Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of unilateral upper extremity swelling, cyanosis, and heaviness. History is significant for repetitive overhead physical activity or strenuous exertion. Denies trauma, fevers, or recent central venous catheter placement. Symptoms are progressive, associated with prominent superficial venous collateralization (venous distension) across the shoulder and chest wall.
Clinical Examination Findings
Upper extremity examination reveals significant edema, erythema, and cyanotic discoloration of the affected limb. Palpation demonstrates increased tension and tenderness along the axillary and subclavian vein distribution. Superficial venous engorgement noted over the pectoral and deltoid regions. Distal pulses are palpable but may be diminished; capillary refill is delayed. Neurological exam is intact; no signs of compartment syndrome.
Treatment Protocol
Immediate anticoagulation therapy initiated. Plan includes urgent vascular surgery consultation for catheter-directed thrombolysis (CDT) or pharmacomechanical thrombectomy. Long-term management involves evaluation for thoracic outlet decompression (first rib resection) to address the underlying anatomical compression. Compression garments and avoidance of precipitating activities are advised.