A Painless, Swollen Upper Limb

Author: Olivia Cox, Sarah Finlay / Editor: Stephen Sheridan / Codes: SLO1, VC3 / Published: 13/04/2026

A 31-year-old male presents to your Emergency Department (ED) with a 2-day history of swelling, prominent veins and some purplish discolouration of his right arm. The swelling is painless, but the medial aspect of the upper arm is mildly tender on palpation. He went to the gym 3 days ago but denies any trauma or injury. He mentions that he suffered a flu-like illness last week.

On examination his right arm is noticeably swollen compared to the left; upper arm circumference is 37cm on the right and only 34cm on the left. Pulses are present and strong bilaterally with CRT 2s, and neurology is normal. His observations are all within normal limits.

Blood results show: Hb 154, WCC 5.2, Platelets 217, INR 1.0, D-Dimer 345, Na 140, K 4.2, Cr 90, CK 428.