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KEY FEATURES

ESSENTIALS OF DIAGNOSIS

  • Redness, swelling, and pain, usually in a preexisting varicose vein

  • Duplex ultrasound detection of thrombosis in a superficial vein

GENERAL CONSIDERATIONS

  • Common in the elderly and usually benign

  • Less common in the upper extremities, where it usually occurs in association with venipuncture, catheter insertion, or chemical phlebitis

CLINICAL PRESENTATION

SYMPTOMS AND SIGNS

  • Redness and pain in an extremity superficial vein

  • Swelling of the affected extremity suggests deep venous involvement

PHYSICAL EXAM FINDINGS

  • Tender, red, warm chord beneath the skin that follows the course of the vein

DIFFERENTIAL DIAGNOSIS

  • Cellulitis

  • Insect bite

  • Trauma

DIAGNOSTIC EVALUATION

IMAGING STUDIES

  • Although the diagnosis is usually based on the physical examination, confirmation can be done by venous ultrasonography

DIAGNOSTIC PROCEDURES

  • Contrast venography can be used if the ultrasound results are equivocal, especially in upper extremity venous thrombosis

TREATMENT

HOSPITALIZATION CRITERIA

  • Suspected deep venous thrombosis accompanying superficial thrombophlebitis:

    • – Occurs in up to 10% of cases of lower extremity thrombophlebitis and < 5% of cases of upper extremity thrombophlebitis

MEDICATIONS

  • Warm compresses

  • Nonsteroidal anti-inflammatory agents

  • Limb elevation

  • Subcutaneous low-molecular-weight heparin or fondaparinux can be considered in those at higher risk of deep venous thrombosis

THERAPEUTIC PROCEDURES

  • IV heparin for refractory cases only

DIET AND ACTIVITY

  • Exercise should be curtailed until the inflammation has abated

ONGOING MANAGEMENT

FOLLOW-UP

  • One visit in 2 weeks to check resolution

COMPLICATIONS

  • Extension to deep venous thrombosis and pulmonary embolus

PROGNOSIS

  • Excellent

PREVENTION

  • Meticulous care with IV injections and catheters

RESOURCES

PRACTICE GUIDELINES

  • Care must be taken not to miss possible underlying deep venous thrombosis, which requires anticoagulation, especially in the lower extremities; extremity swelling is a tip-off

  • Recurrent superficial thrombophlebitis without obvious trauma should prompt a search for underlying malignancy or inherited thrombophilia

REFERENCES

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Di Nisio  M, Middeldorp  S. Treatment of lower extremity superficial thrombophlebitis. JAMA[JAMA and JAMA Network Journals Full Text]. 2014;311(7):729–730.  [PubMed: 24549553]
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Samuelson  B, Go  AS, Sung  SH, Fan  D, Fang  MC. Initial management and outcomes after superficial thrombophlebitis: the Cardiovascular Research Network Venous Thromboembolism study. J Hosp Med. 2016;11(6):432–434.  [PubMed: 27253585]

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