Emergency department point-of-care ultrasound for upper extremity deep venous thrombosis ED POCUS for upper extremity DVT

BACKGROUND: Upper extremity deep vein thrombosis (UEDVT) is an uncommon disease but has to be carefully considered in patients with isolated unilateral upper limb swelling due to its potential to cause devastating complications and sequelae such as pulmonary embolism and septic thrombophlebitis. Given the extreme rarity of this condition, it is not surprising that point-of-care ultrasonographic evaluation of the upper limb for deep venous thrombosis is hardly ever performed in the emergency department. This case report serves to highlight how point-of-care ultrasonographic evaluation of the upper extremity venous system could be incorporated as a tool in the diagnostic armamentarium of the emergency physician. CASE PRESENTATION: A 51-year-old Chinese gentleman presented to the emergency department with a 1-day duration of progressive right upper extremity swelling and pain. On examination, his hemodynamic parameters were stable with no tachycardia. He was noted to have a hyperaemic and grossly swollen but non-tender right upper limb. Distal pulses remained strong. Point-of-care ultrasonography of his right upper limb venous system with Doppler colour flow and single-point augmentation with the arm squeeze manoeuvre immediately confirmed the diagnosis of right upper extremity deep venous thrombosis, which in turn permitted anticoagulation to be instituted promptly whilst in the emergency department. CONCLUSION: The use of point-of-care ultrasonography of the upper limb venous system can prove invaluable as a rapid, non-invasive technique to facilitate expedient diagnosis of and early intervention for UEDVT in the emergency department.