Presentation
Few days of increasing unilateral upper limb swelling and pain at the site of the PICC line. On immunotherapy treatment for breast cancer.
Patient Data
Ultrasound shows upper limb deep venous thrombosis (DVT) with a non-compressible, echogenic thrombus around the PICC line in the brachial vein.
Case Discussion
Upper limb deep vein thrombosis (DVT) accounts for 5-10% of all DVT. Predisposing factors include anatomical factors (e.g., cervical rib, bony exostosis, or compression from local malignancy), prothrombotic conditions, indwelling venous catheters, and malignancy. Exercise-induced thrombosis (known as Paget-Schrotter syndrome) can also occur 1.
In this case, the patient has apparent predisposing factors associated with malignancy and the PICC line. This patient developed dyspnea and pleuritic chest pain, and CTPA on the following day confirmed pulmonary embolism. However, PE is generally less common with an upper limb DVT than lower limb DVT. Patients with upper limb DVT can have high mortality, but this is variable and typically due to underlying malignancy rather than DVT 1.
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