Upper-extremity deep-vein thrombosis secondary to superior vena cava syndrome
Marion O’Sullivan, University College Dublin
Background
Upper-extremity deep-vein thrombosis is a common complication in oncology patients. This case will report on a male patient with lung cancer who developed extensive occlusive upper-extremity deep-vein thrombosis with associated superior vena cava syndrome. Superior vena cava syndrome refers to the compression of the superior vena cava, causing venous congestion and stasis of blood flow. The stasis of blood flow combined with previous vessel trauma is found to be a significant factor contributing to upper-limb deep-vein thrombosis.
Ultrasound examination
Ultrasound was the modality of choice in the initial diagnosis of upper-extremity deep-vein thrombosis. A systematic sonographic approach including B-Mode, colour Doppler and spectral Doppler allowed for a full assessment of the flow dynamics, the thrombus composition and extent of occlusion.
Findings
Diagnosis included right upper-limb deep-vein thrombosis with occlusive thrombus involving the right axillary vein, right subclavian vein, and extending into the right internal jugular vein. A subsequent computed tomography scan confirmed moderate to severe superior vena cava syndrome secondary to a large right apical lung mass causing compression.
Discussion
Upper-extremity deep-vein thrombosis diagnosis is clinically significant due to the risk of pulmonary emboli. The superior vena cava compression was considered a contributing factor to the development of the occlusive thrombus. Treatment options include anticoagulant therapy initially or thrombectomy in severe cases. The patient’s superior vena cava syndrome could only be relieved by tumour resection, which was declined.
Conclusion
Upper-extremity deep-vein thrombosis is a life-threatening diagnosis, and timely management is crucial to implement appropriate treatment plans. This case report identified a rare case where superior vena cava syndrome was the main contributing factor to the formation of the upper-extremity deep-vein thrombosis.