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LETTER TO EDITOR
Year : 2019  |  Volume : 27  |  Issue : 1  |  Page : 54-55

Thrombosed saphena varix


Department of Radiology, Malabar Medical College, Kozhikode, Kerala, India

Date of Submission27-Feb-2018
Date of Acceptance17-Apr-2018
Date of Web Publication18-Mar-2019

Correspondence Address:
Dr. Reddy Ravikanth
Department of Radiology, Malabar Medical College, Kozhikode - 673 315, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JMU.JMU_35_18

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How to cite this article:
Ravikanth R. Thrombosed saphena varix. J Med Ultrasound 2019;27:54-5

How to cite this URL:
Ravikanth R. Thrombosed saphena varix. J Med Ultrasound [serial online] 2019 [cited 2021 Apr 11];27:54-5. Available from: http://www.jmuonline.org/text.asp?2019/27/1/54/234007

Dear Editor,

A 57-year-old female presented with a swelling in her right groin for the last 2 years. There was gradual increase in size of the swelling over 2 years. Currently, she presented with acute pain. The swelling reduced on lying down and increased on standing. It was an isolated groin swelling without evidence of associated great saphenous vein varicosity. On examination, there was a small, round swelling, 4 cm below and lateral to the right pubic tubercle, measuring around 6 cm × 5 cm, hard, tender, noncompressible, irreducible, and nonfluctuant. Cough impulse was negative. The overlying skin appeared to be normal. No associated signs of venous insufficiency in the form of varicosity, edema, pigmentation, ulcer, etc., were found. Diagnosis was confirmed by Duplex imaging which showed echogenic contents suggesting thrombosis within sacculation of the terminal part of greater saphenous vein [Figure 1], [Figure 2], [Figure 3]. The saphena varix, a dilated saccular varicose swelling, arises from the proximal end of the long saphenous vein. It presents as a reducible swelling in the groin situated in the femoral canal region. A cough impulse may be elicited and the swelling disappears when the patient lies down. The differential diagnosis for a nontender, fluctuant groin lump with a cough impulse is a hernia or a saphena varix.[1] The position of the swelling inferior and lateral to the pubic tubercle narrows the differential to a femoral hernia or saphena varix.[2] A history of deep vein thrombosis and examination findings of other venous varicosities in the leg adds further support to the diagnosis. Diagnosis can be confusing clinically, particularly if the varix is thrombosed, and presents as an “irreducible femoral hernia.”[3] Femoral hernia by far is the most common differential for saphena varix and is described as herniation of abdominal viscera through the femoral canal. An incarcerated femoral hernia often requires prompt operative management to decrease the risk of bowel strangulation, perforation, and peritonitis. Thrombosed saphena varix has been rarely described in literature. Duplex ultrasound is a front-line imaging modality where clinical examination cannot diagnose a thrombosed saphena varix.[4] The surgical options available are stripping and ligation of the great saphenous vein, varicose vein ligation, phlebectomy, endovenous vein obliteration, and perforator vein surgery. Treatment of the saphena varix is surgical disconnection and ligation of the saphenofemoral junction. Thrombosis of the saphena varix is rare and clinicians must keep the condition in mind when they encounter any puzzling groin swellings.
Figure 1: A dilated saccular swelling at the proximal end of the great saphenous vein with echogenic contents within, suggesting saphena varix with thrombosis

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Figure 2: Dilated and thrombosed great saphenous vein (arrow)

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Figure 3: Echogenic thrombus extending from the saphena varix (red arrow) upto its junction (green arrow) with superficial femoral vein (orange arrow) and great saphenous vein (blue arrow)

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Scott TE, LaMorte WW, Gorin DR, Menzoian JO. Risk factors for chronic venous insufficiency: A dual case-control study. J Vasc Surg 1995;22:622-8.  Back to cited text no. 1
    
2.
Zelikovski A, Zamir B, Hadar H, Urca I. Sapheno-femoral valve insufficiency in varicose veins of the lower limb. Angiology 1981;32:807-11.  Back to cited text no. 2
    
3.
Jamieson WG. State of the art of venous investigation and treatment. Can J Surg 1993;36:119-28.  Back to cited text no. 3
    
4.
Carroll C, Hummel S, Leaviss J, Ren S, Stevens JW, Everson-Hock E, et al. Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: A systematic review and economic evaluation. Health Technol Assess 2013;17:i-xvi, 1-141.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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