Abstract
A 37-year-old lady was admitted with a 5-day history of spontaneous swelling and pain affecting her right arm associated with skin tightening and discolouration. There was no recent trauma although she had undertaken 3-mile runs on the preceding 3 days. One year previously she sustained a comminuted right clavicular fracture following a bicycle accident, requiring internal fixation surgery. She regained full function of the arm subsequently. There was no other previous medical history or family history of thrombotic disease and her weight was stable. She smoked five cigarettes daily and took no regular medication. On examination, she was slim, apyrexial, pulse 55/min regular, blood pressure 108/65 mmHg, respiratory rate 18/min. There was a general purple tinge and mottled appearance to the skin throughout her arm, which was swollen and had distended superficial veins (Figure 1). There was no arterial insufficiency, radio-radial delay or neurological deficit. …
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