ONLY 20-30% of patients with subclavian thrombosis developed pulmonary embolism just need rest elevation the arm start heparin for 10 days followed by oral anticoagulant  for three months and re-assess again the causes of thrombus if any defect in operation shunt will corrected 

NB: Serous condition can start thrombolytic therapy  for 48 hours followed by heparin

We would start by getting an ultrasound of the RUE to look for thrombus.  If present, we would treat with enoxaparin with transition to warfarin for 3 months.  Re-ustrasound in 3 months and if the thrombus is still present treat for another 3 months.  Did she have a PICC line in the RUE or was this an unprovoked thrombus?

thanks Dr Giglia , there was no PICC line in the RUE, most likely unprovoked thrombus . Hematology suggested autoimmune cause. Echo showed patent Glenn.CT  Chest showed left lower lobe pul embolism . Oxygen sat around 70%.