Thrombosis in an axillary or subclavian vein may be obvious in a patient with known risk factors or be asymptomatic and unsuspected. A high index of clinical suspicion may be required to make the diagnosis.


Risk factors:

(1) surgery or trauma in the region of the axillary or subclavian veins

(2) intravascular catheter in subclavian vein, especially if large and long term

(3) hypercoagulable state

(4) spontaneous or after exercise (Paget-von Schroetter syndrome, effort thrombosis, venous type thoracic outlet syndrome)

(5) history of previous thrombosis in an axillary or subclavian vein



(1) swelling and/or cyanosis of the involved arm, neck and face, with or without pain

(2) if thrombosis extends up the internal jugular vein, pseudotumor cerebri may occur with headache, unilateral or bilateral papilledema, diplopia and 6th cranial nerve palsy

(3) pulmonary embolism with negative studies in the deep veins of the pelvis and lower extremities

(4) sepsis with unknown source (usually in the ICU or trauma patient with a subclavian catheter)

(5) difficulty catheterizing a previously cannulated subclavian vein

(6) appearance of new cutaneous collateral blood vessels over the chest wall


Diagnosis can be established using:

(1) venography

(2) Doppler ultrasonography

(3) MRI


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