Upper, extremity deep vein thrombosis and chronic pulmonary embolism resulting in pulmonary artery hypertension

U pper-extremity deep vein thrombosis (DVT) was until recently considered relatively uncommon, generally benign, and self-limited, with a low incidence of associated complications and sequelae [1]. However, over the past several years, recognition ofupper-extremity DVT and its complications related to thoracic outlet syndrome and central venous catheters has increased. Furthermore, up to 25% of pulmonary emboli are now thought to originate from upper-extremity DVT [2]. These emboli can be fatal [3]. We describe the case of a young man with recurrent pulmonary embolism that, despite anticoagulation therapy, eventually resulted in severe pulmonary hypertension. Upper-extremity DVT related to thoracic outlet syndrome was eventually diagnosed and treated but not before his pulmonary hypertension had reached an advanced state.