The association of unusual site of an idiopathic deep vein thrombosis and chylothorax in an adult

Deep vein thrombosis (DVT) usually presents with pain, swelling, and tenderness, but very uncommonly does it occur in the left cervical region. The association of a DVT with chylothorax as a complication in adults is very uncommon. We present a 53 year-old female that complained of a progressive painful left lower neck swelling and redness for 2 days. These symptoms were preceded by transient painful and erythematous swelling in her left axillary region one week prior to admission. Physical exam was remarkable for tender erythematous swelling around left lower cervical and supraclavicular regions, and peripheral venous dilatations of left upper chest wall and proximal left upper extremity. Work-up with x-ray and CT scan of the chest revealed mild-to-moderate sized right-sided pleural effusion without mediastinal abnormalities. Thoracentesis revealed findings consistent with chylothorax. An inconclusive mammogram lead to additional imaging with ultrasound that yielded an unusual site of thrombosis in the left subclavian and external jugular veins. Especially in adults, this site of DVT is very uncommon, and more so, was the associated complication of chylothorax, with an unremarkable history and an unyielding work-up, etiology of such an unusual site of DVT was not found.