II. Epidemiology

  1. Patients tend to be younger and of leaner body habitus than those with lower extremity DVT

III. Causes

  1. Central Venous Catheter (common)
  2. PICC Line Thrombosis (complicates 3-5% of PICC Lines)
  3. External Vein Compression (Effort Thrombosis)
    1. Athletes with muscle hypertrophy
  4. Idiopathic (uncommon)
    1. Evaluate for occult cancer (more likely than with lower extremity DVT)
    2. Consider evaluation for Hypercoagulable state

IV. Symptoms

  1. Shoulder or Neck Pain
  2. Edema of the hand or arm

V. Signs

  1. Arm with palpable cord
  2. Supraclavicular fullness
  3. Cyanosis of extremity
  4. Serous drainage from PICC Line insertion site
  5. Venous distention
    1. Superficial vein distention
    2. Jugular Venous Distention

VI. Differential Diagnosis

VII. Imaging

  1. Duplex Ultrasound of upper extremity

VIII. Management

  1. Anticoagulation
    1. See Anticoagulation in Thromboembolism
    2. Duration: 3-6 months
  2. Consider catheter directed Thrombolysis

IX. Management: PICC Line Venous Thrombosis

  1. PICC Line venous thrombosis risk: 2.5%
    1. May present as serous drainage from the PICC insertion site
  2. New Recommendations
    1. PICC Line does not need to be removed in most Upper Extremity DVTs (if functional and ongoing need)
    2. Anticoagulate for 3 months regardless of presence of cancer (or as long as PICC in place if longer than 3 months)
    3. Older recommendations were to remove the PICC Line and not replacing (even if placed on opposite side)
  3. References
    1. (2012) Chest 141(2): e419S-e494S [PubMed]
    2. DeLoughery and Orman in Majoewsky (2012) EM:Rap 12(12): 4-5
    3. Jones (2010) J Vasc Surg 51(1):108-13 [PubMed]

X. Complications

  1. Pulmonary Embolism (6% of cases; contrast with lower extremity DVT related PE of 33%)
  2. Superior Vena Cava Syndrome

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Related Studies

Ontology: Upper Extremity Deep Vein Thrombosis (C2717899)

Definition (MSH) DEEP VEIN THROMBOSIS of an upper extremity vein (e.g., AXILLARY VEIN; SUBCLAVIAN VEIN; and JUGULAR VEINS). It is associated with mechanical factors (Upper Extremity Deep Vein Thrombosis, Primary) secondary to other anatomic factors (Upper Extremity Deep Vein Thrombosis, Secondary). Symptoms may include sudden onset of pain, warmth, redness, blueness, and swelling in the arm.
Concepts Pathologic Function (T046)
MSH D056824
SnomedCT 128054009
Dutch diepte veneuze trombose arm
French Thrombose veineuse profonde du bras, Thrombose veineuse profonde du membre supérieur
German tiefe Venenthrombose des Arms, Armvenenthrombose, Achselvenenthrombose, Tiefe Armvenenthrombose
Italian Trombosi venosa profonda del braccio, Trombosi venosa profonda delle estremità superiori
Portuguese Trombose venosa profunda do braço, Trombose Venosa Profunda de Membros Superiores
Spanish Trombosis venosa profunda en el brazo, Trombosis Venosa Profunda de la Extremidad Superior, trombosis venosa profunda de las extremidades superiores (trastorno), trombosis venosa profunda de las extremidades superiores
Japanese 腕深部静脈血栓症, ワンシンブジョウミャクケッセンショウ, ウデシンブジョウミャクケッセンショウ, 上肢深部静脈血栓症, 深部静脈血栓症-上肢
Czech Hluboká žilní trombóza paže, horní končetina - flebotrombóza, horní končetina - hluboká žilní trombóza
English Upper Extremity Deep Vein Thrombosis, thrombosis of deep veins of upper extremity, thrombosis of deep veins of upper extremity (diagnosis), venous thrombosis upper extremity deep veins, DVT of upper extremity, Upper Extremity Deep Vein Thrombosis [Disease/Finding], Deep venous thrombosis arm, Deep venous thrombosis of upper extremity (disorder), Deep venous thrombosis of upper extremity
Russian ВЕРХНИХ КОНЕЧНОСТЕЙ ГЛУБОКИХ ВЕН ТРОМБОЗ, KONECHNOSTEI VERKHNIKH GLUBOKIKH VEN TROMBOZ, VERKHNIKH KONECHNOSTEI GLUBOKIKH VEN TROMBOZ PERVICHNYI, КОНЕЧНОСТЕЙ ВЕРХНИХ ГЛУБОКИХ ВЕН ТРОМБОЗ, PEDZHETA-SHRETTERA SINDROM, TROMBOZ GLUBOKIKH VEN VERKHNIKH KONECHNOSTEI, VERKHNIKH KONECHNOSTEI GLUBOKIKH VEN TROMBOZ, ВЕРХНИХ КОНЕЧНОСТЕЙ ГЛУБОКИХ ВЕН ТРОМБОЗ ПЕРВИЧНЫЙ, ПЕДЖЕТА-ШРЕТТЕРА СИНДРОМ, ТРОМБОЗ ГЛУБОКИХ ВЕН ВЕРХНИХ КОНЕЧНОСТЕЙ
Swedish Upper Extremity Deep Vein Thrombosis
Polish Zakrzepica żył głębokich kończyny górnej, Zakrzepica żył głębokich kończyny górnej pierwotna, Powysiłkowa zakrzepica żył głębokich kończyny górnej, Idiopatyczna zakrzepica żył głębokich kończyny górnej, Zakrzepica żył głębokich kończyny górnej wtórna, Zespół Pageta-Schroettera, Zakrzepica żył głębokich kończyny górnej po ćwiczeniach
Hungarian Kar mélyvenás thrombosisa
Norwegian Dyp venetrombose i overekstremitetene

Ontology: Upper Extremity Deep Vein Thrombosis, Secondary (C2717900)

Definition (MSH) DEEP VEIN THROMBOSIS of an upper extremity vein (e.g., AXILLARY VEIN; SUBCLAVIAN VEIN; and JUGULAR VEINS) that develops as a complication of upper extremity central venous catheters and pacemaker uses, or cancer.
Concepts Pathologic Function (T046)
MSH D056824
English Upper Extremity Deep Vein Thrombosis, Secondary, Central Venous Catheter Thrombosis
French Thrombose sur cathéter veineux central, Thrombose veineuse profonde secondaire du membre supérieur
German Achselvenenthrombose, sekundaere, Armvenenthrombose, sekundaere, Armvenenthrombose, sekundäre, Achselvenenthrombose, sekundäre
Czech horní končetina - hluboká žilní trombóza sekundární
Norwegian Sekundær dyp venetrombose i overekstremitetene
Italian Trombosi venosa profonda secondaria delle estremità superiori