Royal Cornwall Hospital

Truro

Cornwall TR1 3LJ

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© 2023 by Acute GP Service, CPFT. 

Axillary Vein Thrombosis

 

These cases are seen through the DVT clinic

 

 

Patient.co.uk has a useful section, summarised below

 

Risk factors 

  • In situ central venous catheter

  • Venous compression in thoracic outlet syndrome

  • Active malignancy

  • Oral contraceptives, pregnancy

  • Congenital thrombophilia, acquired coagulation defects

  • Diabetes mellitus

  • Obesity, smoking habit or intense sports activity

 

Presentation

 

Symptoms
  • Symptoms can be intermittent, or can develop during a period of up to one week

  • Patients tend to present with discomfort and swelling, associated with discolouration of the hand.

  • 7-20% of cases may lead to pulmonary embolism (PE) with features of pleuritic chest pain, breathlessness and haemoptysis

 

Signs
  • Physical examination may show low-grade fever due to thrombus formation. Higher fevers are seen with septic thrombophlebitis or in patients with associated malignancy 

  • Oedema of the arm and hand - measure the biceps/forearm diameter at a fixed distance from an anatomical landmark.

  • Mild-to-moderate cyanosis of the hand.

  • Dilated superficial collateral veins may be seen over the chest and upper arm - may be the only indicator in central venous cannulation.

  • Fullness in the supraclavicular fossa and even a palpable cord of thrombosed vein.

  • Jugular vein may be distended.

 

Differential diagnosis

  • Superficial phlebitis

  • Cellulitis

  • Severe superficial bruising

  • Muscular tear

  • Intramuscular haemorrhage

  • Lymphoedema

  • Occult fracture

  • Superior vena cava obstruction

  • Lymphangitis

  • Localised allergy

  • Gas gangrene