Paget-Schroetter syndrome
Revision as of 17:13, 1 October 2019 by ClaireLewis (talk | contribs)
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