Signs and Symptoms of Upper Limb Thrombosis
Upper limb thrombosis commonly presents with ipsilateral upper-extremity edema, pain, and paresthesia, with potential functional impairment in more severe cases. 1
Primary Clinical Manifestations
Common Signs
- Unilateral arm swelling (most consistent sign, especially with central vein involvement)
- Pain in affected limb
- Paresthesia (abnormal sensations)
- Functional impairment of the affected arm
- Dilated superficial collateral veins (visible on skin surface)
- Warmth and erythema of the affected limb 1
Location-Specific Findings
- Neck involvement: Ipsilateral upper extremity swelling, cervical edema, dilation of superficial collateral venous circulation 1
- Superior vena cava involvement: Swelling and discoloration of head, neck, and upper chest 1
- Catheter-associated thrombosis: May present as catheter dysfunction rather than limb symptoms 1
Distinguishing Features by Type
Primary Upper Extremity DVT (Paget-Schroetter Syndrome)
- More likely to cause pronounced symptoms
- Often affects dominant arm
- Symptoms may worsen with arm use or elevation 1
Secondary Upper Extremity DVT
- Often catheter-related (most common cause)
- May be asymptomatic or present with catheter malfunction
- Can manifest as an incidental finding on imaging 1
Important Distinctions
Deep vs. Superficial Thrombosis
- Superficial thrombophlebitis: Characterized by local pain, induration, and often a palpable cord, but rarely associated with diffuse arm swelling 1
- Deep vein thrombosis: More likely to cause diffuse swelling, especially with central vein involvement
Anatomical Considerations
- Unilateral swelling: Indicates an obstructive process at the level of the brachiocephalic, subclavian, or axillary veins 1
- DVT limited to brachial veins: May not be associated with swelling
- Isolated jugular vein thrombosis: Often asymptomatic and rarely causes swelling 1
Post-Thrombotic Syndrome
In chronic cases, patients may develop post-thrombotic syndrome with:
- Chronic unilateral limb edema
- Sensation of heaviness
- Cramping
- Venous stasis dermatitis
- Skin ulceration in severe cases 1
Clinical Pitfalls and Caveats
Asymptomatic presentation: Up to 50% of upper extremity DVTs may be asymptomatic, particularly catheter-associated thromboses 2
Correlation with lower extremity DVT: Consider investigating lower extremities if an upper-extremity thrombus is found without a local cause 1
Pediatric considerations: Post-thrombotic syndrome after upper venous system thrombosis appears less frequent in children (19%) compared to lower extremity DVT (65%) 1
Diagnostic confirmation: Clinical symptoms alone are insufficient for diagnosis, as less than 50% of symptomatic subjects actually have UEDVT on objective testing 2
Potential complications: Up to 36% of patients may develop pulmonary embolism, which can be fatal 2
When upper limb thrombosis is suspected based on these signs and symptoms, prompt diagnostic evaluation with duplex Doppler ultrasound is recommended as the first-line imaging test to confirm the diagnosis and initiate appropriate treatment 1, 3.