Paget-Schroetter syndrome

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  • axillary or subclavian vein thrombosis associated with strenuous and repetitive activity of the upper extremities affecting usually young athletic people

Clinical Features

  • upper extremity swelling and discomfort, usually unilateral
  • redness of the upper extremity
  • dilated visible veins around the shoulder (Urschel’s sign)
  • cyanosis
  • may have a discrete precipitating event
    • usually sports-related arm exertion
  • may be acute, subacute or chronic

Differential Diagnosis


  • CBC, CMP, coags
  • consider D-dimer
  • Chest X-ray
    • To rule out anatomic abnormalities or lung masses that might cause thoracic outlet obstruction
  • Ultrasound with color Doppler
    • Preferred initial test (sensitivity 78-100%, specificity 82-100%)
  • MRI venography
    • noninvasive, but expensive and limited availability
  • Gold standard = contrast venography
    • Use when ultrasound findings are equivocal but still have high clinical suspicion


  1. Anticoagulation
  2. Thrombolysis
    • Catheter directed infusion of alteplase or urokinase
    • For moderate to severe cases
  3. Surgical decompression
    • For moderate to severe cases


  • Depends on the severity of symptoms and the acuity of presentation
    • Mild/intermittent/chronic (>2weeks) symptoms
      • Outpatient management with LMWH bridging to Coumadin
    • Severe/acute presentation
      • Admit, consult vascular surgery for thrombectomy or thrombolysis

See Also


  1. Alla V, Ntarajan N, Kaushik M, Warrier R, Nair C. Paget-Schroetter Syndrome: Review of Pathogenesis and Treatment of Effort Thrombosis. Western Journal of Emergency Medicine, Vol XI, No 4, 2010, p 358
  2. Chin E, Zimmerman P, Grant E. Sonographic Evaluation of Upper Extremity DVT. J Ultrasound Med, 2005; 24:829-838
  3. Goshima K, White M. Overview of Thoracic Outlet Syndromes. UpToDate, 2012
  4. Goshima K. Primary (spontaneous) Upper Extremity Deep Venous Thrombosis. UpToDate, 2013