Upper Extremity Venous Abnormalties

What is a deep vein thrombosis (DVT) of the upper extremity?

Thrombosis of deep veins that most commonly occurs due to intravenous catheterization or PICC line

What is the most reliable finding for a DVT diagnosis?

Lack of compressibility

What is the sonographic appearance of an acute DVT?

1. Grayscale shows a non-compressible and dilated vessel lumen

2. Grayscale shows an anechoic structure with poor wall attachment filling lumen

3. Color shows no color fill

4. PW shows no or minimal venous flow

What is the sonographic appearance of a chronic DVT?

1. Grayscale shows a non-compressible and retracted vessel lumen

2. Grayscale shows an echogenic or hyperechoic structure with strong wall attachment lining lumen

3. Grayscale shows echogenic vein walls

4. Color shows partial color fill

5. PW shows continuous or normal venous flow

What is the treatment for DVT?

DVT in ALL arm veins are treated aggressively

• Bedrest

• Lovenox shot

• IV heparin to stop clot progression

• Coumadin, Warfarin, Xarelto, or Eliquis therapy for 3-6 months

What is venous thoracic outlet syndrome (TOS) or Paget-Schroetter syndrome?

Compression of subclavian vein due to repetitive motion that causes thrombosis

What is SVC syndrome?

Progressive venous occlusion of SVC due to malignancy

What is the sonographic appearance of SVC syndrome?

1. Grayscale shows bilateral IJV dilation

2. PW shows continuous IJV flow

What is Lemierre syndrome?

Thrombophlebitis of jugular veins due to pharyngitis or tonsilitis