Related Subjects:
|Pulmonary Embolism
| Deep Vein Thrombosis
| DVT/PE in pregnancy
| CTPA
About
- There are many causes of Subclavian vein thrombosis
- This is an upper-extremity deep-vein thrombosis
Aetiology is Virchows triad
- Changes in blood
- Changes in flow
- Changes in the vessel
Causes
- Causes of Primary SCVT
- Effort induced thrombosis (Paget von Schroetter syndrome)
- Idiopathic (frequently associated with undiagnosed malignancy)
- Causes of Secondary SCVT
- Mechanical trauma
- Chronic CVC placement
- Pacemaker leads
- Clavicle fracture
- Haemodialysis catheters
- Long term feeds
- Prone position in surgery
- Antithrombin III deficiency
- Factor V Leiden mutation
- Protein C deficiency
- Protein S deficiency
- Lung cancer malignancy (rare) - more common with Pancoast tumoc
Clinical
- Swelling, oedema and dilated upper limb veins
- Limb may feel heavy, look for lymphadenopathy - cervical and axillary
- Breast examination
Investigations
- FBC, U&E, ESR/CRP, Elevated D Dimer
- CXR and CT chest if lesion seen
- Mammography may be considered
- Ultrasound of upper limb veins
- Younger patients: Thrombophilia screen
Complications
- Pulmonary embolism
- Post-thrombotic syndrome secondary to venous outflow obstruction and valvar insufficiency
- Range from mild edema to incapacitating venous stasis leading to ulcer or gangrene
- Septic thrombophlebitis
- Embolism
- Superior vena cava
- Loss of access due to occlusion
Differential diagnoses of subclavian vein thrombosis include
- Superior vena cava syndrome
- Lymphatic obstruction
- Cellulitis
- Thoracic outlet obstruction
- Pancoast tumor
- Necrotizing fasciitis
- Superficial thrombophlebitis
Management
- Depends on cause. Catheter-based thrombolysis in some . Stenting may be considered if narrowing.
- Anticoagulation with LMWH and then Warfarin
- Consider looking for underlying causes e.g. malignancy or thrombophilia in those under 45 or with a h/o familial VTE
References