Venography

Diagnostic venography is performed by accessing the antecubital veins on the affected side. The patient is supine and the venogram is performed ideally with the arm at the patient's side and with the arm at right angles to the chest wall. Figures 52.1 and 52.2 demonstrate the venograms of patients with acute axillo-subclavian vein thrombosis. By contrast, Figure 52.2 shows a venogram with long-standing venous thrombosis of the axillo-subclavian vein. Note the extensive collateralization around the shoulder joint.

FIGURE 52.1 Venogram of a patient with less than 12 hours of symptoms of arm swelling, aching, and heaviness. The venogram shows abrupt cutoff of contrast with no visible collateral venous channels suggesting an acute thrombosis of the axillo-subclavian vein.
FIGURE 52.2 Venogram of an 18-year-old swimmer with 6 hours of onset of acute arm swelling, pain, and dusky discoloration, which reveals extensive thrombosis of the axillary and subclavian veins.
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