Diagnosis

Abstract

The first line of approach to make a diagnosis is to use a duplex ultrasound of the axillary subclavian veins. Any patient showing up at the emergency room with a swollen arm should have this test done before assuming any other etiologies that could cause edema of the upper extremity. It is a very simple noninvasive test that will make the diagnosis immediately. There is no need to apply any type of maneuvers implemented on the arm which may actually be contraindicated because if a thrombosis exists abduction of the arm may trigger fragmentation of the clot and cause pulmonary embolism. Typically the tracing will show dampening of the vein pulsations (Fig. 15.1) and total lack of flow which may extend into the axillary vein and occasionally even into the brachial veins. With this information confirmed the next mandatory test is to proceed with a venogram.