Upper extremity venous aneurysm as a source of pulmonary emboli.

[thoracic outlet syndrome]

Spontaneous venous aneurysms of the upper extremities and neck are rare and typically asymptomatic . We present the first reported case of a symptomatic , primary upper extremity venous aneurysm in a patient who initially presented with pulmonary emboli . A 22 -year -old patient was admitted with chest pain , dyspnea , and a right axillary mass . Computed tomography revealed diffuse , bilateral pulmonary emboli in addition to a thrombosed axillary vein . Venography confirmed the diagnosis , and also revealed a subclavian vein stenosis at the crossing of the first rib . Pharmacomechanical thrombolysis , catheter-directed thrombolysis , and venoplasty were performed with adequate flow restoration , also revealing the presence of a previously thrombosed proximal brachial /distal axillary venous aneurysm . Hematologic testing showed a positive and persistent lupus anticoagulant . The patient declined surgical reconstruction and opted for long -term anticoagulation . At 24 months , the patient continued to remain symptom-free .