Incidental Detection of Asymptomatic Upper Extremity Deep Vein Thrombosis in an Elderly Patient With Pulmonary Embolism.

BACKGROUND

Upper extremity deep vein thrombosis (UEDVT) is rare, accounting for 4%-10% of all DVT cases. Central venous catheterization and malignancy are primary risk factors, making cases without these factors uncommon.

CASE PRESENTATION: A 76-year-old woman with hypertension was admitted with sepsis. She had no history of central venous catheterization. Contrast-enhanced CT revealed asymptomatic UEDVT in the left subclavian and brachiocephalic veins, lower extremity DVT, and bilateral pulmonary embolism. D-dimer was elevated. Tests showed elevated homocysteine; other thrombophilic screening was negative. No malignancy was detected. Heparin followed by edoxaban achieved complete resolution on follow-up imaging.

CONCLUSIONS

In elderly patients with elevated D-dimer and multiple DVT risk factors, particularly with sepsis or limited cardiopulmonary reserve, upper extremity imaging may be warranted even without UEDVT-specific symptoms. Asymptomatic UEDVT may have clinical implications for management.