Superficial thrombophlebitis

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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

  • Pain and discoloration to affected area
  • Redness affected superficial vein
  • Tender and hard vein on palpation
  • Minimal limb swelling

Differential Diagnosis

The differential depends on the location of the thrombophlebitis.

Lower extremity

Calf pain

Upper extremity

Groin Pain

Evaluation

  • 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[4]

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. Di Nisio M, et al. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev 2013;4:CD004982.