Abstract

A 42-year-old farmer presented in medicine OPD with history of painless swelling and distended veins over his left shoulder for 25 days. There was vague history of trauma to his upper chest while cutting fodder for his cattle. On suspicion of venous thrombosis, a doppler examination was done which revealed long segment thrombosis with complete occlusion of left brachiocephalic, axillary and left subclavian vein; with patent right subclavian vein and superior vena cava. His blood samples were drawn and sent to rule out common hypercoagulable states which came out to be negative with d-dimer raised. He was started on an overlap of enoxaparin and warfarin initially and was continued on warfarin for 12 weeks. He was followed with weekly INR. The patient improved with decrease in swelling and venous distension. The image [Figure 1] attached shows the dilated veins on his chest and left shoulder.