Long-term outcomes of patients investigated for suspected upper extremities deep venous thrombosis irrespective of imaging results.

BACKGROUND: Outcome data are limited for upper extremity deep venous thrombosis (UEDVT). The outcomes of patients investigated for, but without UEDVT remain uncertain. METHODS: Retrospective analysis of clinical records of adult patients undergoing Doppler ultrasound for potential UEDVT between 1 January 2007 and 31 December 2014 was undertaken. Primary outcome was all-cause mortality. Secondary outcomes were new cancer diagnosis and thromboembolic recurrence. RESULTS: The final cohort (n = 528) comprised 25 primary UEDVT, 100 secondary UEDVT, 40 superficial-venous thrombosis and 363 without thrombus patients. There were 207 deaths. Survival was higher in primary than in secondary UEDVT (log-rank p < 0.0001) or those without thrombus (log-rank p = 0.001). Pre-existing cancer [hazard ratio 3.6 (95% confidence interval 1.5-8.9)] was the biggest independent predictor of mortality and leading cause of death. Developing UEDVT was a poor prognostic marker in cancer patients. CONCLUSION: There was high early mortality regardless of radiological findings, with the exception of primary UEDVT. Prospective studies evaluating aggressive treatment of underlying comorbidities in these patients are needed.

Incidental meandering right pulmonary vein, literature review and proposed nomenclature revision.

We report a case of an anomalous pulmonary vein on chest X-ray resembling a scimitar sign in an 80-year-old female undergoing investigation of syncope. Multislice computed tomography (CT) with multiplanar reformatting and maximum intensity projections demonstrated an aberrant right inferior pulmonary vein coursing inferomedially towards the diaphragm before turning superiorly and draining normally into the left atrium. The diagnosis of an incidental meandering right pulmonary vein was established. The case is used to review the literature on this rare pulmonary anomaly, including pathogenesis, its relationship with scimitar syndrome and scimitar variant, and diagnosis, with an emphasis on the role modern CT techniques can play in non-invasive diagnosis. A revision to the nomenclature of pulmonary vascular anomalies is proposed to help reduce confusion in the literature.