Wednesday, April 11, 2007

Wednesday April 11, 2007
Upper extremity deep vein thrombosis (UEDVT)

Upper extremity deep vein thrombosis (UEDVT) should no longer be regarded as an uncommon and benign disease. It is usually associated with risk factors, as central venous lines, malignancy, and coagulation defects. However, up to 20% of UEDVTs are apparently spontaneous. The clinical picture is characterized by swelling, pain, and functional impairment, although UEDVT may be completely asymptomatic.

Objective testing is mandatory prior to instituting anticoagulation because the prevalence of UEDVT is less than 50% in symptomatic subjects, and compression ultrasound or color Doppler represents the preferred diagnostic methods.

Up to 36% of the patients develop pulmonary embolism, which may be fatal. Unfractionated or low-molecular-weight heparin followed by oral anticoagulation should be regarded as the treatment of choice. Thrombolysis and surgery may be indicated in selected cases.

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