The presence of fever, tender lymphadenopathy, and an elevated WBC may favor these diagnoses but may even be seen in the absence of infection. Musculoskeletal and neurologic causes of pain and tenderness should also be considered in the differential diagnosis. The best diagnostic study is duplex ultrasound, which allows for actual anatomical visualization of the superficial and deep venous systems. The location of any thrombi can be easily detected. Recurrent of migratory ST should prompt an evaluation for underlying malignancy or a hypercoagulable state.
Treatment is directed towards reduction of inflammation.
This may be the most important therapeutic intervention. Ambulation, at least 30-60 minutes per day, should be encouraged. Bedrest is contraindicated. Fortunately, ST is usually a benign and short-term condition. Symptoms generally subside in 1-2 weeks although vein induration may persist longer.