ARM EDEMA, SUBCLAVIAN THROMBOSIS, AND PACEMAKERS - A CASE-REPORT

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.