CASE REPORT
Uncommon series of subclavian vein thrombosis in Emergency Department
 
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1
Emergency Department, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
2
Emergency Department, Regional Specialist Hospital in Olsztyn, Poland
3
Students' Research Group, Emergency Department, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
4
Radiology Department, Regional Specialist Hospital in Olsztyn, Poland
CORRESPONDING AUTHOR
Rakesh Jalali   

Rzędziana 15, 11-041 Olsztyn, Poland. Tel.: +48 504 232 544.
Submission date: 2022-01-28
Final revision date: 2022-03-31
Acceptance date: 2022-03-31
Online publication date: 2022-05-20
 
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Deep vein thrombosis (DVT) is one of the two possible clinical manifestations of venous thromboembolism (VTE), and the other one is the pulmonary embolism. The most common reasons behind the upper limb DVT can be central venous catheterization, compression of subclavian vein or anatomical abnormalities.

Aim:
The aim of this study is to stress the importance of accurate diagnosis of the relatively rare subclavian vein thrombosis (SCVT). Due to low specificity of the clinical signs and symptoms, a careful risk assessment of VTE is extremely helpful in successfully reaching a diagnosis.

Case study:
Authors are presenting a series of 4 cases of diagnosis and initial treatment in Emergency Department (ED) of the patients presenting with common symptoms of upper limb with uncommon SCVT. All patients presented to ED, of which 3 were seen in ED of our hospital and 1 patient, who is co-author of the publication, had the same diagnosis in other ED allocated in another city.

Results and discussion:
Among the 4 patients only 1 has reached high risk in Caprini’s score and moderate in Wells score. In Padua scale patient did not reach high risk. In other patients risks in each score were low.

Conclusions:
In most cases, the Wells, Padua, Caprini scores can be used to evaluate the risk of VTE; this diagnostic tool cannot be efficiently utilized in patients with local anatomical anomalies, which can lead to problems with diagnostics and treatment of such patients.

FUNDING
None declared.
CONFLICT OF INTEREST
None declared.
 
REFERENCES (23)
1.
Flinterman LE, van der Meer FJM, Rosendaal FR, Doggen CJM. Current perspective of venous thrombosis in the upper extremity. J Thromb Haemost. 2008;6(8):1262–1266. https://doi.org/10.1111/j.1538....
 
2.
Kucher N. Deep-Vein Thrombosis of the Upper Extremities. N Engl J Med. 2011;364:861–869. https://doi.org/10.1056/NEJMcp....
 
3.
Lee JA, Zierler BK, Zierler RE. The risk factors and clinical outcomes of upper extremity deep vein thrombosis. Vasc Endovascular Surg. 2012;46(2):139–144. https://doi.org/10.1177/153857....
 
4.
Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ. Risk factors for deep vein thrombosis and pulmonary embolism: A population-based case-control study. Arch Intern Med. 2002;160(6):809–815. https://doi.org/10.1001/archin....
 
5.
Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK. Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. West J Emerg Med. 2010;11(4):358–362.
 
6.
Mustafa J, Asher I, Sthoeger Z. Upper Extremity Deep Vein Thrombosis: Symptoms, Diagnosis, and Treatment. Isr Med Assoc J. 2018;20(1):53–57.
 
7.
Ang DTY, Haseler TWL, Kosar S, McCullough KL, et al. Long-term outcomes of patients investigated for suspected upper extremities deep venous thrombosis irrespective of imaging results. J R Coll Physicians Edinb. 2020;50(1):19–24. https://doi.org/10.4997/jrcpe.....
 
8.
Heit JA, Michael O’Fallon W, Petterson TM, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: A population-based study. Archives of Internal Medicine. 2002;162(11):1245–1248. https://doi.org/10.1001/archin....
 
9.
Thompson RW. Comprehensive management of subclavian vein effort thrombosis. Semin Intervent Radiol. 2012;29(1):44–51. https://doi.org/10.1055/s-0032....
 
10.
Sangani V, Pokal M, Balla M, Gayam V, Konala VM. Paget-Schroetter Syndrome in a Young Female. J Investig Med High Impact Case Rep. 2021;9:232470962110032. https://doi.org/10.1177/232470....
 
11.
di Nisio M, van Sluis GL, Bossuyt PMM, Büller HR, Porreca E, Rutjes AWS. Accuracy of diagnostic tests for clinically suspected upper extremity deep vein thrombosis: A systematic review. J Thromb Haemost. 2010;8(4):684–692. https://doi.org/10.1111/j.1538....
 
12.
Gutiérrez García I, Pérez Cañadas P, Martínez Uriarte J et al. L. D-dimer during pregnancy: establishing trimester-specific reference intervals. Scand J Clin Lab Invest 2018;78(6):439–442. https://doi.org/10.1080/003655....
 
13.
di Nisio M, Squizzato A, Rutjes AWS, Büller HR, Zwinderman AH, Bossuyt PMM. Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: A systematic review. J Thromb Haemost. 2007;5(2):296–304. https://doi.org/10.1111/j.1538....
 
14.
Engelberger RP, Kucher N. Management of deep vein thrombosis of the upper extremity. Circulation. 2012;126(6):768–773. https://doi.org/10.1161/circul....
 
15.
Borsi SH, Shoushtari MH, MalAmir MD, Angali KA, Mavalizadeh MS. Comparison of the D-dimer concentration in pregnant women with or without pulmonary thromboembolism. J Family Med Prim Care. 2020 Aug 25;9(8):4343–4347. https://doi.org/10.4103/jfmpc.....
 
16.
Dharma R, Panjaitan MT, Sumapradja K, Setiabudy R. Profile of D-dimer in Uncomplicated Pregnancy. Majalah Obstet Ginekol Indones. 2019;7(4):283–287. https://doi.org/10.32771/inajo....
 
17.
Grabala M, Grabala P, Malinowski P, Adadyński L. Superior mesenteric and portal vein thrombosis following appendectomy – A case report. Pol Ann of Med. 2017;24(1):55–59. https://doi.org/10.1016/j.poam....
 
18.
Ulloa JG, Gelabert HA, O'Connell JB, Patel R, Rigberg DA. Intravascular ultrasonography provides more sensitive detection of subclavian vein stenosis than venography in patients presenting with Paget-Schroetter syndrome. J Vasc Surg Venous Lymphat Disord. 2021;9(5):1145–1150.e1. https://doi.org/10.1016/j.jvsv....
 
19.
Mustafa S, Stein PD, Patel KC, Otten TR, Holmes R, Silbergleit A. Upper extremity deep venous thrombosis. Chest. 2003;123(6):1953–1956. https://doi.org/10.1378/chest.....
 
20.
Avila ML, Duan L, Cipolla A, et al. Postthrombotic syndrome following upper extremity deep vein thrombosis in children. Blood. 2014;124(7):1166–1173. https://doi.org/10.1182/blood-....
 
21.
Lungren MP, Ward TJ, Patel MN, Racadio JM, Kukreja K. Endovascular thrombolysis to salvage central venous access in children with catheter-associated upper extremity deep vein thrombosis: technique and initial results. J Thromb Thrombolysis. 2015;40(3):274–279. https://doi.org/10.1007/s11239....
 
22.
Lutter C, Monasterio E, Schöffl V. Rock climbing-related subclavian vein thrombosis. BMJ Case Rep. 2015;2015:bcr2015212021. http://dx.doi.org/10.1136/bcr-....
 
23.
Urschel HC, Patel AN. Surgery Remains the Most Effective Treatment for Paget-Schroetter Syndrome: 50 Years’ Experience. Ann Thorac Surg. 2008;86(1):254–260. https://doi.org/10.1016/j.atho....