Symptoms of Superficial Thrombophlebitis of the Abdominal Wall
In an otherwise healthy adult, superficial thrombophlebitis of the abdominal wall typically presents as a palpable, tender cord-like structure along the course of the affected vein, accompanied by localized pain, erythema (redness), and warmth over the involved area. 1, 2
Primary Clinical Manifestations
The hallmark symptoms include:
- Palpable subcutaneous cord: A firm, rope-like structure that can be felt under the skin along the path of the thrombosed superficial vein 1, 2, 3
- Localized tenderness and pain: The affected area is painful to touch and may cause discomfort with movement 1, 2, 4
- Erythema: Redness of the skin overlying the thrombosed vein 1, 2, 3, 4
- Warmth: The skin over the affected vein feels warm compared to surrounding tissue 2, 5
- Edema: Localized swelling may be present in the area of inflammation 3, 4
Presentation Pattern
The condition typically manifests as either elongated nodules clearly following the course of a vein (45% of cases) or as discrete nodules/plaques (55% of cases). 6 In the abdominal wall, you would most commonly see the elongated cord-like pattern following the superficial venous anatomy.
Important Clinical Context
- Superficial thrombophlebitis is more likely to be symptomatic than deep vein thrombosis, particularly when occurring in visible locations like the abdominal wall 1
- The condition is usually self-limited but can be debilitating and limit movement capabilities 4
- Pain and tenderness are the most consistent features, making clinical diagnosis relatively straightforward in most cases 1, 2
Critical Diagnostic Consideration
Despite the typically benign presentation, approximately 25% of patients with superficial thrombophlebitis have concurrent deep vein thrombosis, which is why imaging with venous duplex ultrasound is mandatory even when the clinical diagnosis seems obvious. 7, 8 This is especially important in the abdominal wall, where extension to deeper veins (such as the inferior vena cava or iliac veins) carries significant risk. 8
What You Should NOT Expect
- Systemic symptoms are typically absent unless there is progression to deep venous involvement or pulmonary embolism 1
- Fever, guarding, and rebound tenderness are NOT typical of uncomplicated superficial thrombophlebitis and would suggest either progression to bowel infarction (if mesenteric veins are involved) or an alternative diagnosis 1