Difference between revisions of "Superficial thrombophlebitis"

(Background)
(Clinical Features)
 
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==Clinical Features==
 
==Clinical Features==
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[[File:PMC3505767 ad-24-383-g004.png|thumb| Superficial thrombophlebitis. (A) Nodular lesions are arranged in a linear configuration on the lower leg of the patient. (B) Inflammatory infiltrates obscuring the vessel walls and the lumen completely occluded by the thrombus.]]
 
*Pain and discoloration of affected area
 
*Pain and discoloration of affected area
 
*Redness surrounding superficial vein
 
*Redness surrounding superficial vein
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==Differential Diagnosis==
 
==Differential Diagnosis==
The differential depends on the location of the thrombophlebitis.
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''Depends on the location''
===Lower extremity===
 
 
{{Calf pain DDX}}
 
{{Calf pain DDX}}
 
===Upper extremity===
 
 
{{Upper extremity swelling DDX}}
 
{{Upper extremity swelling DDX}}
 
===Groin Pain===
 
 
{{Groin Pain DDX}}
 
{{Groin Pain DDX}}
  
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*[[Antibiotics]] are only needed if there is an associated [[cellulitis]] or obvious infection
 
*[[Antibiotics]] are only needed if there is an associated [[cellulitis]] or obvious infection
 
*Little evidence for anticoagulation unless associated with a [[Deep venous thrombosis|DVT]]<ref>Di Nisio M, et al. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev 2013;4:CD004982.</ref>
 
*Little evidence for anticoagulation unless associated with a [[Deep venous thrombosis|DVT]]<ref>Di Nisio M, et al. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev 2013;4:CD004982.</ref>
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*More recent data suggests this approach<ref>Cosmi B. Management of superficial vein thrombosis. Journal of thrombosis and haemostasis : JTH. 13(7):1175-83. 2015. PMID: 25903684</ref>:
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**Small clots can be treated with compression, NSAIDs, elevation, follow up within 7-10 days to evaluate for progression
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**Clots > 5 cm should be treated with anticoagulation, [[enoxaparin]] 40 mg subQ QD for 45 days
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**Clots within 3 cm of sapheno-femoral junction should be treated like a [[DVT]]
  
 
==Disposition==
 
==Disposition==

Latest revision as of 16:50, 9 September 2020

Background

  • Also known as "superficial venous thrombosis"
  • More likely in patients with varicose veins[1]
  • Associated DVT is rare and usually only occurs at the junctions with deep venous system such as the groin[2]

Types[3]

  • Sterile thrombophlebitis - No infectious association
  • Traumatic superficial thrombophlebitis - Associated with limb injury from blunt trauma, IV catheters or chemical treatment
  • Infection thrombophlebitis - Associated with prolonged IVs and is the only thrombophlebitis to require antibiotics
  • Migratory thrombophlebitis - Recurrent in multiple differing sites and often associated with malignancies

Clinical Features

Superficial thrombophlebitis. (A) Nodular lesions are arranged in a linear configuration on the lower leg of the patient. (B) Inflammatory infiltrates obscuring the vessel walls and the lumen completely occluded by the thrombus.
  • Pain and discoloration of affected area
  • Redness surrounding superficial vein
  • Tender and hard vein on palpation
  • Minimal limb swelling

Differential Diagnosis

Depends on the location

Calf pain

Upper extremity swelling

Groin pain

Evaluation

Point of care ultrasound may support clinical diagnosis as in this case of cephalic vein thrombophlebitis[4]
  • Diagnosis is purely clinical
    • D-dimer has no clinical benefit and only consider DVT evaluation if there is significant limb swelling or location near a deep vein (popliteal/femoral vein)

Management

  • NSAIDs for local pain
  • Antibiotics are only needed if there is an associated cellulitis or obvious infection
  • Little evidence for anticoagulation unless associated with a DVT[5]
  • More recent data suggests this approach[6]:
    • Small clots can be treated with compression, NSAIDs, elevation, follow up within 7-10 days to evaluate for progression
    • Clots > 5 cm should be treated with anticoagulation, enoxaparin 40 mg subQ QD for 45 days
    • Clots within 3 cm of sapheno-femoral junction should be treated like a DVT

Disposition

  • Discharge

External Links

See Also

References

  1. Leon L et al. Clinical significance of superficial vein thrombosis. Eur J Vasc Endovasc Surg 2005;29:10-17.
  2. Bergqvist D, Jaroszewski H. Deep vein thrombosis in patients with superficial thrombophlebitis of the leg. BMJ 1986;292:658-9.
  3. Nasr H, Scriven JM. Superficial thrombophlebitis (superficial venous thrombosis). BMJ. 2015;350:h2039. doi:10.1136/bmj.h2039.
  4. http://www.thepocusatlas.com/soft-tissue-vascular/
  5. Di Nisio M, et al. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev 2013;4:CD004982.
  6. Cosmi B. Management of superficial vein thrombosis. Journal of thrombosis and haemostasis : JTH. 13(7):1175-83. 2015. PMID: 25903684