Vascular: Superficial Venous Thrombophlebitis (SVT)

Superficial Venous Thrombophlebitis (SVT)

Basics

  • Inflammation with Associated Thrombus of Superficial Veins
  • Most Common in the Lower Extremities
  • Generally Benign & Self-Limited but Can Extend into Deep Veins
  • High-Risk of Concomitant VTE:
    • DVT (6-44%)
    • Asymptomatic PE (20-33%)
    • Symptomatic PE (2-13%)

Presentation

  • Palpable Cord-Like Mass
  • Erythema
  • Pain
  • Swelling

 

Superficial Venous Thrombophlebitis 1

Superficial Venous Thrombophlebitis on US 2

Variations

  • Suppurative Thrombophlebitis
    • Infected (Fever & Purulence)
    • Risk for Septicemia
    • Most Common Cause: Peripheral IV
      • Drug Abuse Also Common
    • Most Common Organism: S aureus
  • Superficial Migratory Thrombophlebitis
    • Recurrent Migratory & Unprovoked
    • Associated with Hypercoagulability from Carcinoma (Trousseau’s Sign)
    • Should Prompt Search for Occult Malignancy (CT Abdomen, etc.)
  • Mondor Disease
    • Definition: Acute SVT of the Chest Wall
    • Most Common Cause: Idiopathic
      • Other Causes: Trauma, Surgery or Malignancy
    • Most Common Site: Lateral Thoracic Vein in Lower Outer Quadrant
    • Need Imaging to Rule Out Malignant Cause
    • *Mondor Disease of the Penis – Thrombophlebitis of the Superficial Dorsal Vein of the Penis

Superficial Migratory Thrombophlebitis Associated with Pancreatic Cancer 3

Mondor Disease 4

Treatment

  • Low-Risk of DVT: NSAIDs, Warm Compress & Elevation
  • Increased-Risk of DVT: Anticoagulation for 45 Days
    • SVT < 3 cm of Saphenofemoral Junction Should Receive Anticoagulation
  • Suppurative: Antibiotics & Remove Foreign Body/Catheter if Able
  • Vein Excision Indications:
    • Within 1 cm of Deep Vein Junction
    • Suppurative with Sepsis (Historically Was Excised More Frequently)

References

  1. Owlia MB, Salimzadeh A, Alishiri G, Kargar S. Ischemic toes after venous thromboembolism: a difficult differential diagnosis with good response to combination therapy-a case report. Case Rep Med. 2012;2012:403685.(License: CC BY-3.0)
  2. Kim SY, Park JS, Ryu KN, Jin W, Park SY. Various tumor-mimicking lesions in the musculoskeletal system: causes and diagnostic approach. Korean J Radiol. 2011 Mar-Apr;12(2):220-31. (License: CC BY-NC-3.0)
  3. Thayalasekaran S, Liddicoat H, Wood E. Thrombophlebitis migrans in a man with pancreatic adenocarcinoma: a case report. Cases J. 2009 Apr 29;2:6610. (License: CC BY-3.0)
  4. Viana GA, Okano FM. Superficial thrombophlebitis (Mondor’s Disease) after breast augmentation surgery. Indian J Plast Surg. 2008 Jul;41(2):219-21. (License: CC BY-2.0)