eMedicine Specialties > Emergency Medicine > Cardiovascular

Thrombophlebitis, Superficial: Follow-up

Author: Adam J Rosh, MD, MS, Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital
Contributor Information and Disclosures

Updated: Sep 28, 2009

Follow-up

Patients should follow-up with their primary care physician or vascular surgeon in 2-3 days to ensure that the disease process is improving.

Complications

  • Extension into deep venous system
  • Conversion to suppurative thrombophlebitis
    • Septicemia
    • Septic emboli
  • Persistence of nodule

Prognosis

  • The prognosis for superficial thrombophlebitis is generally good.

Patient Education

For excellent patient education resources, visit eMedicine's Circulatory Problems Center. Also, see eMedicine's patient education articles Varicose Veins, Blood Clot in the Legs, and Phlebitis.

Miscellaneous

Medicolegal Pitfalls

  • Patients who present with clinical evidence of superficial phlebitis often have deep system involvement that is clinically occult. Those who lack deep system involvement often progress to develop deep vein thrombosis (DVT) over time. The incidence of fatal PE in these patients is not insignificant. Any chest symptoms, no matter how minor, should be considered extremely worrisome in a patient with superficial thrombophlebitis, as pulmonary embolism (PE) is extremely common and can be difficult to diagnose.
  • Phlebitis that has progressed to involve any other deep veins (anterior or posterior tibial veins, proximal peroneal vein, popliteal vein, or femoral vein at any level) is a life-threatening condition that must not be confused with superficial venous thrombophlebitis.
  • The principal deep vein of the thigh often is referred to incorrectly as the "superficial femoral vein." Do not be misled by this nomenclature. A thrombus in the superficial femoral vein is the most serious type of DVT.
  • A small number of often-repeated mistakes in diagnosis and treatment are responsible for a large proportion of the bad outcomes with serious legal repercussions.
    • Failure to pursue a definitive workup, attempting instead to diagnose superficial thrombophlebitis and to rule out DVT on clinical grounds that are known to be unreliable.
    • Failure to warn the patient that superficial phlebitis can progress to the deep veins and that any change in symptoms warrants immediate reevaluation.
    • Failure to begin a workup for pulmonary embolism when a patient has chest symptoms in the presence of leg symptoms
    • Failure to start anticoagulation immediately upon the diagnosis of DVT or at suspicion of pulmonary embolism.

Special Concerns

  • Venous thrombophlebitis and PE are common during all trimesters of pregnancy and for 6-12 weeks after delivery.
  • Superficial varicosities and superficial phlebitis are common during pregnancy, and associated DVT is also common because of a pregnancy-related reduction in intrinsic plasminogen activator activity.
    • The diagnostic approach should be exactly the same in a pregnant patient as in a nonpregnant one.
    • Duplex scanning is safe in pregnancy.
    • If indicated, a nuclear perfusion lung scan may be performed safely in pregnancy.
    • If indicated, heparin may be used in pregnancy.
    • If indicated, fibrinolytics may be used in pregnancy.
    • Failure to treat the mother properly is the most common cause of fetal demise.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Craig F Feied, MD, and Jonathan A Handler, MD, to the development and writing of this article.



More on Thrombophlebitis, Superficial

Overview: Thrombophlebitis, Superficial
Differential Diagnoses & Workup: Thrombophlebitis, Superficial
Treatment & Medication: Thrombophlebitis, Superficial
Follow-up: Thrombophlebitis, Superficial
References
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References

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Further Reading

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Keywords

superficial thrombophlebitis, superficial thrombophlebitis causes, superficial thrombophlebitis treatment, superficial venous thrombosis, superficial vein thrombophlebitis, blood clot, deep vein thrombosis, DVT, pulmonary embolism, phlebitis, deep vein thrombophlebitis, superficial phlebitis

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Contributor Information and Disclosures

Author

Adam J Rosh, MD, MS, Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital
Adam J Rosh, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Samuel M Keim, MD, Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine
Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eddy Lang, MDCM, CCFP (EM), CSPQ, Assistant Professor, Department of Family Medicine, McGill University; Consulting Staff, Department of Emergency Medicine, The Sir Mortimer B Davis-Jewish General Hospital
Eddy Lang, MDCM, CCFP (EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD, Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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