Pulmonary embolism from axillosubclavian thrombosis on a rehabilitation unit: Case report

This report presents a case of angiogram-confirmed pulmonary emboli (PE) from upper extremity deep venous thrombosis (UE DVT) in a patient with Guillain-Barre syndrome. UE DVT has been rarely reported in the rehabilitation literature and it is not described in many standard references in the field. Risk factors for UE DVT include central venous catheterization (CVC), stasis, and hypercoagulability. Rehabilitation patients commonly demonstrate these risk factors, as well as unilateral limb swelling and pain. Although early reports emphasized the rarity of PE from UE DVT, it is now reported in roughly 12% of cases, and there may be an even higher incidence in CVC-related UE DVT. This report includes a review of etiologic, anatomic, diagnostic, and therapeutic considerations, and concludes with a discussion of the potential underrecognized significance of UE DVT in the general rehabilitation population. (C) 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.