[Clinical case of the month. Upper extremity deep venous thrombosis]

According to the studies, approximately 4 to 10% of all the cases of deep venous thrombosis are located in the subclavian, axillary or brachial veins. The more frequent use of central venous catheters and pacemaker leads is probably responsible for their increasing incidence these last decades. The deep venous effort thrombosis also called Paget-Schroetter Syndrome is part of the spontaneous upper extremity venous thromboses. They mostly affect young adults who practice special kinds of sports or whose professions require repetitive arm movements. Colour Duplex sonography provides a simple and accurate tool for the diagnosis of upper extremity deep venous thrombosis. Nowadays venography and venoscan are no longer used for diagnostic purposes. These techniques are limited to venous thromboses including to the brachiocephalic vein or the superior vena cava. This pathology can have major clinical consequences including pulmonary embolism and post-thrombotic syndrome. However, the prevalence of pulmonary embolism is controversial (20-35% according to studies) and fatal PE is very rare. Post-thrombotic syndrome mostly consists of venous stasis syndrome and painful exertion. Low molecular weight heparin followed by oral anticoagulation are recommended. Thrombolysis is often successful, but less frequently used because of its potential risks. Surgery may be required in case of venous compression (eg in case of thoracic outlet syndrome).