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Orville Horwitz, M.D.; Harry F. Zinsser Jr., M.D.
JAMA. 1953;151(12):997-998. doi:10.1001/jama.1953.02940120031005e.
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The occurrence of edema and pain in one arm of a woman in her middle forties would not immediately suggest the diagnosis of venous obstruction caused by a congenital anomaly. Instead, one first might consider a commoner and more serious cause, such as malignant disease of the breast with lymphatic obstruction. In this particular case, physical signs pointed to venous rather than lymphatic obstruction as the cause of symptoms.

In order of frequency, the causes of unilateral obstruction of veins of the upper extremity are (a) venous thrombosis, particularly in patients with congestive heart failure or in cachectic states, (b) masses of neoplastic or other origin causing compression at various sites along the venous drainage of the upper extremity, and (c) congenital lesions manifesting themselves either early or late in life. Instances of venous obstruction caused by congenital lesions manifesting themselves late in life are relatively rare, and for this


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