thrombophlebitis (includes superficial venous thrombosis)
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Introduction
Venous inflammation with thrombus formation.
Clinical manifestations
- erythema, pain, & warmth along the course of a vein, sometimes with tenderness & a palpable cord
- swelling or edema
- slow or insidious in onset
- case with duration of 2 days[2]
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 2.7 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2022.
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ 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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/22832262
- ↑ 8.0 8.1 NEJM Knowledge+