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thrombophlebitis (includes superficial venous thrombosis)

Venous inflammation with thrombus formation. Clinical manifestations: - Symptoms: 1) pain 2) swelling 3) warmth 4) erythema 5) slow or insidious in onset Laboratory: 1) CBC 2) PT/PTT 3) erythrocyte sedimentation rate 4) chem-7 Special laboratory: - 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: 1) deep vein thrombosis, pulmonary embolism [6] (3%) 2) arterial thrombosis - myocardial infarction, ischemic stroke [6] 3) superficial thrombosis of the greater saphenous vein with saphenofemoral extension 4) post-phlebitic syndrome Differential diagnosis: - varicose veins Management: 1) see deep vein thrombosis if suspected 2) superficial thrombosis a) elevation of extremity b) warm compresses c) NSAIDs my provide symptomatic relief, but may obscure picture of thrombus extension d) 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] e) 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 - thrombus above the knee or close to the saphenofemoral junction, - other thromboembolic risk factors - recent surgery, cancer, previous venous thromboembolism [2] f) fondaparinux (Arixtra) 2.5 mg for 45 days diminishes incidence of DVT & PE but does not effect mortality [4]

Related

hypercoagulability livedoid vasculitis postphlebitic syndrome; post-thrombotic syndrome

Specific

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

General

venous thrombosis phlebitis

References

  1. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2022.
  3. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1142
  4. Decousus H et al. Fondaparinux for the treatment of superficial-vein thrombosis in the legs. N Engl J Med 2010 Sep 23; 363:1222 PMID: 20860504 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 PMID: 20860511 http://dx.doi.org/10.1056/NEJMe1005749
  5. Kitchens CS. How I treat superficial venous thrombosis. Blood. 2011 Jan 6;117(1):39-44 PMID: 20980677
  6. 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 PMID: 25398934 http://www.bloodjournal.org/content/125/2/229
  7. 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: 22832262
  8. NEJM Knowledge+