Paget-Schroetter syndrome

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Background

  • Thrombosis of the axillary and/or subclavian vein associated with repetitive movements of the upper extremity, such as those with sporting events (e.g. swimming, wrestling, etc)[1]
  • Usually affects dominant arm
  • May be acute, subacute or chronic

Clinical Features

  • Arm swelling, pain
  • Redness of the upper extremity
  • Dilated, visible veins around the shoulder (Urschel’s sign)
  • Most patients report a precipitating event, generally sports-related arm exertion[1]

Differential Diagnosis

Evaluation

  • Doppler ultrasound is preferred test
  • CTV or MRV have higher sensitivity/specificity if continued clinical concern
  • May also consider:
    • CXR to evaluate for causes of thoracic outlet obstruction
    • Laboratory testing

Management

Paget-Schroetter syndrome treatment
  • Catheter-directed thrombolysis is first-line treatment for acute disease (<2-6 weeks duration)[1]
  • Consider surgical thoracic outlet decompression (TOD) for chronic disease or failure of catheter-directed thrombolysis
  • Anticoagulation alone is not recommended due to high rates of morbidity

Disposition

  • Admit

See Also

References

  1. 1.0 1.1 1.2 Alla, V. M., Natarajan, N., Kaushik, M., Warrier, R., & Nair, C. K. (2010). Paget-Schroetter Syndrome: Review of Pathogenesis and Treatment of Effort Thrombosis. Western Journal of Emergency Medicine, 11(4), 358–362.