Paget-Schroetter syndrome - Revision history

ClaireLewis at 17:13, 1 October 2019

2019-10-01T17:13:23Z

← Older revision		Revision as of 17:13, 1 October 2019
Line 1:		Line 1:
	==Background==		==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)<ref name="Alla">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.</ref>		*[[Thromboembolism\|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)<ref name="Alla">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.</ref>
	*Usually affects dominant arm		*Usually affects dominant arm
	*May be acute, subacute or chronic		*May be acute, subacute or chronic
Line 6:		Line 6:
	==Clinical Features==		==Clinical Features==
	*Arm swelling, pain		*Arm swelling, pain
	*Redness of the upper extremity		*[[rash\|Redness]] of the upper extremity
	*Dilated, visible veins around the shoulder (Urschel’s sign)		*Dilated, visible veins around the shoulder (Urschel’s sign)
	*Most patients report a precipitating event, generally sports-related arm exertion<ref name="Alla" />		*Most patients report a precipitating event, generally sports-related arm exertion<ref name="Alla" />
Line 14:		Line 14:

	==Evaluation==		==Evaluation==
	*Doppler ultrasound is preferred test		*[[Ultrasound: DVT\|Doppler ultrasound]] is preferred test
	*CTV or MRV have higher sensitivity/specificity if continued clinical concern		*CTV or MRV have higher sensitivity/specificity if continued clinical concern
	*May also consider:		*May also consider:
	**[[CXR]] to evaluate for causes of thoracic outlet obstruction		**[[CXR]] to evaluate for causes of [[thoracic outlet obstruction]]
	**Laboratory testing		**Laboratory testing

	==Management==		==Management==
	[[File:PSS.jpg\|thumb\|Paget-Schroetter syndrome treatment]]		[[File:PSS.jpg\|thumb\|Paget-Schroetter syndrome treatment]]
	*Catheter-directed thrombolysis is first-line treatment for acute disease (<2-6 weeks duration)<ref name="Alla" />		*Catheter-directed [[thrombolysis]] is first-line treatment for acute disease (<2-6 weeks duration)<ref name="Alla" />
	*Consider surgical thoracic outlet decompression (TOD) for chronic disease or failure of catheter-directed thrombolysis		*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'''		*'''Anticoagulation alone is not recommended due to high rates of morbidity'''

ClaireLewis: /* Evaluation */

2017-07-12T18:35:45Z

Evaluation

← Older revision		Revision as of 18:35, 12 July 2017
Line 17:		Line 17:
	*CTV or MRV have higher sensitivity/specificity if continued clinical concern		*CTV or MRV have higher sensitivity/specificity if continued clinical concern
	*May also consider:		*May also consider:
	**CXR to evaluate for causes of thoracic outlet obstruction		**[[CXR]] to evaluate for causes of thoracic outlet obstruction
	**Laboratory testing		**Laboratory testing

Mholtz at 00:18, 10 July 2017

2017-07-10T00:18:48Z

← Older revision		Revision as of 00:18, 10 July 2017
Line 1:		Line 1:
	==Background==		==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)<ref name="Alla">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.</ref>		*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)<ref name="Alla">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.</ref>
	**Usually affects dominant arm		*Usually affects dominant arm
	*May be acute, subacute or chronic		*May be acute, subacute or chronic

Line 14:		Line 14:

	==Evaluation==		==Evaluation==
	*~~CBC, CMP, coags~~		*Doppler ultrasound is preferred test
	*~~consider D-dimer~~		*CTV or MRV have higher sensitivity/specificity if continued clinical concern
	*~~Chest X-ray~~		*May also consider:
	**~~To rule out anatomic abnormalities or lung masses that might cause~~ thoracic outlet obstruction		**CXR to evaluate for causes of thoracic outlet obstruction
	*Ultrasound with color Doppler		**Laboratory testing
	**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

	==Management==		==Management==
	~~#Anticoagulation~~		[[File:PSS.jpg\|thumb\|Paget-Schroetter syndrome treatment]]
	~~#*[[LMWH]], Fondaparinux,~~ [[~~Unfractionated Heparin~~]]		*Catheter-directed thrombolysis is first-line treatment for acute disease (<2-6 weeks duration)<ref name="Alla" />
	~~#**Choice depends on further plans for intervention and disposition~~		*Consider surgical thoracic outlet decompression (TOD) for chronic disease or failure of catheter-directed thrombolysis
	~~#**Bridge to [[Coumadin]]~~		*'''Anticoagulation alone is not recommended due to high rates of morbidity'''
	~~#Thrombolysis~~
	#*Catheter directed ~~infusion of alteplase or urokinase~~
	#*~~For moderate to severe cases~~
	~~#Surgical~~ decompression
	#*~~For moderate~~ to ~~severe cases~~

	==Disposition==		==Disposition==
	*Depends on the severity of symptoms and the acuity of presentation		*Admit
	**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==		==See Also==

Mholtz at 23:49, 9 July 2017

2017-07-09T23:49:39Z

← Older revision		Revision as of 23:49, 9 July 2017
Line 1:		Line 1:
	==Background==		==Background==
	*axillary or subclavian vein ~~thrombosis~~ associated with ~~strenuous and~~ repetitive ~~activity~~ of the upper ~~extremities affecting usually young athletic people~~		*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)<ref name="Alla">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.</ref>
			**Usually affects dominant arm
			*May be acute, subacute or chronic

	==Clinical Features==		==Clinical Features==
	*~~upper extremity~~ swelling ~~and discomfort~~, ~~usually unilateral~~		*Arm swelling, pain
	*~~redness~~ of the upper extremity		*Redness of the upper extremity
	*~~dilated~~ visible veins around the shoulder (Urschel’s sign)		*Dilated, visible veins around the shoulder (Urschel’s sign)
	*~~cyanosis~~		*Most patients report a precipitating event, generally sports-related arm exertion<ref name="Alla" />
	*may have a ~~discrete~~ precipitating event
	**usually sports-related arm exertion
	*may be acute, subacute or chronic

	==Differential Diagnosis==		==Differential Diagnosis==
Line 45:		Line 44:

	==See Also==		==See Also==
			*[[Deep venous thrombosis]]
	*[[DVT ultrasound]]		*[[DVT ultrasound]]
	*[[DVT (Deep Venous Thrombosis)]]

	==References==		==References==
	#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		<references/>
	~~#Chin E, Zimmerman P, Grant E. Sonographic Evaluation of Upper Extremity DVT. J Ultrasound Med, 2005; 24:829-838~~
	~~#Goshima K, White M. Overview of Thoracic Outlet Syndromes. UpToDate, 2012~~
	~~#Goshima K. Primary (spontaneous) Upper Extremity Deep Venous Thrombosis. UpToDate, 2013~~

	[[Category:Heme/Onc]]		[[Category:Heme/Onc]]

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-26T04:59:41Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 04:59, 26 July 2016
Line 14:		Line 14:
	{{Upper extremity swelling DDX}}		{{Upper extremity swelling DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*CBC, CMP, coags		*CBC, CMP, coags
	*consider D-dimer		*consider D-dimer

Neil.m.young: Text replacement - "Ultrasound: DVT" to "DVT ultrasound"

2016-07-18T01:47:15Z

Text replacement - "Ultrasound: DVT" to "DVT ultrasound"

← Older revision		Revision as of 01:47, 18 July 2016
Line 45:		Line 45:

	==See Also==		==See Also==
	*[[~~Ultrasound:~~ DVT]]		*[[DVT ultrasound]]
	*[[DVT (Deep Venous Thrombosis)]]		*[[DVT (Deep Venous Thrombosis)]]

Neil.m.young: Text replacement - " ==" to "=="

2016-07-07T23:19:29Z

Text replacement - " ==" to "=="

← Older revision		Revision as of 23:19, 7 July 2016
Line 11:		Line 11:
	*may be acute, subacute or chronic		*may be acute, subacute or chronic

	==Differential Diagnosis ==		==Differential Diagnosis==
	{{Upper extremity swelling DDX}}		{{Upper extremity swelling DDX}}

Ostermayer: /* Differential Diagnosis */

2015-12-10T13:08:35Z

Differential Diagnosis

← Older revision		Revision as of 13:08, 10 December 2015
Line 12:		Line 12:

	==Differential Diagnosis ==		==Differential Diagnosis ==
	*Thoracic outlet obstruction/Pancoast tumor		{{Upper extremity swelling DDX}}
	*lymphatic obstruction
	*[[SVC Syndrome]]
	*[[Cellulitis]]
	*[[Necrotizing Fasciitis]]

	==Diagnosis==		==Diagnosis==

Rossdonaldson1: /* Sources */

2015-07-18T13:16:41Z

Sources

← Older revision		Revision as of 13:16, 18 July 2015
Line 52:		Line 52:
	*[[DVT (Deep Venous Thrombosis)]]		*[[DVT (Deep Venous Thrombosis)]]

	==~~Sources~~==		==References==
	#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		#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
	#Chin E, Zimmerman P, Grant E. Sonographic Evaluation of Upper Extremity DVT. J Ultrasound Med, 2005; 24:829-838		#Chin E, Zimmerman P, Grant E. Sonographic Evaluation of Upper Extremity DVT. J Ultrasound Med, 2005; 24:829-838

Rossdonaldson1: /* Management */

2015-07-18T13:16:31Z

Management

← Older revision		Revision as of 13:16, 18 July 2015
Line 32:		Line 32:
	==Management==		==Management==
	#Anticoagulation		#Anticoagulation
	##[[LMWH]], Fondaparinux, [[Unfractionated Heparin]]		#*[[LMWH]], Fondaparinux, [[Unfractionated Heparin]]
	###Choice depends on further plans for intervention and disposition		#**Choice depends on further plans for intervention and disposition
	###Bridge to [[Coumadin]]		#**Bridge to [[Coumadin]]
	#Thrombolysis		#Thrombolysis
	##Catheter directed infusion of alteplase or urokinase		#*Catheter directed infusion of alteplase or urokinase
	##For moderate to severe cases		#*For moderate to severe cases
	#Surgical decompression		#Surgical decompression
	##For moderate to severe cases		#*For moderate to severe cases

	==Disposition==		==Disposition==