Ciocon J O, Galindo-Ciocon D
Geriatric Section, Cleveland Clinic Florida, Ft. Lauderdale 33309, USA.
Angiology. 1998 Apr;49(4):315-9. doi: 10.1177/000331979804900410.
This reports an arm edema that was initially treated as cellulitis and later diagnosed to be subclavian thrombosis due to pacemaker wire irritation. 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 antibiotics. An axillary venous Doppler study was interpreted as normal with no evidence of venous thrombosis. However, a venogram showed evidence of thrombosis involving the left innominate, subclavian, and axillary veins with multiple collateral veins diverting the blood to the contralateral side and into the superior vena cava. Intravenous anticoagulation was initiated and subsequently the patient was maintained on warfarin (Coumadin). The thrombosis subsequently improved and the original pacemaker was maintained. Arm edema are commonly mistaken for cellulitis, causing a delay in a more definite diagnosis of subclavian thrombosis. In a setting of a patient with pacemaker, subclavian thrombosis should be considered even with a normal screening venous ultrasound test. The incidence, manifestation, venous Doppler, and venogram findings are reviewed and discussed. Upper arm edema and superior vena cava syndrome are the most common presentation of this subclavian thrombosis associated with pacemakers. Venous ultrasound tests may be normal and a venogram is usually required to establish a diagnosis.
本文报道了一例起初被当作蜂窝织炎治疗，后来诊断为因起搏器导线刺激导致锁骨下静脉血栓形成的手臂水肿病例。我们介绍一位87岁的白种男性，其左臂肿胀和疼痛持续了5周，接受了两个疗程的抗生素治疗。腋窝静脉多普勒检查结果显示正常，没有静脉血栓形成的迹象。然而，静脉造影显示有血栓形成，累及左无名静脉、锁骨下静脉和腋静脉，有多个侧支静脉将血液引流至对侧并汇入上腔静脉。开始进行静脉抗凝治疗，随后患者维持使用华法林（香豆素）。血栓随后有所改善，原起搏器得以保留。手臂水肿常被误诊为蜂窝织炎，导致锁骨下静脉血栓形成的明确诊断延迟。对于有起搏器的患者，即使筛查静脉超声检查结果正常，也应考虑锁骨下静脉血栓形成。本文对其发病率、表现、静脉多普勒及静脉造影检查结果进行了回顾和讨论。上臂水肿和上腔静脉综合征是与起搏器相关的锁骨下静脉血栓形成最常见的表现。静脉超声检查结果可能正常，通常需要静脉造影来确诊。
