Snapshot A 60-year-old woman presents to her physician’s office for a painful cord-like rash on her left calf. She reports that it is red, painful to the touch, and seems like a varicose vein. She has had multiple varicose veins in the past but nothing as painful or red as this lesion. She reports that she is currently undergoing estrogen replacement therapy, as menopause has been a difficult transition. On physical exam, there is erythema and tenderness along the cord-like lesion, which feels thick and hardened on palpation. She is counseled on the benefits of compression therapy. Introduction Clinical definition a thrombotic disorder characterized by thrombi and inflammation (phlebitis) in the superficial veins Epidemiology demographics login to view 2 more bullets location login to view 2 more bullets risk factors login to view 7 more bullets Pathogenesis endothelial injury can trigger thrombus formation and inflammatory response Associated conditions migratory thrombophlebitis (Trousseau syndrome) deep venous thrombosis Buerger disease Prognosis self-limited, but can recur frequently Presentation Symptoms pain of the involved site Physical exam erythema and edema along the vein tenderness along the vein palpable thickened or thrombosed vein visibly distended veins login to view 1 more bullet Imaging Duplex ultrasound indications login to view 2 more bullets findings login to view 2 more bullets Studies Labs D-dimer is not useful in this disease Making the diagnosis based on clinical presentation Differential Deep venous thrombosis distinguishing factor login to view 1 more bullet Treatment Management approach pain management prevent extension into deep venous system Conservative compression login to view 2 more bullets Medical anticoagulation login to view 5 more bullets nonsteroidal anti-inflammatory drugs (NSAIDs) login to view 2 more bullets Complications Progression to deep venous system pulmonary embolism deep venous thrombosis