.wikipedia.org]

  The incidence of PE is 0.5% for isolated IJ vein thrombosis and 2.4% for combined IJ vein and subclavian/axillary vein thrombosis. [emedicine.com]

• Chest Pain

  Pulmonary embolism can be minor and go unnoticed, or it can be significant and cause difficulty breathing, sharp chest pain and even death. [lifebridgehealth.org]

  We present a 19-year-old man who was hospitalized due to chest pain following a progressive osteolysis of the bony thorax. The disease later expanded into the pleura, peritoneum and pericardium in a form of massive chylous polyserositis. [ncbi.nlm.nih.gov]

  Pulmonary embolism, which symptoms include chest pain, coughing up blood, an unexplained sudden onset of shortness of breath, and rapid pulse. [docdoc.com.sg]

  Signs or symptoms of thrombosis may include: pain and/or swelling of an arm or leg with warmth over the affected area discoloration of an arm or leg unexplained shortness of breath chest pain or discomfort that worsens on deep breathing unexplained rapid [primaryimmune.org]

• Tachycardia

  chest tightness, shortness of breath, palpitation, or coughing up blood; dizziness or lightheadedness may occur with a massive PE.5 Symptoms may be confused with those of myocardial infarction or pneumonia.5 The patient may present with tachypnea, tachycardia [uspharmacist.com]

  […] continues even when you are resting pain in your chest, which may be worse when you breathe in coughing up blood Other symptoms of pulmonary embolism (PE) include: fainting or collapse a bluish tinge to your skin (cyanosis) rapid breathing rapid heartbeat (tachycardia [hse.ie]

  Patients with acute pulmonary embolism (PE) may present with pleuritic chest pain, shortness of breath, fatigue, back pain, syncope or even death if severe (e.g., PE associated with hemodynamic instability or right heart strain).[11] Signs include tachycardia [ncbi.nlm.nih.gov]

• Hypotension

  […] palpitation, or coughing up blood; dizziness or lightheadedness may occur with a massive PE.5 Symptoms may be confused with those of myocardial infarction or pneumonia.5 The patient may present with tachypnea, tachycardia, and diaphoresis.5 Cyanosis and hypotension [uspharmacist.com]

  Delayed cerebral venous thrombosis in a patient with spontaneous intracranial hypotension. Cephalalgia. 2007 ; 27 :1176–1178. Crossref Medline Google Scholar 47. Wilder-Smith E, Kothbauer-Margreiter I, Lämmle B, Sturzenegger M, Ozdoba C, Hauser SP. [stroke.ahajournals.org]

• Fracture

  Causes of Deep Vein Thrombosis (DVT) There are a variety of risk factors that contribute to the development of deep vein thrombosis: Surgery, particularly surgery of the hip or leg, or abdominal surgery Trauma or bone fracture A long period of bed rest [stanfordhealthcare.org]

  To join fracture fragments together with wire. arch wire In orthodontics, a cable, usually of metal, used to apply tension to the teeth. guide wire A wire used to enter tight spaces (e.g., obstructed valves or channels) within the body. [medical-dictionary.thefreedictionary.com]

  Thrombosis (DVT) Risk Factors Increasing age Prolonged immobility Stroke Paralysis Previous VTE Cancer and its treatment Major surgery (particularly operations involving the abdomen, pelvis and lower extremities) Respiratory failure Trauma (especially fractures [news-medical.net]

  Damaged veins due to injury (major surgery, fractures, severe muscle injury, etc.) [myavls.org]

  Multiple trauma within the preceding 1 mo 5 Acute spinal cord injury/paralysis within the preceding 1 mo 5 Immobilization Current bed rest (medical patient) 1 Bed rest > 72 h 2 Immobilizing plaster cast within the preceding 1 mo 2 Hip, pelvis, or leg fracture [merckmanuals.com]

• Leg Pain

  Symptoms Deep vein thrombosis signs and symptoms can include: Swelling in the affected leg. Rarely, there's swelling in both legs. Pain in your leg. The pain often starts in your calf and can feel like cramping or soreness. [mayoclinic.org]

  leg Red or discolored skin on your leg Veins that are swollen, red, hard, or tender to the touch you can see Call 911 or go to an emergency room right away if you notice leg pain or swelling and: Sudden coughing, which may bring up blood Sharp chest [webmd.com]

  Deep vein thrombosis in the right leg In some instances, there may be no symptoms, but deep vein thrombosis signs and symptoms may often include: swelling of the affected leg (less often, there could be swelling in both) a leg pain, which usually starts [leading-medicine-guide.com]

  Symptoms and Signs of Deep Vein Thrombosis (Blood Clot in Leg) Swelling, usually in one leg Leg pain or tenderness Reddish or bluish skin discoloration Leg warm to touch The symptoms of a blood clot may feel similar to a pulled muscle or a “Charlie horse [stoptheclot.org]

  pain, intractable oedema, leg ulcers) than DVT in non-pregnant women. 1 3 This article provides an update on the diagnosis and management of pregnant women with DVT. [bmj.com]

• Calf Pain

  PTS can involve chronic leg swelling, calf pain, calf heaviness/fatigue, skin discoloration, and/or venous ulcers. What is pulmonary embolism (PE)? A pulmonary embolism is a blood clot that has traveled to the lungs. It often starts as a DVT. [natfonline.org]

  Homan sign: calf pain on dorsal flexion of the foot Meyer sign: Compression of the calf causes pain. [amboss.com]

  The stockings help prevent calf pain and swelling, as well as reduce the risk of complications. A person should wear compression stockings for as long as their doctor recommends. [medicalnewstoday.com]

  This can affect the tissues of your calf and lead to symptoms, including: calf pain swelling a rash ulcers on the calf (in severe cases) When a DVT develops in your thigh vein, there's an increased risk of post-thrombotic syndrome occurring. [nhsinform.scot]

  Common causes of calf pain that mimic acute DVT include Cellulitis that causes painful erythema of the calf Ruptured popliteal (Baker) cyst (pseudo-DVT), which causes calf swelling, pain, and sometimes bruising in the region of the medial malleolus Partial [merckmanuals.com]

• Leg Cramp

  Symptoms of DVT include: Pain in the leg (most often the calf) that gets worse as you move Swelling in the leg Sudden onset of a leg cramp that does not subside Sudden onset of shortness of breath or pain in the chest when breathing deeply A red, tender [myavls.org]

  Symptoms and signs of DVT occur in the leg with the blood clot, and include: Swelling Pain Redness Warmth to the touch Worsening leg pain when bending the foot Leg cramps (especially at night and/or in the calf) Discoloration of skin Causes of deep vein [emedicinehealth.com]

  Classic symptoms include: Pain Swelling Warmth Redness Leg cramps, often starting in the calf Leg pain that worsens when bending the foot Bluish or whitish skin discoloration You may or may not have all of these symptoms, or your may have none. [medicinenet.com]

  Similar to those with lower extremity DVT, patients with IVC thrombosis commonly complain of leg heaviness, pain, swelling, and cramping. Nonspecific back and abdominal/pelvic pain along with scrotal swelling frequently precede leg symptoms (19). [interventions.onlinejacc.org]

• Leg Discoloration

  Symptoms: Swelling of leg, discoloration of leg, pain in leg, acute chess pain, breathlessness, cough, hemoptysis, dizziness, confusion, limb weakness, sensory dysfunction, speech disorders, facial asymmetry, bladder dysfunction, abnormal gait, sweating [symptoma.com]

• Erythema

  References:[2][4][5] Clinical features May be asymptomatic Localized unilateral symptoms Typically affects deep veins of the legs, thighs, or pelvis Swelling, feeling of tightness or heaviness Warmth, erythema, and possibly livid discoloration Progressive [amboss.com]

  When present, symptoms and signs of DVT (eg, vague aching pain, tenderness along the distribution of the veins, edema, erythema) are nonspecific, vary in frequency and severity, and are similar in arms and legs. [merckmanuals.com]

  Physical exam may reveal a palpable cord, ipsilateral edema, erythema, or venous distension. Rarely, patients with DVT may present with evidence of arterial insufficiency due to massive iliofemoral DVT. [acc.org]

  Symptoms range from mild erythema and localized induration to massive extremity swelling and ulceration, usually exacerbated by standing and relieved by elevation of the extremity. [emedicine.medscape.com]

  Patients with deep vein thrombosis (DVT) often present with isolated extremity swelling, pain, warmth, and erythema at the site of the blockage. [ncbi.nlm.nih.gov]

• Flank Pain

  LESSONS: This previously unreported case should alert sonographers to include IRVT in the differential diagnosis of flank pain associated with hematuria. [ncbi.nlm.nih.gov]

• Confusion

  Embolus in internal carotids, vertebral arteries and circle of Willis presents with recurrent dizziness, confusion, limb weakness, sensory dysfunction, speech disorders, facial asymmetry, bladder dysfunction and abnormal gait. [symptoma.com]

  […] an ambulance or go to the emergency department if: you have chest pain you cough up blood you are short of breath you feel faint or pass out you are nauseous or vomiting you are numb and weak down one side, or there is a weakness in your face you are confused [healthdirect.gov.au]

  Stroke, which symptoms include sudden confusion, numbness or weakness of one side of the body, vision problems, and loss of balance, among others. [docdoc.com.sg]

  Filling defects should not be confused with Pacchionian bodies (arachnoid granulations) which can be seen in essentially all dural sinuses and are especially common in the superior sagittal sinus and transverse sinus. [radiopaedia.org]

  Bleeding in your brain can bring on severe headaches, vision changes, unnatural movements, and confusion. Call 911 or go to the emergency room if you notice any of these symptoms. [medicinenet.com]

• Unable to Walk

  These include individuals on bed rest (such as during or after a surgical procedure or medical illness, like heart attack or stroke) or those who are confined and unable to walk for prolonged periods of time (such as during prolonged air or car travel [vascularcures.org]

  Your healthcare team will usually advise you to walk regularly after you've been prescribed compression stockings. [nhsinform.scot]

  </p><h3>Immobility</h3><p>If a person is immobile (confined to a bed, unable to walk or spending large parts of the day in a bed or chair), the skeletal-muscle pumps, which help blood in the deep veins to return to the heart, are at rest. [aboutkidshealth.ca]

Objective of workup is confirming obstruction of vessel lumen by imaging studies such as color Doppler for deep venous thrombosis and portal vein thrombosis, angiography in case of myocardial infarction or ischemia, CT scan and X-ray in case of jugular or carotid involvement. ECG, complete blood count (CBC), kidney function test, liver function test, urine examination and blood coagulation profile (PT, aPTT, INR), must be done to rule out complications and set baseline. Depending on complications other investigations like CSF or peritoneal fluid examination may be advised [7].

Treatment is directed towards two aspects. Treatment of complication and treatment to dissolve as well prevent recurrence of thrombus. Treatment of complication like swelling and pain of leg in DVT are managed by stockings and NSAIDS. Myocardial ischemia/infarction with centrally acting analgesics, nitroglycerine and life support. Pulmonary thromboembolism with oxygen, and other life support, antibiotics.

Whatever is a complication, cornerstone of treatment is dissolving blood clot and prevent recurrence. Thrombolytic drugs like streptokinase or human tissue plasminogen activator are used to dissolve clot. For prevention of thrombus formation anticoagulants like heparin, warfarin, and dabigatran are used. Anticoagulant and thrombolytic therapy needs routine INR monitoring [8].

Mostly cases are detected upon symptoms or complications. If left untreated thrombosis causes significant morbidity and mortality due to cardiopulmonary complications like pulmonary thromboembolism, stroke or myocardial infarction. Complications are mostly prevented by anticoagulant therapy. Even after treatment in 33 percent of cases, the condition recurs [5].

Thrombosis occurs as a result of altered pathophysiology between blood flow, protection of vessel wall by endothelium and blood composition. Regular blood flow prevents endothelial injuries and activation of coagulation pathway. This flow is altered in certain conditions like sedentary behavior, prolonged sitting or standing, occlusion of vessels by tumors, atrial or ventricular fibrillation, shock and heart failure [1].

In the endothelium if injured, connecting tissue containing collagen, is exposed to coagulation factor which activates coagulation pathway. Endothelial injury may be caused by uncontrolled blood pressure, stress, atheroma, infection and altered blood flow.

Hypercoagulability indicates altered composition of blood. It is mostly due to autoimmune conditions like deficiency of antithrombin, protein C or protein S or immunological conditions like antiphospholipid antibody syndrome [2].

Annually 1 to 2 per thousand new cases are diagnosed in US. Incidence increases with age up to 1 per 100. Out of this 10 to 30 percent of diagnosed cases die within month of diagnosis. In 33 percent cases there is recurrence of condition in next 10 years. 5 to 8 percent of Americans have genetic predisposition for thrombosis. Incidence of thrombosis increases with age, weight, sedentary lifestyle, smoking and stress [3].

Injury to blood vessel causes exposure to tissue factor or collagen in vessel walls depending on nature of injury. In both cases it activates platelets and forms a platelet plug. Activated platelets along with tissue factor and collagen in vessel wall initiate a cascade of actions known as coagulation pathway which may be intrinsic or extrinsic depending on etiology. This leads to initiation and formation of plug of platelets enmeshed in fibrin thread. This plug if large in size causes diminution of vessel lumen size resulting in either decreasing blood flow if vessel is vein and diminished blood supply to tissues if vessel is artery.

Accordingly thrombosis is classified as arterial or venous. Arterial thrombosis causes decreased blood supply to supplying tissue resulting in ischemia or infarct [4]. Examples are stroke, myocardial infarction and limb ischemia. Venous thrombosis causes stagnant blood flow in backward direction of flow and edema of distal part of body where it is occluded. Examples are jugular vein thrombosis, cerebral venous sinus thrombosis, Budd-Chiari syndrome and Paget-Schroetter disease.

Since many risk factors for thrombosis are modifiable, prevention of thrombosis is possible. This includes weight reduction, exercise, diet control, smoking cessation, stopping hormonal contraceptive and control of blood pressure. Once condition is developed, anticoagulant therapy will be added to this list of factors for prevention of recurrence [9].

Formation of clot within vessel wall is called thrombosis. Thrombosis cause stagnancy of blood flow within vessels by narrowing the lumen which may precipitate edema if vein is involved or ischemia of tissue if artery is involved. Clot may dislodge from its original position leading to embolism in organ where it is lodged.

Symptoms and sign of thrombosis depend on vessel and organ involved. The condition is often detected after complications such as myocardial infarction, pulmonary embolism, and stroke. Management includes management of complication and thrombolytic therapy. Thrombosis is a preventable condition and could be avoided by diet and weight control, control of blood pressure, regular exercise, change of occupation, early detection and treatment of certain conditions with anticoagulants or antiplatelet drugs.  

• Definition: Formation of clot within vessel wall is called thrombosis. Thrombosis cause stagnancy of blood flow within vessels by narrowing the lumen which may precipitate edema if vein is involved or ischemia of tissue if artery is involved. Clot may dislodge from its original position leading to embolism in organ where it is lodged. Symptoms and sign of thrombosis depend on vessel and organ involved.
• Cause: Thrombosis occurs as a result of like sedentary behavior, prolonged sitting or standing, occlusion of vessels by tumors, atrial or ventricular fibrillation, shock, heart failure, uncontrolled blood pressure, stress, atheroma, infection and altered blood flow and deficiency of certain coagulation proteins.
• Symptoms: Swelling of leg, discoloration of leg, pain in leg, acute chess pain, breathlessness, cough, hemoptysis, dizziness, confusion, limb weakness, sensory dysfunction, speech disorders, facial asymmetry, bladder dysfunction, abnormal gait, sweating, palpitation, anxiety and syncope may occur.
• Diagnosis: Objective of workup is confirming obstruction of vessel lumen by imaging studies. ECG, complete blood count (CBC), kidney function test, liver function test, urine examination and blood coagulation profile must be done to rule out complications and set baseline. Depending on complications other investigations may be advised.
• Treatment: Treatment is directed towards two aspects. Treatment of complication and treatment to dissolve as well prevent recurrence of thrombus. Treatment of complication like swelling and pain of leg in DVT are managed by stockings and NSAIDS. Myocardial ischemia/infarction with centrally acting analgesics, nitroglycerine and life support. Pulmonary thromboembolism with oxygen, and other life support, antibiotics. Whatever is a complication cornerstone of treatment is dissolving blood clot and prevent recurrence. Thrombolytic drugs like streptokinase, human tissue plasminogen activator are used to dissolve clot. For prevention of thrombus formation anticoagulants like heparin, warfarin, and dabigatran are used. Anticoagulant and thrombolytic therapy needs routine INR monitoring [10].

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2. Mateo J, Oliver A, Borrell M, et al. Laboratory evaluation and clinical characteristics of 2,132 consecutive unselected patients with venous thromboembolism--results of the Spanish Multicentric Study on Thrombophilia (EMET-Study). Thromb Haemost 1997; 77:444.
3. Dahlbäck B. Advances in understanding pathogenic mechanisms of thrombophilic disorders. Blood 2008; 112:19.
4. Emmerich J, Rosendaal FR, Cattaneo M, et al. Combined effect of factor V Leiden and prothrombin 20210A on the risk of venous thromboembolism--pooled analysis of 8 case-control studies including 2310 cases and 3204 controls. Study Group for Pooled-Analysis in Venous Thromboembolism. Thromb Haemost 2001; 86:809.
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