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

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]

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.