2006 Volume 17 Issue 5 Pages 275-280
Case 1: A 43 years-old female. On May 6, 2006, a day after she had a massage on her arms, the patient became aware of swelling and an oppressive feeling in her right upper limb, and admitted on May 8. The circumference of the arm was 4.5 cm larger than the unaffected side and that of the forearm was 5 cm larger. Venography revealed a complete obstruction of the right axillary vein. Catheter directed thrombolysis therapy with urokinase (240 000 IU/day) and unfractionated heparin (10 000 U/day) was performed for 3 days. Follow-up venography revealed partial lysis of the thrombus. The patient was normal on hypercoagulability screening including antithrombin III (AT III), protein C and protein S. Oral anti-coagulant therapy with warfarin sodium was initiated, and she was discharged 9th day of the hospitalization.
Case 2: A 16 years-old male, left-handed baseball pitcher. On June 29, 2005, this patient noticed swelling of his left arm and admitted our hospital the next day. The circumference of the arm and the forearm were 3 cm larger than the unaffected side. Venography revealed an obstruction of the left subclavian vein. Catheter directed thrombolysis therapy as mentioned above was performed. Venography performed 5 days after the admission demonstrated partial lysis of the thrombus. AT III activity of this patient was 59.6% (normal 75.0-125.0%) and antigen concentration was 41.9 mg/dl (normal 15.0-31.0 mg/dl). His father had been diagnosed as deep vein thrombosis of the left lower leg 4 years ago and AT III activity of his father was 45.0%. These findings levealed the diagnosis of type II inherited AT III deficiency. Wafarin sodium was administered and he was discharged 8th day of the hospitalization.
Both of the two patients were relieved from symptoms and returned to social life without any complications. It is important to begin immediately fibrinolytic therapy combined with anticoagulant therapy after the diagnosis. In recent years, fibrinolytic therapy via a catheter has become the usual choice for the initial treatment of acute phase subclavian and axillary vein thrombosis.
