Progressive Superficial Thrombophlebitis in Varicose Vein Following Spontaneous Bruising

Case at a Glance

A 58-year-old postmenopausal woman with obesity and varicose veins developed progressive superficial thrombophlebitis following a spontaneous bruising episode, with the thrombotic process migrating proximally along the affected vein over a 10-day period.

Patient's Story

The patient presented with concerns about a progressively ascending painful, tender area along her varicose vein. She described a history of spontaneous bruising episodes ('blowouts') which had been previously deemed benign. Approximately 2-3 weeks prior, she experienced a palm-sized, dark bruise above her knee that formed spontaneously without trauma. About 10 days ago, as the bruise was resolving, she noticed the development of a painful, firm lump in the vein just above the bruise margin, accompanied by tenderness, reddish discoloration, and warmth.

Initial Assessment

The patient reported the condition initially moving downward to her shin, then reversing direction and progressively ascending up her leg in a 'leapfrogging' pattern. The upper edge of involvement was consistently marked by a firm, painful nodule, with areas below showing warmth, discoloration, and tenderness, while areas above remained unaffected. At presentation, the process had reached her upper thigh, several inches below the groin, causing significant swelling and discomfort in a previously visible but asymptomatic varicose vein.

The Diagnostic Journey

The patient had self-researched superficial vein thrombosis and was concerned about potential progression to deep vein thrombosis. She specifically noted the absence of typical DVT symptoms, with normal calf appearance and localized thigh pain. Recent medication changes included initiation of progesterone therapy for postmenopausal endometrial hyperplasia and levothyroxine. Her medical history was significant for obesity but notably absent diabetes, hypertension, or other cardiovascular risk factors.

Final Diagnosis

Ascending superficial thrombophlebitis in varicose vein, likely precipitated by recent hormonal therapy initiation in the setting of underlying venous insufficiency and obesity-related risk factors.

Treatment Plan

Urgent vascular surgery consultation recommended given the rapid proximal progression and proximity to the saphenofemoral junction. Immediate anticoagulation consideration pending specialist evaluation. Patient education regarding signs of DVT progression and when to seek emergency care.

Outcome and Follow-up

Patient advised this represents a 'see someone ASAP' rather than routine appointment situation due to the rapid proximal migration and potential for extension into the deep venous system. Close monitoring required for progression to deep vein thrombosis, particularly given recent hormonal therapy initiation.