JAMA 剛刊出一篇關於Superficial thrombophlebitis的文章，
即然是表淺部位，用超音波診斷就不是太困難的事，
在有症狀的部位進行掃描時，記得要選擇高頻的探頭，
掃描時不要施加太多的壓力，在看到目標血管後，再輕輕施壓，
看靜脈會不會被完全壓扁，
有時也可以看到高回音性質的血栓在內。
這段影片的個案在接受點滴注射後的隔天，抱怨打針附近持續疼痛，
打針處摸起來有局部腫痛，但不至於至蜂窩性組織炎的變化，
進行超音波掃描所見為superficial venous thrombosis，
因屬侷限性表淺血栓，
治療建議給予: Compression & NSAID
在遇到可能是軟組織內的問題時， 超音波可用來確認是在那一個區域發生了問題， 是皮下組織 ? 肌肉組織 ? 血管病變 ? 淋巴結病變 ? 或是異常的血腫、膿瘍等 ..... 目標區域如果是表淺部位， 建議選擇解析度高的線形高頻探頭進行掃描， 適當的施加壓力可以知道軟組織的質地，也可以知道靜脈內是否有血栓形成， 也可視需要開始都卜勒功能來了解是否有血流過多的發炎性變化， 懷疑動脈阻塞時，更是需要藉由都卜勒的功能來確認是否有完全阻塞。 POCUS是重點性的檢查，有助於快速確認問題所在並給予治療建議， 之後還是應該建議患者至相關專科追蹤及接受完整評估和治療。
Treatment of Lower Extremity Superficial Thrombophlebitis
from JAMA clinical evidence synopsis (2018)
【Clinical Question】
Which treatments for lower extremity superficial thrombophlebitis (ST) are associated with lower rates of venous thromboembolic events (VTEs) vs placebo?
【Bottom Line】
A dose of 2.5 mg of fondaparinux administered subcutaneously once daily for 45 days is associated with fewer cases of symptomatic VTE without an increase in major bleeding vs placebo. Low-molecular-weight heparin (LMWH) and nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with lower rates of ST extension or recurrence vs placebo, but data regarding symptomatic VTE remain inconclusive. Oral rivaroxaban requires further evaluation.
Superficial thrombophlebitis (superficial venous thrombosis)
from BMJ 2015
【The bottom line】
1. Superficial thrombophlebitis is usually a benign, self limiting disease, but consideration should be given to specialist referral for duplex ultrasound imaging and further management
2. Patients with limited (below knee) superficial thrombophlebitis without evidence of deep vein thrombosis can be safely managed in primary care with non-steroidal anti-inflammatory drugs and compression
3. Patients with thrombosis near the saphenofemoral or saphenopopliteal junction should be considered for surgical ligation or anticoagulation
4. Surgery should be considered in those with persistent symptoms or evidence of thrombus propagation despite medical treatment
