Chest
Selected ReportsUpper Extremity Deep Venous Thrombosis: Underdiagnosed and Potentially Lethal
Section snippets
CASE REPORT
A 67-year-old white man was admitted to the hospital for further investigations of progressively worsening right lower limb claudication. The patient had bilateral claudication for approximately six years. The patient's history included a left thoracotomy for a bronchogenic adenocarcinoma four years previous to his current hospital admission. He continued to smoke against medical advice.
The patient had multiple attempted vascular reconstructions, each one unsuccessful ultimately due to
Recognition
The possibility of pulmonary thromboembolism originating from the upper extremity veins must now be seriously considered with catheters and pacemaker hardware commonly being utilized in accessing the central venous system. It is now well established that pulmonary embolism frequently presents in an asymptomatic fashion.2, 4 It is therefore not surprising that 30 percent of those with angiographically proven pulmonary emboli have a normal lower extremity venogram.5 Possible explanations for the
CONCLUSIONS
A recent prospective trial concluded that pulmonary embolism is not a rare complication in upper extremity DVT, and catheter-related DVT seems to be at the greatest risk.2 Upper extremity DVT must now be taken seriously as a harbinger of possible pulmonary thromboembolism. As illustrated in our case, a combination of risk factors, ie, hypercoagulability secondary to recurrent pulmonary carcinoma, and the cannulation of the central veins made embolization from an upper extremity DVT possible.
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