Superficial vein thrombosis

Case history

A 45-year-old woman presents with a burning pain in her right calf, over an existing varicose vein, for the past 3 days. She has also noticed some reddening around that area extending from just below the knee to halfway down the lateral aspect of the right leg. The varicose vein has been relatively asymptomatic and first appeared after the birth of her first child when she was 32 years old. She has no known medical conditions and does not take any medicines. She has no previous history of deep vein thrombosis (DVT). Physical examination reveals a cord-like superficial vein on the outer aspect of her right leg. The overlying skin is erythematous and warmer than the adjacent leg skin. She is afebrile and her heart rate is normal. There is no clinical evidence of DVT.

Other presentations

Atypical presentations of superficial vein thrombosis (SVT) include infected SVT, migratory thrombophlebitis, and Mondor's disease.

Infected SVT can present with or without purulent discharge (suppurative and non-suppurative thrombophlebitis, respectively). Infected SVT is usually a complication of a skin infection (such as cellulitis); intravenous cannulation or chemical injection of the vein; or intravenous drug use.

Migratory thrombophlebitis is defined by repeated thromboses developing in superficial veins, at varying sites but most commonly in the leg. It is usually associated with malignancy, particularly pancreatic adenocarcinoma. It can also be seen with Behcet's and Buerger's disease.

Mondor's disease describes thrombophlebitis of a superficial vein in the subcutaneous fat of the breast and anterior chest wall, usually in women, and it may be associated with underlying malignancy. It also includes thrombophlebitis of the dorsal vein of the penis, generally caused by trauma or repetitive injury.