SPR Unknown #83 -- FINAL

Thomas Gast, MD

Wyers, Mary

Children's Memorial Hospital

Abstract

13 y.o male with history of right upper extremity swelling.

Keywords

1434 subclavian vein thrombosis, clot, unilateral upper extremity swelling, DVT, paget schroetter, thoracic outlet obstruction, spr unknown 83


Publication Date: 2008-06-26

History

13 y.o male with history of right upper extremity swelling and prominent right arm veins. Patient denies trauma, however, states he has been weight lifting.

Findings

Doppler and color flow images of the right axillary, subclavian, internal jugular and inominate veins. An echogenic filling defect can be seen within the right subclavian vein at the level of the armpit. Only a scant amount of flow is detected throught the subclavian vein along the peripheral margin. At least one large dilated vessel can be seen branching from the axillary vein just prior to the filling defect.

Diagnosis

Paget-Schroetter syndrome: Right subclavian vein thrombosis

Discussion

Paget-Schroetter syndrome also known as "effort thrombosis": A form of thoracic outlet syndrome with compression and thrombosis of the axillo-subclavian vein by muscular / skeletal or ligamentous structures, related to repetetive or strenuous upper extremity activity. Can be seen in weight lifters, wrestlers, swimmers, and other sports with strenuous upper extremity activity, especially retroversion, hyperabduction and extension of the arm. More common in younger patients, average age 31 years

Etiology is chronic repetetive trauma to endothelium and thoracic outlet anatomic abnormalities including hypertrophy of the subclavius and scalenus muscles, rib abnormalities, and possibly hypercoagulable states (controversial).

Imaging findings: thrombosis or abnormal flow in subclavian or axillary vein, collaterals, findings may be accentuated with stress. Look for bony abnormalities of thoracic outlet.

Therapy: catheter directed thrombolysis and possible thoracic outlet decompression surgery

References

  1. Venkata M et al. "Paget-Schroetter Syndrome: Review of Pathogenesis and Treatment of Effort Thrombosis" West J Emerg Med. 2010 September; 11(4): 358–362

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