Superficial thrombophlebitis

Background

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

Types

• 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

• Achilles tendon rupture
• Calcaneal bursitis
• Cellulitis
• Compartment syndrome
• Deep venous thrombosis (DVT)
• Distal leg fractures
• Gastrocnemius strain
• Ruptured popliteal cyst (Bakers cyst)
• Superficial thrombophlebitis

Upper extremity swelling

• Cellulitis
• Deep venous thrombosis
  • Paget-Schroetter syndrome
• Lymphatic obstruction
• Necrotizing fasciitis
• Superficial thrombophlebitis
• SVC Syndrome
• Thoracic outlet obstruction/Pancoast tumor

Groin pain

• Athletic pubalgia
• Cellulitis
• Deep venous thrombosis
• Hernia
• Superficial thrombophlebitis

Evaluation

Point of care ultrasound may support clinical diagnosis as in this case of cephalic vein thrombophlebitis

• 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
• More recent data suggests this approach:
  • 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 5 cm of sapheno-femoral junction should be treated like a DVT

Disposition

• Discharge

See Also

• DVT
• Cellulitis