Axillary Vein Thrombosis
These cases are seen through the DVT clinic
Patient.co.uk has a useful section, summarised below
Risk factors
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In situ central venous catheter
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Venous compression in thoracic outlet syndrome
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Active malignancy
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Oral contraceptives, pregnancy
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Congenital thrombophilia, acquired coagulation defects
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Diabetes mellitus
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Obesity, smoking habit or intense sports activity
Presentation
Symptoms
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Symptoms can be intermittent, or can develop during a period of up to one week
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Patients tend to present with discomfort and swelling, associated with discolouration of the hand.
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7-20% of cases may lead to pulmonary embolism (PE) with features of pleuritic chest pain, breathlessness and haemoptysis
Signs
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Physical examination may show low-grade fever due to thrombus formation. Higher fevers are seen with septic thrombophlebitis or in patients with associated malignancy
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Oedema of the arm and hand - measure the biceps/forearm diameter at a fixed distance from an anatomical landmark.
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Mild-to-moderate cyanosis of the hand.
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Dilated superficial collateral veins may be seen over the chest and upper arm - may be the only indicator in central venous cannulation.
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Fullness in the supraclavicular fossa and even a palpable cord of thrombosed vein.
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Jugular vein may be distended.
Differential diagnosis
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Superficial phlebitis
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Cellulitis
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Severe superficial bruising
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Muscular tear
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Intramuscular haemorrhage
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Lymphoedema
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Occult fracture
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Superior vena cava obstruction
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Lymphangitis
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Localised allergy
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Gas gangrene