DVT

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EM@3AM: Upper Extremity DVT

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. 

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EM@3AM: DVT

A 28-year-old female presents with right lower leg swelling and redness. She just returned from an overseas flight. She denies chest pain or shortness of breath. VS are normal, and her right lower leg is swollen, with diameter > 3 cm compared to her left. What’s the next step in your evaluation and treatment?

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