Trauma is not required, however. Signs and symptoms. The whole arm often becomes swollen to a variable degree. While swelling is the most common presenting finding, sometimes it becomes apparent only after arm exercise. Physical examination demonstrates nonpitting edema in virtually all patients.
Pulses are normal, and the arm often has a dusky color and mottling.
Palpable cords are inconsistently present in the axilla or proximal arm, and tenderness may be present along the brachial and axillary veins. Color flow duplex ultrasonography can usually be used to diagnose the condition, but false-negative results can occur, as in this patient. The diagnosis may require confirmation with venography, which also provides IV access for treatment. This often led to the need for job reclassification or even to disability. Immediate treatment with IV heparin for 4 to 7 days is important to halt clot propagation, and local, catheter-directed urokinase in the acute phase is now the most effective modality for achieving thrombolysis and vein patency.