Abstract
Recurrent deep venous thrombosis, involving bilateral upper extremities, is an extremely rare phenomenon. We are presenting a 43-year-old man who was diagnosed with left upper extremity deep vein thrombosis (UEDVT) and was treated with anticoagulation and surgical decompression in 2004. 9 years later, he presented with right arm swelling and was diagnosed with right UEDVT using US venous Doppler. Venogram showed compression of the subclavian vein by the first rib, diagnosing thoracic outlet syndrome (TOS). He was treated with anticoagulation and local venolysis and later by surgical decompression of the subclavian vein. Bilateral UEDVT, as mentioned above, is an extremely rare condition that is uncommonly caused by TOS. To our knowledge, we are reporting the first case of bilateral UEDVT due to TOS. Diagnosis usually starts with US venous Doppler to detect the thrombosis, followed by the gold standard venogram to locate the area of obstruction and lyse the thrombus if needed. The ultimate treatment for TOS remains surgical decompression of the vascular bundle at the thoracic outlet.
Highlights
Recurrent deep venous thrombosis, involving bilateral upper extremities, is an extremely rare phenomenon
We are presenting a 43year-old man who was diagnosed with left upper extremity deep vein thrombosis (UEDVT) and was treated with anticoagulation and surgical decompression in 2004. 9 years later, he presented with right arm swelling and was diagnosed with right UEDVT using US venous Doppler
He was treated with warfarin for 6 months and later underwent left first rib resection in 2006. He remained asymptomatic until May 2013 when he started complaining of right upper extremity discomfort and reddish discoloration that started after minimal muscle strain of his right arm while walking his dog
Summary
We are reporting a case of a 43-year-old male with a past medical history of DVT of the left subclavian vein as a result of thoracic outlet syndrome, diagnosed in 2004. He was treated with warfarin for 6 months and later underwent left first rib resection in 2006. The patient had no neurological deficit in the right arm and did not complain of any weakness He visited an urgent care center and had a US Doppler of the right upper extremity that confirmed the diagnosis of right subclavian vein thrombosis. The procedure and anticoagulation were successful in treating his condition and no recurrence of his condition has been observed in a one-year follow-up (Figure 7)
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