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Superficial thrombophlebitis
From WikEM
Contents
Background
Superficial thrombophlebitis is also known as "superficial venous thrombosis" and mainly involves symptomatic control. It is more likely in patients with varicose veins[1] Associated DVTusually 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.
Calf pain
- DVT
- Compartment syndrome
- Gastrocnemius strain
- Calcaneal bursitis
- Achilles tendon rupture
- Cellulitis
- Superficial thrombophlebitis
- Ruptured Popliteal cyst (Baker's)
Upper Extremity Pain
- Thoracic outlet obstruction/Pancoast tumor
- Lymphatic obstruction
- SVC Syndrome
- Cellulitis
- Necrotizing Fasciitis
- Superficial thrombophlebitis
Groin Pain
- DVT
- Hernia
- Cellulitis
- Superficial thrombophlebitis
- Acute pubalgia
Evaluation
- Diagnosis is purely clinical
- D-dimer has no clinical benefit and only consider DVTevaluation if there is significant limb swelling or location at 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
- Outpatient follow-up for evaluation of resolution of symptoms
See Also
External Links
References
- ↑ Leon L et al. Clinical significance of superficial vein thrombosis. Eur J Vasc Endovasc Surg 2005;29:10-17.
- ↑ Bergqvist D, Jaroszewski H. Deep vein thrombosis in patients with superficial thrombophlebitis of the leg. BMJ 1986;292:658-9.
- ↑ Nasr H, Scriven JM. Superficial thrombophlebitis (superficial venous thrombosis). BMJ. 2015;350:h2039. doi:10.1136/bmj.h2039.
- ↑ Di Nisio M, et al. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev 2013;4:CD004982.
