Upper Extremity Phlegmasia Cerula Dolens: Presentation by Color Duplex Ultrasound

2003 ◽  
Vol 27 (1) ◽  
pp. 35-38
Author(s):  
Nancy Tuvell ◽  
Kelly Bates ◽  
Kathryn Sorrell
Keyword(s):  
Upper Extremity ◽  
Duplex Ultrasound ◽  
Open Lung Biopsy ◽  
Vein Thrombosis ◽  
Right Hand ◽  
Superficial Vein Thrombosis ◽  
Doppler Signals ◽  
The Right ◽  
Deep Vein ◽  
Color Duplex Ultrasound

Introduction Phlegmasia cerula dolens (PCD) is an uncommon complication of deep vein thrombosis (DVT), and involvement in the upper extremities is rare. We report a case in which color duplex ultrasound (CDU) was used to diagnose PCD in a patient with extensive upper extremity DVT. Patient A 57-year-old woman underwent an open lung biopsy. On the first postoperative day, she had right hand and forearm pain, edema, and cyanosis. Findings CDU revealedacute DVT in the right radial, ulnar, and brachial veins and extensive thrombosis of the right cephalic and basilic veins. Arterial signals recorded from the ipsilateral arteries were remarkable for pandiastolic flow reversal (PDFR). In contrast, arterial signals from the contralateral arm had a normal, triphasic pattern. Arteriography revealed patent arteries to the wrist and no flow present in the right hand. Conclusions This report demonstrates the sensitivity of CDU to arterial compromise associated with PCD in a case of upper extremity DVT. Vascular technologists should consider including arterial Doppler signals in their venous duplex protocols in cases of extensive deep and superficial vein thrombosis.

scholarly journals Is There Any Association between PEEP and Upper Extremity DVT?

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Farah Al-Saffar ◽  
Ena Gupta ◽  
Furqan Siddiqi ◽  
Muhammad Faisal ◽  
Lisa M. Jones ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Duplex Ultrasound ◽  
Venous Catheter ◽  
Venous Stasis ◽  
Retrospective Case ◽  
Vein Thrombosis ◽  
Medical Intensive Care ◽  
The Mean ◽  
Deep Vein ◽  
Control Study

Background. We hypothesized that positive end-exploratory pressure (PEEP) may promote venous stasis in the upper extremities and predispose to upper extremity deep vein thrombosis (UEDVT).Methods. We performed a retrospective case control study of medical intensive care unit patients who required mechanical ventilation (MV) for >72 hours and underwent duplex ultrasound of their upper veins for suspected DVT between January 2011 and December 2013.Results. UEDVT was found in 32 (28.5%) of 112 patients. Nineteen (67.8%) had a central venous catheter on the same side. The mean ± SD duration of MV was13.2±9.5days. Average PEEP was7.13±2.97 cm H2O. Average PEEP was ≥10 cm H2O in 23 (20.5%) patients. Congestive heart failure (CHF) significantly increased the odds of UEDVT (OR 4.53, 95% CI 1.13–18.11;P=0.03) whereas longer duration of MV (≥13 vs. <13 days) significantly reduced it (OR 0.29, 95% CI 0.11–0.8;P=0.02). Morbid obesity showed a trend towards significance (OR 3.82, 95% CI 0.95–15.4;P=0.06). Neither PEEP nor any of the other analyzed predictors was associated with UEDVT.Conclusions. There is no association between PEEP and UEDVT. CHF may predispose to UEDVT whereas the risk of UEDVT declines with longer duration of MV.

Morbidly Obese Patient on Rivaroxaban Presents With Recurrent Upper Extremity Deep Vein Thrombosis: A Case Report

2019 ◽  
Vol 33 (5) ◽  
pp. 712-719 ◽  
Author(s):  
Sin-Ling T. Jennings ◽  
Khanh N. P. Manh ◽  
Jusilda Bita
Keyword(s):  
Deep Vein Thrombosis ◽  
Obese Patient ◽  
Upper Extremity ◽  
Oral Anticoagulants ◽  
Morbidly Obese ◽  
Vein Thrombosis ◽  
Morbidly Obese Patient ◽  
The Right ◽  
Direct Acting ◽  
Deep Vein

A morbidly obese patient with history of deep vein thrombosis and pulmonary embolism was diagnosed with an acute left upper extremity deep vein thrombosis and started on rivaroxaban. Three months later, the patient returned with swelling in the right arm and was found to have a right brachial thrombosis. Anticoagulant therapy was switched to a low-molecular-weight heparin, and patient was discharged on enoxaparin along with an order to follow-up with a hematologist. Subanalyses from randomized controlled trials, pharmacokinetic/pharmacodynamic, and real-world studies suggest that rivaroxaban may be effective and safe in morbidly obese patients for primary and secondary prevention of venous thromboembolism. However, the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis does not recommend the use of direct-acting oral anticoagulants in this population. If used, drug levels should be monitored to guide the therapy. Due to the disparity in data to show efficacy and safety of rivaroxaban in morbidly obese subjects, the interpatient variability of rivaroxaban’s effects in subjects, and the lack of defined therapeutic range for rivaroxaban drug concentration, rivaroxaban should be used cautiously in this population.

scholarly journals Upper Extremity Thrombosis Presenting as Medial Elbow Pain after Shoulder Arthroscopy

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Moiz I. Manaqibwala ◽  
Irene E. Ghobrial ◽  
Alan S. Curtis
Keyword(s):  
Deep Vein Thrombosis ◽  
Upper Extremity ◽  
Shoulder Arthroscopy ◽  
Duplex Ultrasound ◽  
Elbow Pain ◽  
True Incidence ◽  
Vein Thrombosis ◽  
Ultrasound Evaluation ◽  
Arthroscopic Shoulder Surgery ◽  
Deep Vein

Deep vein thrombosis of the upper extremity is believed to be an uncommon complication of arthroscopic shoulder surgery. It most commonly presents with significant swelling and pain throughout the upper extremity. However the diagnosis can be easily missed when findings are more subtle and unrelated or the patient asymptomatic. In this study we report on 5 cases of postoperative upper extremity deep vein thrombosis (UEDVT). Each case was performed in the lateral decubitus position with an interscalene block and postoperative sling immobilization. All patients presented with a primary complaint of medial elbow pain and went on to require anticoagulation. Only one patient was found to have a heritable coagulopathy. The true incidence of thromboembolic phenomena after shoulder arthroscopy may be higher than that reported in the current literature. Therefore a high index of suspicion must be maintained when evaluating patients postoperatively to avoid misdiagnosis. Symptoms of medial elbow pain after immobilization in a sling should be considered an indication for duplex ultrasound evaluation. Ultimately, further prospective study is needed to better understand the prevalence, prevention, and management of this entity.

scholarly journals Upper extremity deep vein thrombosis in an informal porter

2020 ◽  
Vol 39 (3) ◽  
pp. 207
Author(s):  
Dewi S. Soemarko ◽  
Herlinah Herlinah
Keyword(s):  
Deep Vein Thrombosis ◽  
Upper Extremity ◽  
Rare Condition ◽  
Predisposing Factor ◽  
Manual Lifting ◽  
Vein Thrombosis ◽  
Medicine Physician ◽  
The Right ◽  
Deep Vein

Background<br />Upper extremity deep vein thrombosis (UEDVT) is a rare condition, in which job-related arm movements and repetitive, forceful or overhead arm activities have been recognized as the predisposing factor for this condition. UEDVT can occur among informal porters. This report describes a case of UEDVT in an informal porter due to manual lifting of heavy goods and reviews the literature for occupational reports of this condition.<br /><br />Case description<br />A 35-year-old male informal porter presented with marked swelling, pain, and numbness of his right arm 3 days after a prolonged episode of lifting heavy goods. A Doppler ultrasound showed thrombosis in the right subclavian and axillary veins and laboratory tests found elevated D-dimer. Patient was diagnosed as having axillo-subclavian thrombosis and treated with low molecular-weight heparin. One month after the last follow-up, patient returned to work with modified capacity and after 3 months of return to work, patient was able to resume his regular duties without impairment or disability.<br /><br />Conclusion<br />The occupation of informal porter should be considered a risk factor for upper extremity deep vein thrombosis (UEDVT), thus the occupational medicine physician should be aware of this condition in the context of manual workers. Detailed occupational history to aid the diagnosis and future risk assessment are needed, and education for preventing UEDVT should be provided to porters.

scholarly journals Primary upper extremity deep vein thrombosis in a Caucasian woman

2019 ◽  
Vol 2 (1) ◽  
pp. 67-72
Author(s):  
Mihaela Ioana Maris ◽  
Mihaela Flavia Avram ◽  
Danina Mirela Muntean
Keyword(s):  
Deep Vein Thrombosis ◽  
Upper Extremity ◽  
Thrombotic Event ◽  
Signs And Symptoms ◽  
Acute Onset ◽  
Lower Limbs ◽  
Caucasian Woman ◽  
Vein Thrombosis ◽  
The Right ◽  
Deep Vein

AbstractCompared to deep vein thrombosis in the lower limbs, upper extremity deep vein thrombosis is uncommon and therefore much less explored or even neglected.We present the case of a 40-year-old female working in the bakery industry, who was admitted for acute onset of upper limb oedema accompanied by pain and functional impairment, affirmative secondary to the sustained and intense effort of the dominant arm. The diagnosis was confirmed by Duplex Ultraso nography on the eighth day after the onset of symptoms. Since clinical examinations and laboratory work excluded any cause of secondary thrombosis, the diagnosis of primary thrombosis was established. The only possible cause of this episode was linked to the woman’s work. The trigger for the thrombotic event was represented most likely by strenuous physical activity with temporary obstruction of the thoracic outlet in the work field. Under anticoagulant treatment, the signs and symptoms gradually resolved. Unfortunately, at the one-year follow-up exam, the patient was diagnosed with post-thrombotic syndrome of the right, dominant arm.

Internal valvuloplasty combined with sleeve wrapping in the treatment of severe deep venous incompetence: A case report

Vascular ◽  
2021 ◽  
pp. 170853812199012
Author(s):  
Yingfeng Wu ◽  
Libing Wei ◽  
Xixiang Gao ◽  
Yixia Qi ◽  
Zhu Tong ◽  
...  
Keyword(s):  
Lower Limb ◽  
Venous Insufficiency ◽  
Femoral Vein ◽  
Duplex Ultrasound ◽  
Vein Wall ◽  
Polyester Urethane ◽  
Left Lower Limb ◽  
Deep Vein ◽  
Color Duplex Ultrasound

Background The main cause of severe chronic venous insufficiency is deep venous incompetence. Deep venous reconstructive surgeries are reserved for cases that do not show a good response to conservative therapies. Method We present the case of a 68-year-old man presenting with swelling, pain, and pigmentation in his left lower limb for 14 years and ulcers for 10 years. Descending venography identified a Kistner’s grade IV reflux in the deep vein of the left lower limb. Internal valvuloplasty was performed following Kistner’s method. Meanwhile, external wrapping with a 1-cm-wide polyester-urethane vascular patch was performed to strengthen the vein wall in the venospasm condition. Results Symptoms were immediately relieved postoperatively. Refractory ulcers healed five months after the procedure. At the six-month follow-up, color duplex ultrasound of the deep vein of the left lower limb showed no reflux in the proximal segment of the femoral vein. Conclusion Internal valvuloplasty combined with sleeve wrapping is feasible in the treatment of severe deep venous incompetence with good short-term results.

scholarly journals Recurrence of Upper Extremity Deep Vein Thrombosis Secondary to COVID-19

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 878
Author(s):  
Yesha H. Parekh ◽  
Nicole J. Altomare ◽  
Erin P. McDonnell ◽  
Martin J. Blaser ◽  
Payal D. Parikh
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Upper Extremity ◽  
Thromboembolic Events ◽  
Vein Thrombosis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Deep Vein

Infection with SARS-CoV-2 leading to COVID-19 induces hyperinflammatory and hypercoagulable states, resulting in arterial and venous thromboembolic events. Deep vein thrombosis (DVT) has been well reported in COVID-19 patients. While most DVTs occur in a lower extremity, involvement of the upper extremity is uncommon. In this report, we describe the first reported patient with an upper extremity DVT recurrence secondary to COVID-19 infection.

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