Updated: 11/1/2019

Superficial Thrombophlebitis

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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
  • 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
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
  • Making the diagnosis
    • based on clinical presentation
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 
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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