Was Diagnosed With A Upper Extremity Dvt Right Arm Brachial

Posted on Thu, 5 Mar 2020

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 5 Mar 2020 Answered on

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Question : Was diagnosed with a upper extremity dvt right arm brachial vein .
I am 10 weeks out have generalized weakness,nausea,lightheadedness, upper abdominal pain,short of breath that comes and goes.
Ultrasound diagnosed dvt.Had a ct pe scan at 6 weeks out from dvt..Scan was clear.Doc doesn't think this could be a pe at 10 weeks out .He stated the dvt would be ahered to vein wall and very unlikely to break off and form a pe at 10 weeks out..Had upper endoscopy negative.ct pelvis abdomen negatives

Answered by Dr. Bhagyesh V. Patel (7 hours later)

Brief Answer:
systemic circulatory micro thombi may be possible.

Detailed Answer:
Hello and welcome to Ask A Doctor services.
I have read your query and here is my advise.

* As per my clinical experience, constellation of symptoms with generalized
weakness, nausea, light headache, short breath can be part of underlying
systemic circulatory response to previous deep vein thrombosis episode as
residual micro thrombi in circulation or else.

However, additional relevant information would be of help to clear further details as per your case demand.

1. Give details of symptoms before the diagnosis of DVT with duration and
progress.
2. Scanned reports of doppler, CT scan with blood panel if available.
When was last Prothombin time with INR was carried out ?
3. Therapy given with dose details and duration with current emphasis till
date.

Awaiting for your response.
Regards.

Dr Bhagyesh ( MS consultant surgeon )

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Bhagyesh V. Patel (8 hours later)

Had a picc line that was put in to treat lyme disease.A week of having it in was getting pain in shoulder of that arm .Doc ordered a plain film xray to look at the placement.Place was ok doc still wasn't comfortable due to pain order a right upper arm ultrasound came back with a diagnose of a brachial dvt.Only vessel involved.Was put on eliquis lasted there's weeks due to side effects then tried xarrelto lasted one day due to side effects.Had another ultrasound 4 weeks no change vessel occluded.
Then had another ultrasound and also a pe ct scan which showed no emboli.
2 weeks after scan startrd to develop upper abdominal pain,nausea,lightheadedness, weakness,short of breath..
Saw a cardiologist did a stress echo all ok.Ended up in er due to symptoms Had cbc ,comp profile ,tropinin
Red blood cells elevated,hemoglobin hemocrit elevated as well as calcium and alt.Repeat blood was done a few days later elevated alt red blood cells etc back to nornal. Had upper endoscopy all was told ok

Answered by Dr. Bhagyesh V. Patel (2 hours later)

Brief Answer:
follow up.

Detailed Answer:
Hi XXXXXXX
Thanks for the details.

* As the precisely needed therapy of anti coagulation was not possible due
to side effects, there is possibility of micro circulatory effects still going on.

The pain right upper abdomen, nausea indicates liver response to the same via haptoglobin pathway possibly.

My guidelines at present

- anti platelet agent is demand of time and symptoms ( though PET scan of
lungs is normal ), but the same is not feasible due to side effects with
Eliquis & Xarelto
- deep breathing exercises
- walking in fresh air
- avoid spices, non veg, junk food, dairy fat
- balanced nutritious diet to boost the immunity response
- plenty of liquids in sessions to get back homeostasis rapidly

- avoid smoking ( active or passive ) if applicable
- regular lab and physical evaluation with your physician regarding the
progress of symptoms and settling of blood parameters

Wish you best recovery.
Regards.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bhagyesh V. Patel (1 hour later)

Do you think that after after 6 weeks and a negative pe ct scan that a pe could have occurred even after six weeks and a negative scan.My primary doc thinks no as he thinks that the dvt at 6 weeks is pretty much adhered to the vein wall and that it would be unlikely to break loose at that point.

Answered by Dr. Bhagyesh V. Patel (6 hours later)

Brief Answer:
follow up.

Detailed Answer:
Hi XXXXXXX
Welcome for follow up.

* My narration was not pertaining to pulmonary embolism, but I am
concerned possible micro particles circulating in the body and giving
systemic symptoms, which do not show up on any scan of the highest
resolution.

Those particles may be even microthrombi already detached from the
primary event, ill effects of elevated RBC or others.

* If that was a pulmonary embolism, you would not be at home right now.

Hope this made it more clear as it is symptomatic narration with reports. However, it's also co-relation on clinical grounds without clinical examination, so it can not be that precise as your clinician evaluation though.

Thank you

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Above answer was peer-reviewed by : Dr. Arnab Banerjee