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Have A Dvt In Right Upper Arm In Brachial Vein.Dvt
Question: have a dvt in right upper arm in brachial vein.Dvt has been there since Dec 14.Within the last 3 And a half weeks developed chest pain radiating upper back onto shoulders and have been short of breath dizzy.Have been to er 3 times EKG was done tropinin all nornal.Ct was done without contrast as I am allergic to XXXXXXX d dimer was done <150 .On my most previous visit they did a chest xray which was normal and a vq scan only the perfusion part because of the corona virus here in NY.I have had these symptoms that I presently have as stated or 3 and a half weeks..Can a Pe be clearly ruled out ?Attached are lab and studies..Also saw a cardiologist out patient who did a echo stress test which was normal.
have a dvt in right upper arm in brachial vein.Dvt has been there since Dec 14.Within the last 3 And a half weeks developed chest pain radiating upper back onto shoulders and have been short of breath dizzy.Have been to er 3 times EKG was done tropinin all nornal.Ct was done without contrast as I am allergic to XXXXXXX d dimer was done <150 .On my most previous visit they did a chest xray which was normal and a vq scan only the perfusion part because of the corona virus here in NY.I have had these symptoms that I presently have as stated or 3 and a half weeks..Can a Pe be clearly ruled out ?Attached are lab and studies..Also saw a cardiologist out patient who did a echo stress test which was normal.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome on - Ask a Doctor - service!
After reviewing your recent medical history let me explain that upper extremity deep vein thrombosis has a lower risk of pulmonary embolism when compared with lower extremities DVT.
In fact a clinically apparent pulmonary embolism occurs in only 5%-8% pf such patients and it is almost always not life-threatening.
So, don't worry too much about it!
From the other side, sub-clinical pulmonary embolism may occur in up to one third of upper extremity DVT.
Now, returning to your exact question, I would like to explain that pulmonary angio CT (with contrast) is the test of choice for excluding PE.
As you have performed pulmonary CT without contrast we can't be sure on such issue. Anyways, a perfusion scan would detect a relevant pulmonary perfusion defect. So, coming to this point, my answer is yes, a clinical pulmonary embolism may be well detected to suspected with your performed tests. So, you should relax!
On my opinion, an important issue to consider would be to investigate the exact cause of of your DVT. And that would explain also the associated symptomatology (chest pain, breathing problems).
Upper extremity DVT could result from an anatomical variant, such as thoracic outlet syndrome, or by secondary causes like local venous catheters, certain malignancies, systemic inflammation/infections causing pro-coagulant conditions.
I am sorry of not being able to completely review your uploaded report due to insufficient resolution.
Hope to have been helpful to you!
Let me know in case of any further questions.
Kind regards,
Dr. Ilir Sharka
cardiologist
I would explain as follows:
Detailed Answer:
Hello!
Welcome on - Ask a Doctor - service!
After reviewing your recent medical history let me explain that upper extremity deep vein thrombosis has a lower risk of pulmonary embolism when compared with lower extremities DVT.
In fact a clinically apparent pulmonary embolism occurs in only 5%-8% pf such patients and it is almost always not life-threatening.
So, don't worry too much about it!
From the other side, sub-clinical pulmonary embolism may occur in up to one third of upper extremity DVT.
Now, returning to your exact question, I would like to explain that pulmonary angio CT (with contrast) is the test of choice for excluding PE.
As you have performed pulmonary CT without contrast we can't be sure on such issue. Anyways, a perfusion scan would detect a relevant pulmonary perfusion defect. So, coming to this point, my answer is yes, a clinical pulmonary embolism may be well detected to suspected with your performed tests. So, you should relax!
On my opinion, an important issue to consider would be to investigate the exact cause of of your DVT. And that would explain also the associated symptomatology (chest pain, breathing problems).
Upper extremity DVT could result from an anatomical variant, such as thoracic outlet syndrome, or by secondary causes like local venous catheters, certain malignancies, systemic inflammation/infections causing pro-coagulant conditions.
I am sorry of not being able to completely review your uploaded report due to insufficient resolution.
Hope to have been helpful to you!
Let me know in case of any further questions.
Kind regards,
Dr. Ilir Sharka
cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome on - Ask a Doctor - service!
After reviewing your recent medical history let me explain that upper extremity deep vein thrombosis has a lower risk of pulmonary embolism when compared with lower extremities DVT.
In fact a clinically apparent pulmonary embolism occurs in only 5%-8% pf such patients and it is almost always not life-threatening.
So, don't worry too much about it!
From the other side, sub-clinical pulmonary embolism may occur in up to one third of upper extremity DVT.
Now, returning to your exact question, I would like to explain that pulmonary angio CT (with contrast) is the test of choice for excluding PE.
As you have performed pulmonary CT without contrast we can't be sure on such issue. Anyways, a perfusion scan would detect a relevant pulmonary perfusion defect. So, coming to this point, my answer is yes, a clinical pulmonary embolism may be well detected to suspected with your performed tests. So, you should relax!
On my opinion, an important issue to consider would be to investigate the exact cause of of your DVT. And that would explain also the associated symptomatology (chest pain, breathing problems).
Upper extremity DVT could result from an anatomical variant, such as thoracic outlet syndrome, or by secondary causes like local venous catheters, certain malignancies, systemic inflammation/infections causing pro-coagulant conditions.
I am sorry of not being able to completely review your uploaded report due to insufficient resolution.
Hope to have been helpful to you!
Let me know in case of any further questions.
Kind regards,
Dr. Ilir Sharka
cardiologist
I would explain as follows:
Detailed Answer:
Hello!
Welcome on - Ask a Doctor - service!
After reviewing your recent medical history let me explain that upper extremity deep vein thrombosis has a lower risk of pulmonary embolism when compared with lower extremities DVT.
In fact a clinically apparent pulmonary embolism occurs in only 5%-8% pf such patients and it is almost always not life-threatening.
So, don't worry too much about it!
From the other side, sub-clinical pulmonary embolism may occur in up to one third of upper extremity DVT.
Now, returning to your exact question, I would like to explain that pulmonary angio CT (with contrast) is the test of choice for excluding PE.
As you have performed pulmonary CT without contrast we can't be sure on such issue. Anyways, a perfusion scan would detect a relevant pulmonary perfusion defect. So, coming to this point, my answer is yes, a clinical pulmonary embolism may be well detected to suspected with your performed tests. So, you should relax!
On my opinion, an important issue to consider would be to investigate the exact cause of of your DVT. And that would explain also the associated symptomatology (chest pain, breathing problems).
Upper extremity DVT could result from an anatomical variant, such as thoracic outlet syndrome, or by secondary causes like local venous catheters, certain malignancies, systemic inflammation/infections causing pro-coagulant conditions.
I am sorry of not being able to completely review your uploaded report due to insufficient resolution.
Hope to have been helpful to you!
Let me know in case of any further questions.
Kind regards,
Dr. Ilir Sharka
cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
sorry should have explained how I got the dvt. The dvt was caused by a picc line rhat was put in to treat llyme disease Never heard of a subclinical .Pe what exactly is that?
sorry should have explained how I got the dvt. The dvt was caused by a picc line rhat was put in to treat llyme disease Never heard of a subclinical .Pe what exactly is that?
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again!
PICC lines are the most common cause of upper extremity DVT.
Sub-clinical PE are the cases that do not show any specific symptomatology and are generally undetected until pulmonary artery angiography of pulmonary angio CT scan is performed. In general, they are clinically irrelevant, very small embolism in the peripheral pulmonary circulation without any significance regarding prognosis.
Considering you have a specific cause of DVT, an alternative strategy would be to remove the catheter and meanwhile continue on low molecular weight heparin therapy.
A potential source of chest pain could be related to Lyme disease. Controversial facts exist on its clinical course, physiopathology and therapeutic strategy.
Hope to have clarified your issue of concern!
Regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again!
PICC lines are the most common cause of upper extremity DVT.
Sub-clinical PE are the cases that do not show any specific symptomatology and are generally undetected until pulmonary artery angiography of pulmonary angio CT scan is performed. In general, they are clinically irrelevant, very small embolism in the peripheral pulmonary circulation without any significance regarding prognosis.
Considering you have a specific cause of DVT, an alternative strategy would be to remove the catheter and meanwhile continue on low molecular weight heparin therapy.
A potential source of chest pain could be related to Lyme disease. Controversial facts exist on its clinical course, physiopathology and therapeutic strategy.
Hope to have clarified your issue of concern!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again!
PICC lines are the most common cause of upper extremity DVT.
Sub-clinical PE are the cases that do not show any specific symptomatology and are generally undetected until pulmonary artery angiography of pulmonary angio CT scan is performed. In general, they are clinically irrelevant, very small embolism in the peripheral pulmonary circulation without any significance regarding prognosis.
Considering you have a specific cause of DVT, an alternative strategy would be to remove the catheter and meanwhile continue on low molecular weight heparin therapy.
A potential source of chest pain could be related to Lyme disease. Controversial facts exist on its clinical course, physiopathology and therapeutic strategy.
Hope to have clarified your issue of concern!
Regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again!
PICC lines are the most common cause of upper extremity DVT.
Sub-clinical PE are the cases that do not show any specific symptomatology and are generally undetected until pulmonary artery angiography of pulmonary angio CT scan is performed. In general, they are clinically irrelevant, very small embolism in the peripheral pulmonary circulation without any significance regarding prognosis.
Considering you have a specific cause of DVT, an alternative strategy would be to remove the catheter and meanwhile continue on low molecular weight heparin therapy.
A potential source of chest pain could be related to Lyme disease. Controversial facts exist on its clinical course, physiopathology and therapeutic strategy.
Hope to have clarified your issue of concern!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the quick response.
I was on eliquis and then but couldn't tolerate the side effects the same with xarrelto..I was only on a blood thinner the first three weeks of the Dvt.I am very symptomatic thats the problem here..
Thank you for going into detail on this i appreciate it.
I was on eliquis and then but couldn't tolerate the side effects the same with xarrelto..I was only on a blood thinner the first three weeks of the Dvt.I am very symptomatic thats the problem here..
Thank you for going into detail on this i appreciate it.
Thank you for the quick response.
I was on eliquis and then but couldn't tolerate the side effects the same with xarrelto..I was only on a blood thinner the first three weeks of the Dvt.I am very symptomatic thats the problem here..
Thank you for going into detail on this i appreciate it.
I was on eliquis and then but couldn't tolerate the side effects the same with xarrelto..I was only on a blood thinner the first three weeks of the Dvt.I am very symptomatic thats the problem here..
Thank you for going into detail on this i appreciate it.
Brief Answer:
You are welcome!
Detailed Answer:
It would be necessary to follows-up brachial vein by means of Doppler ultrasound and if necessary to switch to another anticoagulant (low molecular weight heparin like enoxaparin or anti vitamin K drugs like warfarin), that may be better tolerated.
You need to discuss with your attending internist or infectious diseases specialist on possible implication of Lyme disease (its clinical guidelines has evolved and changed over time) and/or investigate for any other potential inflammatory or neoplastic disorders implicated on your recent symptomatology.
I remain at your disposal for further discussions if necessary.
Wishing you good health!
Best regards,
Dr. Iliri
You are welcome!
Detailed Answer:
It would be necessary to follows-up brachial vein by means of Doppler ultrasound and if necessary to switch to another anticoagulant (low molecular weight heparin like enoxaparin or anti vitamin K drugs like warfarin), that may be better tolerated.
You need to discuss with your attending internist or infectious diseases specialist on possible implication of Lyme disease (its clinical guidelines has evolved and changed over time) and/or investigate for any other potential inflammatory or neoplastic disorders implicated on your recent symptomatology.
I remain at your disposal for further discussions if necessary.
Wishing you good health!
Best regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
You are welcome!
Detailed Answer:
It would be necessary to follows-up brachial vein by means of Doppler ultrasound and if necessary to switch to another anticoagulant (low molecular weight heparin like enoxaparin or anti vitamin K drugs like warfarin), that may be better tolerated.
You need to discuss with your attending internist or infectious diseases specialist on possible implication of Lyme disease (its clinical guidelines has evolved and changed over time) and/or investigate for any other potential inflammatory or neoplastic disorders implicated on your recent symptomatology.
I remain at your disposal for further discussions if necessary.
Wishing you good health!
Best regards,
Dr. Iliri
You are welcome!
Detailed Answer:
It would be necessary to follows-up brachial vein by means of Doppler ultrasound and if necessary to switch to another anticoagulant (low molecular weight heparin like enoxaparin or anti vitamin K drugs like warfarin), that may be better tolerated.
You need to discuss with your attending internist or infectious diseases specialist on possible implication of Lyme disease (its clinical guidelines has evolved and changed over time) and/or investigate for any other potential inflammatory or neoplastic disorders implicated on your recent symptomatology.
I remain at your disposal for further discussions if necessary.
Wishing you good health!
Best regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I had a Doppler ultra sound on the upper arm brachial vein the dvt is still rhere but was told it was chronic at this being its over 3 monrhs old and that with it being chronic its adhered to the vein wall and couldnt break away.
I had a Doppler ultra sound on the upper arm brachial vein the dvt is still rhere but was told it was chronic at this being its over 3 monrhs old and that with it being chronic its adhered to the vein wall and couldnt break away.
Brief Answer:
Periodic follow up is necessary:
Detailed Answer:
Hello again!
I recommend repeating Doppler ultrasound periodically again every year and review the clinical status.
Greetings,
Dr. Iliri
Periodic follow up is necessary:
Detailed Answer:
Hello again!
I recommend repeating Doppler ultrasound periodically again every year and review the clinical status.
Greetings,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Brief Answer:
Periodic follow up is necessary:
Detailed Answer:
Hello again!
I recommend repeating Doppler ultrasound periodically again every year and review the clinical status.
Greetings,
Dr. Iliri
Periodic follow up is necessary:
Detailed Answer:
Hello again!
I recommend repeating Doppler ultrasound periodically again every year and review the clinical status.
Greetings,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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