Superficial Thrombophlebitis

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