Pseudothrombophlebitis

Pseudothrombophlebitis syndrome is a clinical condition where there are signs and symptoms of phlebitis in the absence of a thrombophlebitis lesion. Symptoms include pain, swelling, erythema and tenderness evolving over hours or days. It is often associated with the rupture or dissection of a popliteal cyst otherwise known as a Baker's cyst, although it can be associated with other disorders such as the arthritides. It may also occur as an orthopaedic surgical complication, secondary to trauma or as a presentation of septic arthritis. It is crucial to differentiate this condition from deep vein thrombosis as the treatment for DVT can cause adverse effects in patients with pseudothrombophlebitis.The symptoms of pseudothrombophlebitis include pain, swelling, erythema and tenderness. It most commonly, but not exclusively, affects the legs. The presence of a popliteal cyst makes this diagnosis more likely. However, the presence of a popliteal cyst does not rule out deep vein thrombosis and warrants further investigation. Pseudothrombophlebitis and deep vein thrombosis are not mutually exclusive conditions, and in rare instances may co-occur.Commonly, pseudothrombophlebitis is caused by rupture of a popliteal cyst causing leakage of synovial fluid, leading to inflammatory irritation to the gastrocnemius muscle. Where pseudothrombophlebitis and thrombophlebitis present as differential diagnoses, DVT is excluded by the absence of a deep vein thrombosis, and the presence of a popliteal cyst is suggestive of pseudothrombophlebitis. The differentiation requires the use of radiological or arthroscopic imaging modalities.Once diagnosed, and after deep vein thrombosis other disease masquerades have been excluded, the treatment for pseudothrombophlebitis is supportive. This includes the use of anti-inflammatory medications such as NSAIDs.