Snapshot A 56-year-old man presents to his physician for pain in his right calf. He noticed his calf appears red and denies any trauma to the affected area. A week prior to presentation, he was flying on a plane for 14 hours. Medical history is significant for venous insufficiency. On physical exam, there is erythema on the posterior calf and tenderness along the course of a superficial vein. A duplex ultrasound demonstrates impaired blood flow and incompressibility of a superficial vein. Introduction Clinical definition a thrombotic disorder characterized by thrombi and inflammation (phlebitis) in the superficial veins Associated conditions deep venous thrombosis Buerger disease migratory thrombophlebitis (Trousseau syndrome) Prognosis self-limited, but can recur frequently Epidemiology Demographics women > men more common in adults Location most commonly in the lower extremities can also occur at sites of trauma (e.g., sites of intravenous catheters) Risk factors venous stasis hypercoagulable state varicose veins pregnancy high-dose estrogen therapy malignancy immobilization ETIOLOGY Pathogenesis endothelial injury can trigger thrombus formation and an inflammatory response Presentation Symptoms pain of the involved site Physical exam erythema and edema along the vein tenderness along the vein palpable, thickened, or thrombosed vein visibly distended veins while distended veins below the ankle are normal, it is suggestive of pathology if the distended veins are above the ankle Imaging Duplex ultrasound indications a confirmatory imaging test to evaluate for deep venous thrombosis findings impaired blood flow lack of compressibility of the vein Studies Labs D-dimer is not useful in this disease Differential Deep venous thrombosis distinguishing factor thrombosed vein is typically not palpable Septic thrombophlebitis septic pelvic thrombophlebitis seen in pregnant women s/p delivery with "picket fence" fevers Lemierre syndrome HEENT septic thrombophlebitis typically s/p procedure or recent HEENT infection caused by Fusobacterium necrophorum DIAGNOSIS Making the diagnosis based on clinical presentation Treatment Conservative compression indication for all patients Medical anticoagulation indication not usually indicated unless process involves deep venous system drugs low molecular weight heparin fondaparinux nonsteroidal anti-inflammatory drugs (NSAIDs) indication pain management only in patients who did not undergo anticoagulation Complications Progression to deep venous system pulmonary embolism deep venous thrombosis