Superficial thrombophlebitis: Difference between revisions
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==Background== | ==Background== | ||
*Also known as "superficial venous thrombosis" | |||
thrombophlebitis of the leg. BMJ 1986;292:658-9.</ref> | *More likely in patients with varicose veins<ref>Leon L et al. Clinical significance of superficial vein thrombosis. Eur J Vasc Endovasc Surg 2005;29:10-17.</ref> | ||
*Associated [[Deep venous thrombosis|DVT]] is rare and usually only occurs at the junctions with deep venous system such as the groin<ref>Bergqvist D, Jaroszewski H. Deep vein thrombosis in patients with superficial thrombophlebitis of the leg. BMJ 1986;292:658-9.</ref> | |||
===Types<ref>Nasr H, Scriven JM. Superficial thrombophlebitis (superficial venous thrombosis). BMJ. 2015;350:h2039. doi:10.1136/bmj.h2039.</ref>=== | ===Types<ref>Nasr H, Scriven JM. Superficial thrombophlebitis (superficial venous thrombosis). BMJ. 2015;350:h2039. doi:10.1136/bmj.h2039.</ref>=== | ||
*'''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== | ==Clinical Features== | ||
*Pain and discoloration | [[File:PMC3505767 ad-24-383-g004.png|thumb| Superficial thrombophlebitis. (A) Nodular lesions are arranged in a linear configuration on the lower leg of the patient. (B) Inflammatory infiltrates obscuring the vessel walls and the lumen completely occluded by the thrombus.]] | ||
*Redness | *Pain and discoloration of affected area | ||
*Redness surrounding superficial vein | |||
*Tender and hard vein on palpation | *Tender and hard vein on palpation | ||
*Minimal limb swelling | *Minimal limb swelling | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
''Depends on the location'' | |||
{{Calf pain DDX}} | {{Calf pain DDX}} | ||
{{Upper extremity swelling DDX}} | {{Upper extremity swelling DDX}} | ||
{{Groin Pain DDX}} | {{Groin Pain DDX}} | ||
== | ==Evaluation== | ||
[[File:Cephalic Vein Thrombophlebitis Bowra.gif|thumbnail|Point of care ultrasound may support clinical diagnosis as in this case of cephalic vein thrombophlebitis<ref>http://www.thepocusatlas.com/soft-tissue-vascular/</ref>]] | |||
*Diagnosis is purely clinical | *Diagnosis is purely clinical | ||
**D-dimer has no clinical benefit and only consider DVT evaluation if there is significant limb swelling or location | **D-dimer has no clinical benefit and only consider [[Deep venous thrombosis|DVT]] evaluation if there is significant limb swelling or location near a deep vein (popliteal/femoral vein) | ||
==Management== | ==Management== | ||
*[[NSAIDs]] for local pain | *[[NSAIDs]] for local pain | ||
*[[Antibiotics]] are only needed if there is an associated [[cellulitis]] or obvious infection | *[[Antibiotics]] are only needed if there is an associated [[cellulitis]] or obvious infection | ||
*Little evidence for anticoagulation unless associated with a [[DVT]]<ref>Di Nisio M, et al. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev 2013;4:CD004982.</ref> | *Little evidence for anticoagulation unless associated with a [[Deep venous thrombosis|DVT]]<ref>Di Nisio M, et al. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev 2013;4:CD004982.</ref> | ||
*More recent data suggests this approach<ref>Cosmi B. Management of superficial vein thrombosis. Journal of thrombosis and haemostasis : JTH. 13(7):1175-83. 2015. PMID: 25903684</ref>: | |||
**Small clots can be treated with compression, NSAIDs, elevation, follow up within 7-10 days to evaluate for progression | |||
**Clots > 5 cm should be treated with anticoagulation, [[enoxaparin]] 40 mg subQ QD for 45 days | |||
**Clots within 3 cm of sapheno-femoral junction should be treated like a [[DVT]] | |||
==Disposition== | ==Disposition== | ||
* | *Discharge | ||
==External Links== | |||
==See Also== | ==See Also== | ||
*[[DVT]] | *[[DVT]] | ||
*[[Cellulitis]] | *[[Cellulitis]] | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Dermatology]][[Category:Vascular]] | [[Category:Dermatology]] | ||
[[Category:Vascular]] | |||
Revision as of 16:50, 9 September 2020
Background
- Also known as "superficial venous thrombosis"
- More likely in patients with varicose veins[1]
- Associated DVT is rare and usually 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 of affected area
- Redness surrounding superficial vein
- Tender and hard vein on palpation
- Minimal limb swelling
Differential Diagnosis
Depends on the location
Calf pain
- Achilles tendon rupture
- Calcaneal bursitis
- Cellulitis
- Compartment syndrome
- Deep venous thrombosis (DVT)
- Distal leg fractures
- Gastrocnemius strain
- Ruptured popliteal cyst (Bakers cyst)
- Superficial thrombophlebitis
Upper extremity swelling
- Cellulitis
- Deep venous thrombosis
- Lymphatic obstruction
- Necrotizing fasciitis
- Superficial thrombophlebitis
- SVC Syndrome
- Thoracic outlet obstruction/Pancoast tumor
Groin pain
Evaluation
Point of care ultrasound may support clinical diagnosis as in this case of cephalic vein thrombophlebitis[4]
- Diagnosis is purely clinical
- D-dimer has no clinical benefit and only consider DVT evaluation if there is significant limb swelling or location near 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[5]
- More recent data suggests this approach[6]:
- Small clots can be treated with compression, NSAIDs, elevation, follow up within 7-10 days to evaluate for progression
- Clots > 5 cm should be treated with anticoagulation, enoxaparin 40 mg subQ QD for 45 days
- Clots within 3 cm of sapheno-femoral junction should be treated like a DVT
Disposition
- Discharge
External Links
See Also
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.
- ↑ http://www.thepocusatlas.com/soft-tissue-vascular/
- ↑ Di Nisio M, et al. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev 2013;4:CD004982.
- ↑ Cosmi B. Management of superficial vein thrombosis. Journal of thrombosis and haemostasis : JTH. 13(7):1175-83. 2015. PMID: 25903684