A.48 Thrombophlebitis of Superficial Veins. Erysipelas

Question 1

A.48 Thrombophlebitis of Superficial Veins. Erysipelas
Definition

Superficial Thrombophlebitis

Answer 1

Inflammation and thrombosis of a superficial vein, often associated with DVT, although it is less likely to lead to pulmonary embolism (PE).

Question 2

A.48 Thrombophlebitis of Superficial Veins. Erysipelas
Risk Factors

Superficial Thrombophlebitis

Answer 2

• Varicose veins
• Venous cannulation or intravenous drug administration
• History of deep vein thrombosis (DVT)

Question 3

A.48 Thrombophlebitis of Superficial Veins. Erysipelas
Treatment

Superficial Thrombophlebitis

Answer 3

• Symptomatic relief with NSAIDs, compression, and limb elevation.
• Anticoagulation (e.g., low molecular weight heparin) if segments of the vein are involved.
• Consideration of surgical intervention if thrombosis extends into deep veins or is associated with DVT.

Question 4

A.48 Thrombophlebitis of Superficial Veins. Erysipelas
Variants

Superficial Thrombophlebitis

Answer 4

• Thrombophlebitis migrans (Trousseau syndrome)
• Superficial thrombophlebitis of the breast (Mondor disease)

Question 5

A.48 Thrombophlebitis of Superficial Veins. Erysipelas
Complications

Superficial Thrombophlebitis

Answer 5

• Extension into deep veins leading to DVT.
• Potential for distal embolization (PE).

Question 6

A.48 Thrombophlebitis of Superficial Veins. Erysipelas
Clinical Features

Superficial Thrombophlebitis

Answer 6

Symptoms include pain, tenderness, and induration over the affected vein, often with a palpable cord in the involved area.

Question 7

A.48 Thrombophlebitis of Superficial Veins. Erysipelas
Diagnostics

Superficial Thrombophlebitis

Answer 7

• Typically involves clinical diagnosis.
• Duplex ultrasound may be utilized if the clinical diagnosis is uncertain.
• Findings: A thickened, edematous, nonscompressible vessel, with or without an intraluminal thrombus.

Question 8

A.48 Thrombophlebitis of Superficial Veins. Erysipelas
Definition

Erysipelas

Answer 8

A superficial skin infection affecting the upper dermis, often associated with lymphatics and lymphadenitis, primarily caused by Group A streptococcus (e.g., Streptococcus pyogenes).

Question 9

A.48 Thrombophlebitis of Superficial Veins. Erysipelas
Pathophysiology

Erysipelas

Answer 9

Generally occurs due to minor skin injury, leading to an infection of the upper dermis and surrounding tissues.

Question 10

A.48 Thrombophlebitis of Superficial Veins. Erysipelas
Clinical Features

Erysipelas

Answer 10

Location: Usually affects the lower limbs (80% of cases) and the face.

Appearance: Characterized by a well-defined, sharply demarcated red lesion, often compared to sunburn.

Symptoms: Includes erythema, edema, and warmth in the affected area. Systemic symptoms like fever, chills, nausea, and headache may also occur.

Question 11

A.48 Thrombophlebitis of Superficial Veins. Erysipelas
Diagnosis

Erysipelas

Answer 11

1. Clinical Assessment:
   - Inspect the skin for signs of infection.
   - Evaluate the health history to identify potential risk factors.
2. Laboratory Indicators:
   - Leukocytosis: Elevated white blood cell count.
   - CRP, ESR: Increased C-reactive protein and erythrocyte sedimentation rate.

Question 12

A.48 Thrombophlebitis of Superficial Veins. Erysipelas
Treatment

Erysipelas

Answer 12

Initial treatment options include penicillin or cephalosporin (e.g., cefadroxil or dicloxacillin) or clindamycin (for penicillin-allergic patients).

Question 13

A.48 Thrombophlebitis of Superficial Veins. Erysipelas
Further Management

Erysipelas

Answer 13

Hospitalization: May be required for intravenous antibiotics if there is extensive infection or if systemic symptoms are severe.

Monitoring: Watch for complications like sepsis, endocarditis, STSS (STrep Toxic Shock Syndrome).