thrombophlebitis (includes superficial venous thrombosis)
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Introduction
Venous inflammation with thrombus formation.
Clinical manifestations
Laboratory
Diagnostic procedures
- duplex ultrasonography (US) to rule out DVT, assess length of thrombus, & assess superficial thrombophlebitis of the greater saphenous vein or small saphenous vein* (see Management:)[2]
* some mention of progressive symptoms & extremity swelling > than expected from superficial thrombophlebitis alone, but case presentation recommending US ambiguous at best[2]
Complications
- deep vein thrombosis, pulmonary embolism[6] (3%)
- arterial thrombosis
- superficial thrombosis of the greater saphenous vein with saphenofemoral extension
- post-phlebitic syndrome
Differential diagnosis
Management
- see deep vein thrombosis if suspected
- superficial thrombosis
- elevation of extremity
- warm compresses
- NSAIDs my provide symptomatic relief, but may obscure picture of thrombus extension
- patients managed with warm compresses & NSAIDs require follow-up evaluation in 1 week to determine if symptoms have resolved[2]
- ultrasound indicated for persistence or worsening of symptoms[2]
- therapeutic anticoagulation for 6 weeks to prevent &/or treat involvement of the deep venous system[2][5]
- not indicated if duplex ultrasound rules out thrombosis (see varicose veins)[8]
- progressive &/or extensive superficial thrombophlebitis
- superficial vein thrombosis > 5 cm in length
- thrombophlebitis of greater saphenous vein
- thrombosis close to the deep venous system
- other thromboembolic risk factors
- recent surgery, cancer, previous venous thromboembolism[2]
- fondaparinux (Arixtra) 2.5 mg for 45 days diminishes incidence of DVT & PE but does not effect mortality[4]
More general terms
More specific terms
- deep vein thrombosis (DVT)
- Lemierre's syndrome; jugular vein suppurative thrombophlebitis
- midline granuloma (facial granuloma)
- portal pyemia
- thromboangiitis obliterans; Buerger's disease
- Trousseau's syndrome; Trousseau's sign of malignancy; thrombophlebitis migrans
Additional terms
References
- ↑ Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2022.
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1142
- ↑ 4.0 4.1 Decousus H et al. Fondaparinux for the treatment of superficial-vein thrombosis in the legs. N Engl J Med 2010 Sep 23; 363:1222 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20860504 <Internet> http://dx.doi.org/10.1056/NEJMoa0912072
Goldman L and Ginsberg J. Superficial phlebitis and phase 3.5 trials. N Engl J Med 2010 Sep 23; 363:1278 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20860511 <Internet> http://dx.doi.org/10.1056/NEJMe1005749 - ↑ 5.0 5.1 Kitchens CS. How I treat superficial venous thrombosis. Blood. 2011 Jan 6;117(1):39-44 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20980677
- ↑ 6.0 6.1 6.2 Cannegieter SC et al. Risk of venous and arterial thrombotic events in patients diagnosed with superficial vein thrombosis: A nationwide cohort study. Blood 2015 Jan 8; 125:229 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25398934 <Internet> http://www.bloodjournal.org/content/125/2/229
- ↑ Quere I, Leizorovicz A, Galanaud JP et al Superficial venous thrombosis and compression ultrasound imaging. J Vasc Surg. 2012 Oct;56(4):1032-8.e1 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22832262
- ↑ 8.0 8.1 NEJM Knowledge+