A case of upper left extremity deep vein thrombosis with right side middle lobe syndrome

Sathish Babu^a, Tom Devasia^b, Yeshwanth Rao Karkal^c*, Ashwini Mohapatra^d

^aDepartment of Radiology, Consultant Radiologist, Manipal Hospital, Vijayawada, Andhra Pradesh, India, ^bDepartment of Cardiology, Kasturba Hospital, Manipal University, Manipal, Karnataka, India, ^cDepartment of Pharmacology, Melaka Manipal Medical College, Manipal University, Manipal, Karnataka, India, ^dDepartment of Chest Medicine, Kasturba Hospital, Manipal University, Manipal, Karnataka, India

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Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation

Abstract
Upper extremity deep vein thrombosis is an extremely important clinical entity with potential for considerable morbidity and mortality. A 64‑year‑old woman was brought to the emergency department with complaints of left upper limb and neck swelling for 4 days. Ultrasonography of the neck showed thrombosis of the left internal jugular and other surrounding veins associated with local lymphadenopathy. Computed tomography (CT) of the neck also showed a hypodense 0.6 cm × 0.8 cm × 1.2 cm lesion in the right middle lobe bronchus, causing complete occlusion and collapse of the right middle lobe of the lung. Fine‑needle aspiration cytology and a lymph node biopsy showed nongranulomatous lymphadenitis. The patient was started on fondaparinux 10 mg subcutaneously once daily. She was discharged on oral anticoagulants for 6 months. Repeat CT scan after 6 months showed dissolution of the lesion and reexpansion of the right lung.

Keywords: Lymphadenopathy, Middle lobe syndrome, Upper extremity deep vein thrombosis