A Woman With Acute Dilated Veins Over the Anterior Chest Wall

Abstract

CLINICAL HISTORY This case is a 25-year-old right-handed female that presented with left upper extremity pain, numbness and tingling, and sensitivity to temperature with purple changes occurring in the fourth digit of the left hand. She experienced complaints of pins and needle– like sensations with the left hand becoming colder and the fourth digit of the left hand turning purple 2 years before. She went to the emergency room and was diagnosed with Raynaud’s, carpal tunnel, and/or arthritis. She was placed on pain medications and referred to local physicians. Her symptoms progressed, so that she could not even raise her left arm above shoulder height. A Doppler exam of the left arm revealed possible clot formation. Cortisone injections were prescribed and refused. She sought a second opinion from a local rheumatologist, who requested an angiogram, which was not available for review. A radiologist tried without success to dissolve the clots in the left arm over a 4-day period. Blood thinners were prescribed. She experienced bleeding in her legs and was referred to a cardiologist who placed her on Procardia. Symptoms returned and thereafter she was referred to a vascular surgeon at UCLA for further opinion. Because of suspected clot formation and possible Paget-Schroetter syndrome, bilateral magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and magnetic resonance venography (MRV) of the brachial plexus were requested to detect the anatomy before the scheduled left first rib resection and scalenectomy.