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)[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
- 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)[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

See Also

References

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.

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