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Old 11-01-2013
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Question Jackhammer Operator Arm Swelling

32 years old male jackhammer operator complains of pain and swelling right arm for 3 days, moderate exacerbation by exertion, examination reveals erythema and moderate edema, capillary refill less than 3 seconds :
a) Axillary-subclavian venous thrombosis
b) Deep vein valve insufficiency
c) Superficial thrombophlebitis of basilic vein
d) SVC syndrome
e) Thoracic outlet syndrome

Can you please explain your answer with a differential diagnosis ... thank you
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Old 11-01-2013
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see its not superficial thrombophlebitis ..usually associated with palpable cord...
not thoracic outlet..usually has arterial symptoms..capillary refill is normal..
not svc syndrome..facial plethora, congestion..associated with lung cancer..no such point in the h/o..
i am confused between a or b..but it looks more like dvt than just a valve insufficiency which will cause edema n later hemosideric changes you'll see[stasis dermatitis]..so i will go with a..
not sure tho..what's the answer?
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Quote:
Originally Posted by drsrb View Post
see its not superficial thrombophlebitis ..usually associated with palpable cord...
not thoracic outlet..usually has arterial symptoms..capillary refill is normal..
not svc syndrome..facial plethora,congestion..associated with lung cancer..no such point in the h/o..
i am confused between a or b..but it looks more like dvt than just a valve insufficiency which will cause edema n later hemosideric changes you'll see[stasis dermatitis]..so i will go with a..
not sure tho..what's the answer?
thank you for your answer
the answer is A like you said ... I was also confused between a and b ... but chose b lol
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Old 11-01-2013
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Default Paget–Schroetter syndrome-Jackhammer is the key here

http://en.wikipedia.org/wiki/Paget%E...oetter_disease

http://www.veinspecialists.com/blog/...bclavian-vein/

Paget–Schroetter syndrome was described once for a viola player who suddenly increased practice time 10-fold, creating enough repetitive pressure against the brachiocephalic and external jugular veins to cause thrombosis.

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Originally Posted by Estacado View Post
thank you for your answer
the answer is A like you said ... I was also confused between a and b ... but chose b lol
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Old 11-01-2013
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Default This was a good case

We have a case in UW about this non effort type, where a thrombosis secondary 2 TPN.

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Originally Posted by ddaydreamer View Post

In addition to this effort thrombosis another category of thrombosis has been described in patients with indwelling IV catheters in these veins for medications.
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