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Updated: Dec 8 2021

Superficial Thrombophlebitis

  • 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
    • 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
    • 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
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