title: Thromboembolic disease involving the superior vena cava and brachiocephalic veins.
abstract: OBJECTIVE
  To evaluate the frequency of diagnosis and the characteristics of brachiocephalic vein and superior vena cava (SVC) thromboembolic disease.
  
  
  BACKGROUND
  Thromboembolic disease of the brachiocephalic veins or SVC rarely has been reported. In view of the frequent use of central venous access lines, it would seem that the percentage of hospitalized patients with thromboembolic disease of the brachiocephalic veins or SVC should be higher than is generally recognized.
  
  
  METHODS
  A retrospective search for thromboembolic disease involving the brachiocephalic veins and SVC was made of patients who were hospitalized over a 2-year period.
  
  
  RESULTS
  Thromboembolic disease of the brachiocephalic veins or SVC was diagnosed in 23 of 34,567 hospitalized adults (0.06%) who were > or = 20 years old. Two of 23 patients (8.7%) had pulmonary embolism. Cancer was present in 17 of 23 patients (74%), and 15 of 23 patients (65%) had central venous access lines. Edema of the arm, face, or neck was present in 21 of 23 patients (91%). Pain or discomfort was present 15 of 23 patients (65%).
  
  
  CONCLUSIONS
  Isolated brachiocephalic vein and SVC thrombosis occur in a sufficient number of hospitalized patients to merit consideration of the diagnosis in patients who have cancer, central venous access lines, or both. The signs and symptoms of brachiocephalic vein thrombosis have features in common with SVC syndrome as well as with upper extremity deep venous thrombosis. In a patient with appropriate clinical findings, venography or other imaging may be indicated.
authors.affiliation: St. Joseph Mercy Oakland, Pontiac, MI 48341, USA.
authors.forename: Todd R
authors.initials: TR
authors.lastname: Otten
authors.forename: Paul D
authors.initials: PD
authors.lastname: Stein
authors.forename: Kalpesh C
authors.initials: KC
authors.lastname: Patel
authors.forename: Syed
authors.initials: S
authors.lastname: Mustafa
authors.forename: Allen
authors.initials: A
authors.lastname: Silbergleit
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016121:Brachiocephalic Veins; D002405:Catheterization, Central Venous / Q000009:adverse effects; D015984:Causality; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013479:Superior Vena Cava Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D013923:Thromboembolism / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology