Extensive venous thrombosis of the upper extremity in a diabetic patient with a hyperosmolar hyperglycemic state

We report a case of extensive venous thrombosis of the upper extremity in a patient with a hyperosmolar hyperglycemic state (HHS). Thrombosis of the upper extremities is generally found in 4% of cases with deep venous thrombosis. Extensive, symptomatic venous thrombosis of the upper extremity, as seen in this patient, is rare except with catheter-related thrombosis. Recent studies have supported the safety and efficacy of catheter-directed thrombolysis in patients with no contraindication to thrombolytic therapy, and have recommended early catheter-directed thrombolysis. Therefore, our patient was treated with early catheter-directed thrombolysis followed by anticoagulation.