Paget-Schroetter syndrome: Difference between revisions
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==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 | ||
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==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" /> | ||
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==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''' | ||
Latest revision as of 17:13, 1 October 2019
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
Upper extremity swelling
- Cellulitis
- Deep venous thrombosis
- Lymphatic obstruction
- Necrotizing fasciitis
- Superficial thrombophlebitis
- SVC Syndrome
- Thoracic outlet obstruction/Pancoast tumor
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
- 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