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Presentation

History

Symptoms potentially caused by venous thrombosis are generally nonspecific.

In superficial thrombophlebitis, acute-onset pain and swelling usually occur over a previous varicose vein. At times, this pain and swelling, which is often associated with warm erythema, can appear even without an obvious underlying varicosity. Swelling and pain in an upper extremity are suggestive of thrombosis. Pain associated with SVT is usually localized over the site of thrombosis. Pain associated with DVT is generally more diffuse and more common in the lower extremities than elsewhere.

Recent surgery (especially orthopedic surgery), trauma, immobilization, or prolonged bed rest are factors that can contribute to SVT or DVT.

Inquire about a history or symptoms suggestive of heart disease or congestive heart failure; relevant findings include dizziness, bilateral extremity swelling, and weight gain.

Inquire about a history of previous thrombosis.

Obtain a thorough family history.

Document the patient's age when thrombosis was diagnosed, as well as the type of thrombosis (eg, DVT, SVT, PE, myocardial infarction, stroke).

Obtain an accurate obstetric history in female patients. Recurrent spontaneous abortions may suggest an underlying factor deficiency.

Because hypercoagulability occurs in association with a number of malignancies, a history or symptoms suggestive of malignancy (eg, fever, bone pain, weight loss, bruising, fatigue) should be investigated in individuals without other known risk factors for thrombosis.

Inquire about sickle cell disease.

Risk factors (in the healthy flying population) include factors of immobilization associated with prolonged chair-rest deconditioning, including dehydration, hypovolemia, increased viscosity of the blood, and reduced venous blood flow.^[114]

Illicit drug use can be a factor. Cannibis use has been attributed as a cause of SVT in a case report.^[115]

Physical Examination

The classic findings of SVT are a firm, tender, erythematous fibrous cord, usually in the area of a previous varicose or normal-appearing vein.

In cases of DVT, mild-to-moderate edema, erythema, and tenderness prevail.^[90]A discrete cord rarely is palpable in persons with DVT, especially DVT in a lower extremity.

Patients with venous thrombosis (or cellulitis) may present with a hot, swollen leg.

See the images below.

Superficial thrombophlebitis. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/vascular/thrombophlebitis.jpg).

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Deep venous thrombosis.

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Complications

The progression of SVT to DVT should be prevented. DVT should be treated at the first sign of its development. Untreated, DVT may result in life-threatening PE.

Differential Diagnoses

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Beatty J, Fitridge R, Benveniste G, Greenstein D. Acute superficial venous thrombophlebitis: does emergency surgery have a role?. Int Angiol. 2002 Mar. 21(1):93-5. [QxMD MEDLINE Link].

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Superficial thrombophlebitis. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/vascular/thrombophlebitis.jpg).
Deep venous thrombosis.

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Author

Padma Chitnavis, MD Resident Physician, Department of Dermatology, Howard University Hospital and Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Mary Piazza Maiberger, MD Assistant Professor of Dermatology, Howard University College of Medicine; Assistant Clinical Professor of Dermatology, George Washington University School of Medicine and Health Sciences; Chief of Dermatology and Residency Program Site Director, Washington DC VA Medical Center

Mary Piazza Maiberger, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Washington DC Dermatological Society, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Julia R Nunley, MD Professor, Department of Dermatology, Virginia Commonwealth University Medical Center

Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, Women's Dermatologic Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Board of Dermatology<br/>Author for: Up-to-date.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Zoltan Trizna, MD, PhD Private Practice

Zoltan Trizna, MD, PhD is a member of the following medical societies: Texas Medical Association

Disclosure: Nothing to disclose.

Mitchel P Goldman, MD Voluntary Clinical Professor of Dermatology, University of California, San Diego, Medical Center; Dermatologist, West Dermatology and Cosmetic Laser Dermatology

Mitchel P Goldman, MD is a member of the following medical societies: Aerospace Medical Association, American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Phlebology, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Society of Lipo-Suction Surgery, California Medical Association, Dermatology Foundation, Phi Beta Kappa, San Diego County Medical Society

Disclosure: Nothing to disclose.

Carrie L Kovarik, MD Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania School of Medicine

Carrie L Kovarik, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Melanie D Palm, MD, MBA, FAAD Director, Art of Skin MD; Assistant Volunteer Clinical Professor, University of California, San Diego, School of Medicine; Affiliate Physician, Scripps Encinitas Memorial Hospital

Melanie D Palm, MD, MBA, FAAD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Thrombophlebitis Clinical Presentation

History

Physical Examination

Complications

References

Tables

Contributor Information and Disclosures

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