superficial thrombophlebitis

Mondor's disease is named after Henri Mondor (1885–1962), a surgeon in Paris, France who first described the disease in 1939.{{cite journal | vauthors = Mondor H | title = Tronculite sous-cutanée subaiguë de la paroi thoracique antérolatérale. | trans-title = Subacute subcutaneous trunculitis of the anterolateral chest wall. | language = fr | journal = Mém. Acad. Chir. | date = 1939 | volume = 65 | pages = 1271–1278 }}{{Cite book | vauthors = Smith RP, Turek P |url=https://books.google.com/books?id=ySriOOirL_UC&pg=PA293 |title=Netter Collection of Medical Illustrations: Reproductive System |date=2011-02-15 |publisher=Elsevier Health Sciences |isbn=978-1-4377-3648-9 |pages=293 |language=en}}

Findings of tenderness, induration, pain, or erythema (redness) along the course of a superficial vein usually establish a clinical diagnosis, especially in patients with known risk factors. In addition, there is often a palpable, sometimes nodular "cord", due to thrombus (blood clot) within the affected vein. Persistence of this cord when the extremity is raised suggests the presence of thrombus.

On the chest wall, patients with this disease often have abrupt onset of superficial pain, with possible swelling and redness of a limited area of their anterior chest wall or breast. There is usually a lump present, which may be somewhat linear and tender. Because of the possibility of the lump being from another cause, patients are often referred for mammogram and/or breast ultrasound.{{cite journal | vauthors = Shetty MK, Watson AB | title = Mondor's disease of the breast: sonographic and mammographic findings | journal = AJR. American Journal of Roentgenology | volume = 177 | issue = 4 | pages = 893–896 | date = October 2001 | pmid = 11566698 | doi = 10.2214/ajr.177.4.1770893 }}

Superficial vein thrombosis (SVT) extension to the deep vein system and/or recurrence of SVT.

Suppurative thrombophlebitis is suspected when erythema extends significantly beyond the margin of the vein and is likely to be associated with significant fever. If suspected, antibiotic treatment, surgical drainage, and potentially vein excision are indicated.{{cite journal | vauthors = Davidović L, Kostić D, Lotina S, Cinara I | title = [Indications for surgical treatment of acute superficial thrombophlebitis] | journal = Srpski Arhiv Za Celokupno Lekarstvo | volume = 118 | issue = 11–12 | pages = 471–3 | date = 1990 | pmid = 2133604 }}

Venous thromboembolism can occur with superficial vein thrombosis. Estimates of the percentage of patients with SVT who also have DVT vary between 6% and 53%, and symptomatic pulmonary embolism has been reported in 0% to 10% of patients with SVT.{{cite journal | vauthors = Decousus H, Quéré I, Presles E, Becker F, Barrellier MT, Chanut M, Gillet JL, Guenneguez H, Leandri C, Mismetti P, Pichot O, Leizorovicz A | title = Superficial venous thrombosis and venous thromboembolism: a large, prospective epidemiologic study | journal = Annals of Internal Medicine | volume = 152 | issue = 4 | pages = 218–24 | date = February 2010 | pmid = 20157136 | doi = 10.7326/0003-4819-152-4-201002160-00006 | s2cid = 55403187 }} Deep venous system, and may lead to pulmonary embolism.{{cite web| vauthors = Menesez N |title=Superficial thrombophebitis|url=http://emedicine.medscape.com/article/463256-overview|publisher=MedScape|access-date=28 August 2012}}

On the breast, there have been occasional cases of associated cancer.{{cite journal | vauthors = Catania S, Zurrida S, Veronesi P, Galimberti V, Bono A, Pluchinotta A | title = Mondor's disease and breast cancer | journal = Cancer | volume = 69 | issue = 9 | pages = 2267–2270 | date = May 1992 | pmid = 1562972 | doi = 10.1002/1097-0142(19920501)69:9<2267::aid-cncr2820690910>3.0.co;2-u | hdl-access = free | s2cid = 38025663 | hdl = 2434/892627 }}

Patient characteristics and predisposing factors for thrombophlebitis nearly mirror those for DVT; thrombophlebitis is a risk factor for the development of DVT, and vice versa.{{cite journal | vauthors = Decousus H, Epinat M, Guillot K, Quenet S, Boissier C, Tardy B | title = Superficial vein thrombosis: risk factors, diagnosis, and treatment | journal = Current Opinion in Pulmonary Medicine | volume = 9 | issue = 5 | pages = 393–7 | date = September 2003 | pmid = 12904709 | doi = 10.1097/00063198-200309000-00009 | s2cid = 8778278 }}

Lower extremity superficial phlebitis (inflamed vein) is associated with conditions that increase the risk of thrombosis, including abnormalities of coagulation or of fibrinolysis, endothelial dysfunction, infection, venous stasis, intravenous therapy, and intravenous drug use.{{cite journal | vauthors = Fernandez L, Scovell S, Eidt JF, Mills JL, Collins KA | title = Superficial thrombophlebitis of the lower extremity. | location = Waltham, MA | journal = UpToDate | date = 2011 }}

Image:UOTW 43 - Ultrasound of the Week 1.webm seen on ultrasound of the dorsal penile vein{{cite web|title=UOTW #43 - Ultrasound of the Week|url=https://www.ultrasoundoftheweek.com/uotw-43/|website=Ultrasound of the Week|access-date=27 May 2017|date=2 April 2015}}|left]]

Clinical evaluation is the primary diagnostic tool for thrombophlebitis. People with thrombophlebitis complain of pain along the affected area. Some report constitutional symptoms, such as low-grade fever and aches. On physical examination, the skin over the affected vein exhibits erythema, warmth, swelling, and tenderness. Later in the disease, as induration subsides, erythema gives way to a ruddy or bruised color.

Duplex ultrasound identifies the presence, location and extent of venous thrombosis, and can help identify other pathology that may be a source of the patient's complaints. Ultrasound is indicated if superficial phlebitis involves or extends into the proximal one-third of the medial thigh, there is evidence for clinical extension of phlebitis, lower extremity swelling is greater than would be expected from a superficial phlebitis alone or diagnosis of superficial thrombophlebitis in question.

Treatment with compression stockings should be offered to patients with lower extremity superficial phlebitis, if not contraindicated (e.g., peripheral artery disease). Patients may find them helpful for reducing swelling and pain once the acute inflammation subsides.

Nonsteroidal anti-inflammatory drugs (NSAID) are effective in relieving the pain associated with venous inflammation and were found in a randomized trial to significantly decrease extension and/or recurrence of superficial vein thrombosis.{{cite journal | author = Superficial Thrombophlebitis Treated By Enoxaparin Study Group| title = A pilot randomized double-blind comparison of a low-molecular-weight heparin, a nonsteroidal anti-inflammatory agent, and placebo in the treatment of superficial vein thrombosis | journal = Archives of Internal Medicine | volume = 163 | issue = 14 | pages = 1657–63 | date = July 2003 | pmid = 12885680 | doi = 10.1001/archinte.163.14.1657 | doi-access = free }}

Anticoagulation is recommended for patients with lower extremity superficial thrombophlebitis at increased risk for thromboembolism (affected venous segment of ≥5 cm, in proximity to deep venous system, positive medical risk factors).{{cite journal | vauthors = Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ | title = Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) | journal = Chest | volume = 133 | issue = 6 Suppl | pages = 454S–545S | date = June 2008 | pmid = 18574272 | doi = 10.1378/chest.08-0658 }}

Treatment with fondaparinux reduces the risk of subsequent venous thromboembolism.{{cite journal | vauthors = Di Nisio M, Wichers IM, Middeldorp S | title = Treatment for superficial thrombophlebitis of the leg | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | pages = CD004982 | date = February 2018 | issue = 2 | pmid = 29478266 | pmc = 6491080 | doi = 10.1002/14651858.CD004982.pub6 }}

Surgery is reserved for patients with extension of the clot to within 1 cm of the saphenofemoral junction, in patients deemed unreliable for anticoagulation, upon failure of anticoagulation, and in patients with intense pain. Surgical therapy with ligation of the saphenofemoral junction or stripping of thrombosed superficial veins appears to be associated with higher rates of venous thromboembolism compared with treatment with anticoagulants.{{cite journal | vauthors = Belcaro G, Nicolaides AN, Errichi BM, Cesarone MR, De Sanctis MT, Incandela L, Venniker R | title = Superficial thrombophlebitis of the legs: a randomized, controlled, follow-up study | journal = Angiology | volume = 50 | issue = 7 | pages = 523–9 | date = July 1999 | pmid = 10431991 | doi = 10.1177/000331979905000701 | s2cid = 41619126 }}

Some 125,000 cases a year have been reported in the United States, but actual incidence of spontaneous thrombophlebitis is unknown.{{cite journal | vauthors = Blumenberg RM, Barton E, Gelfand ML, Skudder P, Brennan J | title = Occult deep venous thrombosis complicating superficial thrombophlebitis | journal = Journal of Vascular Surgery | volume = 27 | issue = 2 | pages = 338–43 | date = February 1998 | pmid = 9510288 | doi = 10.1016/S0741-5214(98)70364-7| doi-access = free }} A fourfold increased incidence from the third to the eight decade in men and a preponderance among women of approximately 55-70%.{{cite journal | vauthors = Coon WW, Willis PW, Keller JB | title = Venous thromboembolism and other venous disease in the Tecumseh community health study | journal = Circulation | volume = 48 | issue = 4 | pages = 839–46 | date = October 1973 | pmid = 4744789 | doi = 10.1161/01.cir.48.4.839| doi-access = free }} The average mean age of affected patients is 60 years.

Thrombophlebitis can develop along the arm, back, or neck veins, the leg is by far the most common site. When it occurs in the leg, the great saphenous vein is usually involved, although other locations are possible.{{cite journal | vauthors = Karwowski JK | title = How to manage thrombophlebitis of the lower extremities: why this malady warrants close attention. | journal = Contemporary Surgery | date = November 2007 | volume = 63 | issue = 11 | pages = 552–8 }}

• Septic thrombophlebitis
• Superficial vein thrombosis

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{{Medical resources

| DiseasesDB = 32183

| ICD10 = {{ICD10|I|80|8|i|80}} (ILDS I80.81)

| ICD9 = {{ICD9|451.89}}

| ICDO =

| OMIM =

| MedlinePlus =

| eMedicineSubj = derm

| eMedicineTopic = 909

| MeshID =

}}

{{Vascular diseases}}

Category:Vascular-related cutaneous conditions

pt:Tromboflebite