em@3am

A 54-year-old woman presents with right arm swelling, heaviness, and dull discomfort. She recently underwent chemotherapy via a peripherally inserted central catheter (PICC) placed two weeks ago on her right side for newly diagnosed breast cancer. She denies fever, chest pain, or shortness of breath. On exam, her right upper extremity is visibly swollen from the mid-bicep to the shoulder with mild erythema, increased warmth, and prominent, dilated superficial veins across the upper arm and chest wall. A tender, palpable cord is noted over the medial aspect of the upper arm. Radial and ulnar pulses are intact, and there are no signs of infection or fluctuance around the PICC site.