We report a case of extensive venous thrombosis of the upper extremity in a patient with a hyperosmolar hyperglycemic state (HHS). Thrombosis of the upper extremities is generally found in 4% of cases with deep venous thrombosis. Extensive, symptomatic venous thrombosis of the upper extremity, as seen in this patient, is rare except with catheter-related thrombosis. Recent studies have supported the safety and efficacy of catheter-directed thrombolysis in patients with no contraindication to thrombolytic therapy, and have recommended early catheter-directed thrombolysis. Therefore, our patient was treated with early catheter-directed thrombolysis followed by anticoagulation.
Venous Thrombosis/diagnosis/drug therapy/*etiology ; Ultrasonography, Doppler ; Thrombolytic Therapy/methods ; *Subclavian Vein ; Phlebography ; Male ; Insulin/administration & dosage/therapeutic use ; Injections, Intravenous ; Hypoglycemic Agents/administration & dosage/therapeutic use ; Hyperglycemic Hyperosmolar Nonketotic Coma/*complications/drug therapy ; Humans ; Diagnosis, Differential ; Catheterization, Peripheral/*adverse effects ; *Brachiocephalic Veins ; *Axillary Vein ; Anticoagulants/administration & dosage/therapeutic use ; Adult