This reports an arm edema that was initially treated as cellulitis and
later diagnosed to be subclavian thrombosis due to pacemaker wire irr
itation. We present an 87-year-old Caucasian man with 5 weeks duration
of left arm swelling and pain that was treated with two courses of an
tibiotics. An axillary venous Doppler study was interpreted as normal
with no evidence of venous thrombosis. However, a venogram showed evid
ence of thrombosis involving the left innominate, subclavian, and axil
lary veins with multiple collateral veins diverting the blood to the c
ontralateral side and into the superior vena cava. Intravenous anticoa
gulation was initiated and subsequently the patient was maintained on
warfarin (Coumadin). The thrombosis subsequently improved and the orig
inal pacemaker was maintained. Arm edema are commonly mistaken for cel
lulitis, causing a delay in a more definite diagnosis of subclavian th
rombosis. In a setting of a patient with pacemaker, subclavian thrombo
sis should be considered even with a normal screening venous ultrasoun
d test. The incidence, manifestation, venous Doppler, and venogram fin
dings are reviewed and discussed. Upper arm edema and superior vena ca
va syndrome are the most common presentation of this subclavian thromb
osis associated with pacemakers. Venous ultrasound tests may be normal
and a venogram is usually required to establish a diagnosis.