Intravenous literature: Kucher, N. (2011) Deep-Vein Thrombosis of the Upper Extremities. The New England Journal of Medicine. 364, p.861-869. This article has no abstract; the first 100 words appear below.
Foreword: This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations.
Stage: A 58-year-old woman presents with a 3-day history of pain, heaviness, and functional impairment in her left arm. She has received chemotherapy for ovarian cancer through an implanted port and catheter (Port-a-Cath) on the left side. Physical examination reveals a swollen and erythematous left arm and visible venous collaterals at the neck, shoulder, and chest. Compression ultrasonography reveals a patent left distal subclavian vein, but there is an abnormal Doppler-flow pattern suggestive of a more proximal thrombosis. How should this case be further evaluated and managed?