Upper Extremity Venous Aneurysm as a Source of Pulmonary Emboli

Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Annals of Vascular Surgery (Impact Factor: 1.03). 02/2013; 27(2):240.e5-8. DOI: 10.1016/j.avsg.2012.05.019
Source: PubMed

ABSTRACT Spontaneous venous aneurysms of the upper extremities and neck are rare and typically asymptomatic. We present the first reported case of a symptomatic, primary upper extremity venous aneurysm in a patient who initially presented with pulmonary emboli. A 22-year-old patient was admitted with chest pain, dyspnea, and a right axillary mass. Computed tomography revealed diffuse, bilateral pulmonary emboli in addition to a thrombosed axillary vein. Venography confirmed the diagnosis, and also revealed a subclavian vein stenosis at the crossing of the first rib. Pharmacomechanical thrombolysis, catheter-directed thrombolysis, and venoplasty were performed with adequate flow restoration, also revealing the presence of a previously thrombosed proximal brachial/distal axillary venous aneurysm. Hematologic testing showed a positive and persistent lupus anticoagulant. The patient declined surgical reconstruction and opted for long-term anticoagulation. At 24 months, the patient continued to remain symptom-free.

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