Young Woman With a Blue, Painful and Swollen Arm

A 32-year-old woman presented to the emergency department (ED) with 1 hour of right upper extremity pain, swelling, and discoloration. The swelling and discoloration started on waking, but she had been experiencing right upper extremity pain for the previous 2 weeks, for which she had a negative ultrasonographic result initially. The patient was previously healthy and engaged in yoga often. Her examination revealed an edematous, tender, and cyanotic right upper extremity with dilatated veins across the shoulder and upper arm (Urschel's sign) (Figure 1) compared with a normal left arm (Figure 2).

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