Subclavian-axillary venous thrombosis: role of noninvasive diagnostic methods

The diagnosis of primary subclavian axillary venous thrombosis (SAVT) was evaluated in eight patients to compare the accuracy of clinical diagnosis and noninvasive vascular evaluation with phlebography. Clinical evaluation led to three misdiagnoses: lymphedema (1), and inflammatory breast carcinoma (2). Doppler ultrasound detection of venous flow performed on three patients detected SAVT in only one. Plethysmography also performed on three patients led to unquestionable diagnosis in only one. Plethysmography also performed on three patients led to unquestionable diagnosis in only one. Phlebography positively identified SAVT in all patients and showed bilateral disease in one. Two patients had pulmonary embolism, and in one, permanent sequelae developed, thus emphasizing the necessity for energetic treatment of SAVT. Because of the risks of therapy and the inaccuracy of other diagnostic methods, SAVT should be positively identified by phlebography if anticoagulation is considered. Doppler and plethysmography are useful to rule out concomitant leg phlebothrombosis, to evaluate the arterial sector, and to document venous hemodynamic recovery after SAVT.