Paget-Schroetter syndrome

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)
• 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

Differential Diagnosis

Upper extremity swelling

• Cellulitis
• Deep venous thrombosis
  • Paget-Schroetter syndrome
• 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

Paget-Schroetter syndrome treatment

• Catheter-directed thrombolysis is first-line treatment for acute disease (<2-6 weeks duration)
• 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

• Deep venous thrombosis
• DVT ultrasound