0:00

So this is another kind of acute case, I think.

0:03

So this is another patient

0:05

who had white upper extremity swelling.

0:07

Now here, the diagnosis is pretty obvious why

0:10

this patient has swelling.

0:12

The right intra jugular vein is markedly expanded,

0:15

and there is an echogenic material within it,

0:18

and it doesn't compress, right?

0:20

So that's, and this, this, this

0:23

quad is almost floating in the vein.

0:25

Okay? Now then we look at the direction of flow.

0:29

So this is the subclavian artery for comparison,

0:32

the subclavian artery, like all peripheral arteries.

0:34

And we talk, we'll talk about, uh, uh,

0:37

about it a little bit later.

0:38

In the, in the, in those cases,

0:41

a peripheral artery should have nice phasic

0:46

waveform, or at least biphasic waveform

0:49

because it is supplying muscles, which is a high resistance

0:54

fat as opposed to, for example,

0:56

the liver or the brain, right?

0:57

So you need to see this high resistant stroke.

1:01

But when we look, so we on the right side, so the, um,

1:07

the, the, the right SubCal artery is, is, is here.

1:11

When we look at the right subclavian vein,

1:15

now the vein should be draining towards the center.

1:20

This is a transverse shoe, and now the heart will be here.

1:23

So it should be draining towards the heart.

1:24

So it should be going away from the transducer,

1:28

and yet it is blue.

1:30

So that means it is going away from the transducer wide

1:34

because there is a more central blockage.

1:37

The artery should be going mostly

1:40

this part towards the arm.

1:42

So it should be going towards the transgressor.

1:46

Okay, so here, uh, we can see that there is,

1:49

so there is a clot, but what is the explanation?

1:52

So this is in the internal jugular vein.

1:54

What is the explanation in the subclavian vein?

1:58

Well, then I have to worry.

2:00

What we would suggest is, first of all,

2:02

what we should do is look at the other side,

2:05

and if it's similar, then you have to suggest

2:07

that there is a central, um, blockage

2:12

occlusion of the SVC.

2:14

Uh, I'm not sure we looked at the other side,

2:16

but what I, I wanna share is this CT scan

2:20

who basically shows that there is a hotspot in the liver.

2:24

Okay? There's marked enhancement of what used

2:27

to be the quadric lobe.

2:28

And this is a tell, tell sign, which was initially, I think,

2:31

describing nuclear medicine, the hot spot in the liver.

2:35

And that indicates that there is an occlusion of the SVC.

2:39

And then there's some collaterals bypassing the,

2:42

and you can see here a bunch

2:43

of collaterals even on these patient subcutaneous, uh,

2:47

tissue here and on the, on the Corona as well.

2:51

And so that is an indication that there is a

2:55

more central SVCO collision.