Computed tomography venography of the upper extremities - Using low dose bilateral contrast media injection in a patient with suspected venous thoracic outlet syndrome.

Venous thoracic outflow syndrome may occur as a result from compression of the subclavian and/or axillary vein and consequently, decreased blood flow and increased risk of thrombus formation. A previously healthy 34-year-old woman who, after intensive crossfit training, experienced sudden intense pain and swelling in her right upper arm was referred for computed tomography of her right upper arm and thoracic veins. The computed tomography was performed using bilateral injection of low dose, diluted contrast medium. The computed tomography venography revealed an elongated contrast medium embraced thrombus in the right subclavian and axillary vein. By using a dual injection consisting of diluted contrast medium, artifact-free visualization of arm veins and sufficient enhancement of thoracic veins can be achieved.