Superficial thrombophlebitis

Definition

• Thrombosis in superficial vein, associated with inflammation

Incidence

• Common

Aetiology

• Idiopathic
• Iatrogenic – IV line, IV injections
• Thromboangiitis obliterans (Buerger’s disease)
• Polyarteritis
• Polycythaemia / other hypercoagulable state
• Occult carcinoma (especially if transient & migratory and/or in the arm veins)
• Mondor’s – see Benign Breast Disease
• Trauma

Clinical

• More common in lower extremities
• Sudden appearance of painful lump → pain subsides within 3-7 days, leaving a tender lump which takes 2-3 weeks to disappear
• Erythematous palpable cord coursing along a superficial vein

Investigations

• USS to rule out DVT (20% association)
• Thrombotic screen for recurrent cases
• ± work-up for occult malignancy (not necessary on first presentation)

Management

• Analgesia – NSAIDS
• Antibiotics if secondary infection
• Local heat
• Elevation
• Compression stockings
• ± Hirudoid cream (heparinoid cream)
• Anticoagulation only for progressive cases, or cases associated with DVT
• Consider surgery for varicosities if
  • Sx persist >2/52 despite Rx
  • Recurrent in the same segment
  • Abuts the SFJ – controversial - SF ligation can be considered
• Prognosis
  • PE very unusual