Superficial Venous Thrombosis Embolizes to Cause Pulmonary Embolus

Abstract

Introduction

Superficial venous thrombosis (SVT) has not received as much attention in research and publications as that of deep venous thrombosis. This case demonstrates the importance of identifying the characteristics of an SVT before releasing the patient and stating the patient was positive for SVT.

Case Study

A 56-year-old man presented to our emergency department complaining of left lower-extremity pain for 2 weeks. The patient described the location of the pain as an area below his left knee. The area was erythematous, cord-like, and the patient denied any history of trauma. A venous duplex was performed on the left lower extremity. Upon examination of the greater saphenous vein (GSV), a free floating SVT was noted. The thrombus moved with patient respirations and was described as a loosely attached, acute SVT.

Conclusion

Research has provided clinicians the percentages of SVT that cause a pulmonary embolism. However, the question is raised: do the superficial venous thromboses that cause a pulmonary embolism become dangerous because they propagate into the deep system or can the SVT itself embolize from the superficial system and travel through the deep system and into the lungs? This case study revealed a loosely attached free-floating SVT within the GSV in the distal thigh. This SVT moved proximally and joined the otherwise-unaffected deep system and moved out of range of ultrasound and embolized to the pulmonary arteries. The patient complained of chest pain and shortness of breath within 2 min. The patient was treated with systemic thrombolytics and anticoagulation and had a favorable outcome.