Thrombophlebitis is superficial thrombosis and inflammation of veins or varicosities characterized by redness, tenderness, and palpable, indurated, cordlike venous segments. Common associations are intravenous (IV) line insertion, irritant IV solutions, trauma, pregnancy, and recent postpartum states. There is little risk of pulmonary embolism when associated with varicose veins or superficial veins distal to the popliteal fossa. However, pulmonary embolism can occur secondary to thrombus propagation to more proximal veins of the deep venous system, particularly with greater saphenous vein involvement. Lymphangitis, DVT, and cellulitis are in the differential.
Thrombophlebitis. Thrombophlebitis of the superficial leg veins. The thrombosed veins are erythematous, close to the surface, and palpable. (Photo contributor: Lawrence B. Stack, MD.)
Thrombophlebitis. Linear erythema from the popliteal fossa to the mid-calf in thrombophlebitis. (Reproduced with permission from Wolff K, Johnson R, Saavedra AP, Roh EK. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 8th ed. New York, NY: McGraw Hill; 2017.)
Management and Disposition
Elevation with warm compresses, rest, and analgesia is sufficient treatment for uncomplicated superficial thrombophlebitis. Superficial thrombophlebitis of the saphenofemoral or iliofemoral system requires treatment as a DVT. Admission is warranted if there are septic signs, progression of symptoms despite treatment, or severe inflammatory reactions.
Septic Thrombophlebitis. Purulence associated with erythematous thrombosed veins. (Photo contributor: Lawrence B. Stack, MD.)
Thrombophlebitis of the greater saphenous vein may be confused with lymphangitis, since the lymphatic drainage from the leg runs along the vein.
The superficial femoral vein, despite its name, is considered a deep vein, and thrombosis involving this requires standard DVT treatment.
Anticoagulation may be considered for lower extremity thrombophlebitis involving the greater saphenous vein close to the femoral junction.
Thrombophlebitis of the upper extremity is unlikely to progress to DVT.
Suppurative thrombophlebitis should be suspected with high fevers, signs of extensive erythema or purulent drainage, or track marks indicating IV drug use.