Updated: 11/1/2019

Superficial Thrombophlebitis

Review Topic
  • 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.
  • Clinical definition
    • a thrombotic disorder characterized by thrombi and inflammation (phlebitis) in the superficial veins
  • 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
  • Associated conditions
    • deep venous thrombosis
    • Buerger disease
    • migratory thrombophlebitis (Trousseau syndrome)
  • Prognosis
    • self-limited, but can recur frequently
  • 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
  • Duplex ultrasound
    • indications 
      • a confirmatory imaging test
      • to evaluate for deep venous thrombosis
    • findings
      • impaired blood flow
      • lack of compressibility of the vein
  • Labs
    • D-dimer is not useful in this disease
  • Making the diagnosis
    • based on clinical presentation
  • 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 
  • 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
  • Progression to deep venous system
    • pulmonary embolism
    • deep venous thrombosis

Please rate topic.

Average 3.8 of 6 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (1)
Private Note