A Rare Case of Compartment Syndrome due to Massive Superficial Vein Thrombosis
Author : A.C. Undarsa, V.A. Damay, M. Aziz, E. Oepangat
Upload Date : 19-04-2018
Introduction: Superficial vein thrombosis(SVT) is usually underestimated as mostly self-limiting and rarely causes complication.
Case Presentation: A-37-years-old-woman with unknown past medical history complained worsening of dyspnea-on-exertion a day prior admission. Electrocardiogram showed sinus tachycardia while echocardiography revealed dilated cardiomyopathy, LVEF 14% and thick spontaneous echo contrast in both ventricles. She was diagnosed with acute decompensated heart failure with metabolic acidosis. IV line for acidosis correction was inserted on her right palmar vein. Few hours later, pain and swelling occurred on her right hand and IV catheter was removed.
The following day, manifestations of acute compartment syndrome such as worsening pain and swelling, bluish discoloration, cold in palpation and weak radial pulse were shown on her right arm. CT-angiography showed total occlusion of right radial, ulnar until distal branch digitalis arteries. Patient underwent fasciotomy and massive superficial venous thrombus up to elbow portion was revealed during surgery. Venography was then exposed severe thrombosis on distal right cephalic vein until mid-humerus region, mild thrombosis median cubital until mid-basilica vein. Hereby assured diagnosis of massive SVT leading to compartment syndrome. Over next several days, occlusive symptoms and edema showed remarkable improvement with continued anticoagulation.
Discussion: Vein thrombus causing compartment syndrome had only been reported in deep vein cases as phlegmasia cerulea dolens, but none in superficial veins yet. Although rare, bicarbonate infusion may be considered as cause of massive thrombophlebitis shown in this case. Chemical reaction itself is uncommon to cause such a devastating case, therefore other vein thrombosis predisposing factors in this patient such as cardiac failure which can coincidentally deteriorate the manifestations should not be missed, although malignancy and hypercoagulability could not be excluded yet.
Conclution:Superficial thrombophlebitis should not be underestimated as it may lead to deteriorating events such as compartment syndrome which could threat limb even patient’s life especially when other comorbid disease coincides.
KEYWORDS : Superficial vein thrombosis, Thrombophlebitis, Phlegmasia Cerulea Dolens, Compartment syndrome