Patients who develop UEDVT often present with symptoms of ipsilateral upper-extremity edema, pain, paresthesia and, in some instances, functional impairment [16]. Catheter-associated thrombosis may be asymptomatic, rather manifesting as catheter dysfunction or as an incidental finding upon imaging. Superficial thrombophlebitis is associated with local pain, induration, and, often, a palpable cord but is rarely associated with diffuse arm swelling [17]. Unilateral swelling indicates an obstructive process at the level of the brachiocephalic, subclavian, or axillary veins [17,18]. DVT limited to the brachial veins need not be associated with swelling. Isolated jugular vein thrombosis is asymptomatic and rarely causes swelling. There may be a correlation between UEDVT and lower- extremity DVT, and investigation of the lower extremities as well should be considered if an upper-extremity thrombus is found in the absence of a local cause [19]. Diagnosis of UEDVT Venous thrombosis must initially be considered in a patient with upper-extremity swelling because it typically requires anticoagulation and sometimes thrombolysis. Risk stratification can be performed from a combination of clinical features [20] or by using blood tests. Plasma levels of D-dimer, a degradation product of cross-linked fibrin that is elevated during thromboembolic events, is highly sensitive but not very specific [21] and may be useful in ruling out UEDVT in conjunction with low pretest probability [22-24]. However, D-dimer cannot assess the location and extent of DVT, which is critical for proper therapeutic management [25], and is unreliable to distinguish between acute DVT from recurrent DVT. Imaging is often required for definitive exclusion of DVT and to document Reprint requests to: publications@acr.org Suspected Upper-Extremity Deep Vein Thrombosis its location and extent. Noninvasive imaging is frequently the initial step to assess DVT and includes ultrasound (US), MRI, or CT.
Suspected Upper Extremity Deep Vein Thrombosis. Patients who develop UEDVT often present with symptoms of ipsilateral upper-extremity edema, pain, paresthesia and, in some instances, functional impairment [16]. Catheter-associated thrombosis may be asymptomatic, rather manifesting as catheter dysfunction or as an incidental finding upon imaging. Superficial thrombophlebitis is associated with local pain, induration, and, often, a palpable cord but is rarely associated with diffuse arm swelling [17]. Unilateral swelling indicates an obstructive process at the level of the brachiocephalic, subclavian, or axillary veins [17,18]. DVT limited to the brachial veins need not be associated with swelling. Isolated jugular vein thrombosis is asymptomatic and rarely causes swelling. There may be a correlation between UEDVT and lower- extremity DVT, and investigation of the lower extremities as well should be considered if an upper-extremity thrombus is found in the absence of a local cause [19]. Diagnosis of UEDVT Venous thrombosis must initially be considered in a patient with upper-extremity swelling because it typically requires anticoagulation and sometimes thrombolysis. Risk stratification can be performed from a combination of clinical features [20] or by using blood tests. Plasma levels of D-dimer, a degradation product of cross-linked fibrin that is elevated during thromboembolic events, is highly sensitive but not very specific [21] and may be useful in ruling out UEDVT in conjunction with low pretest probability [22-24]. However, D-dimer cannot assess the location and extent of DVT, which is critical for proper therapeutic management [25], and is unreliable to distinguish between acute DVT from recurrent DVT. Imaging is often required for definitive exclusion of DVT and to document Reprint requests to: publications@acr.org Suspected Upper-Extremity Deep Vein Thrombosis its location and extent. Noninvasive imaging is frequently the initial step to assess DVT and includes ultrasound (US), MRI, or CT.