Upper limb DVT - PICC line associated thrombus
Updates to Case Attributes
Upper limb deep vein thrombosis (DVT) accounts for 5-10% of all DVT. Predisposing factors include anatomical factors (e.g., from the cervical rib, bony exostosis, or compression from local malignancy), prothrombotic conditions, the presence of indwelling venous catheters, and malignancy 1. Exercise induced-induced thrombosis (known as Paget - Schrotter-Schrotter syndrome) can also occur 1.
In this case, the patient has clear predisposing factors associated with malignancy and the PICC line. This patient developed dyspnoea and pleuritic chest pain, and CTPA on the following day confirmed pulmonary embolism. However, generally, PE is less common with an upper limb DVT compared to lower limb DVT 1. Patients with upper limb DVT can have a high mortality, but this is variable and typically due to underlying malignancy rather than the DVT 1.
-<p>Upper limb deep vein thrombosis (DVT) accounts for 5-10% of all DVT. Predisposing factors include anatomical factors (e.g. from cervical rib, bony exostosis or compression from local malignancy), prothrombotic conditions, the presence of indwelling venous catheters and malignancy <sup>1</sup>. Exercise induced thrombosis (known as Paget - Schrotter syndrome) can also occur <sup>1</sup>.</p><p>In this case, the patient has clear predisposing factors with malignancy and PICC line. This patient developed dyspnoea and pleuritic chest pain, and CTPA on the following day confirmed pulmonary embolism. However, generally PE is less common with an upper limb DVT compared to lower limb DVT <sup>1</sup>. Patients with upper limb DVT can have a high mortality, but this is variable and typically due to underlying malignancy rather than the DVT <sup>1</sup>.</p>- +<p>Upper limb deep vein thrombosis (DVT) accounts for 5-10% of all DVT. Predisposing factors include anatomical factors (e.g., from the cervical rib, bony exostosis, or compression from local malignancy), prothrombotic conditions, the presence of indwelling venous catheters, and malignancy <sup>1</sup>. Exercise-induced thrombosis (known as Paget-Schrotter syndrome) can also occur <sup>1</sup>.</p><p>In this case, the patient has clear predisposing factors associated with malignancy and the PICC line. This patient developed dyspnoea and pleuritic chest pain, and CTPA on the following day confirmed pulmonary embolism. However, generally, PE is less common with an upper limb DVT compared to lower limb DVT <sup>1</sup>. Patients with upper limb DVT can have a high mortality, but this is variable and typically due to underlying malignancy rather than DVT <sup>1</sup>.</p>
References changed:
- 1. Heil J, Miesbach W, Vogl T, Bechstein W, Reinisch A. Deep Vein Thrombosis of the Upper Extremity. Deutsches Ärzteblatt International. 2017;114(14):244-9. <a href="https://doi.org/10.3238/arztebl.2017.0244">doi:10.3238/arztebl.2017.0244</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28446351">Pubmed</a>
- Heil J, Miesbach W, Vogl T, Bechstein W, Reinisch A. Deep Vein Thrombosis of the Upper Extremity. Deutsches Ärzteblatt International. 2017;114(14):244-9. <a href="https://doi.org/10.3238/arztebl.2017.0244">doi:10.3238/arztebl.2017.0244</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28446351">Pubmed</a>
Updates to Study Attributes
Ultrasound confirms upper limb DVT, with a non-compressible, echogenic thrombus around the PICC line in the brachial vein.