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Weekly Chest CasesArchive of Old Cases

Case No : 905 Date 2015-03-02

  • Courtesy of Jong Min Park, Jae-Kwang Lim / Kyungpook National University Hospital
  • Age/Sex 28 / M
  • Chief ComplaintSudden onset of left arm swelling, recent excessive physical activity
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Paget-Schroetter syndrome (Venous thoracic outlet syndrome)
Radiologic Findings
Initial non-enhance CT scan shows a high density area in the proximal level of left subclavian vein which is caused by upstream vessel dilatation.
CT venography shows a filling defect in the left subclavian vein with prominent collateral vessel formation. Also mild fat infiltration around the left subclavian vein thrombosis is noted.
Direct venogram reveals a filling defect in the left subclavian vein with dilated upstream vein and collateral vessel formation.
Surgical venous thrombectomy for left subclavian vein was performed. After taking an anticoagulant therapy for 6months, Doppler ultrasonography showed the patency of left subclavian vein.
Brief Review
Paget-Schroetter syndrome is also known as venous thoracic outlet syndrome (TOS) or subclavian vein effort thrombosis. It refers to axillary-subclavian vein thrombosis associated with strenuous and repetitive activity of the upper extremities. Anatomical abnormalities at the thoracic outlet and repetitive trauma to the endothelium of the subclavian vein are key factors in its initiation and progression.
Paget-Schroetter Syndrome is more common in young and otherwise healthy men. It preferentially involves the dominant arm. Swelling and arm discomfort are the most frequent presenting problems. Other symptoms include heaviness, redness of arm, cyanosis and dilated, visible veins across the shoulder and upper arm. Symptom onset is usually acute or sub-acute but an occasional patient can present with chronic symptoms. Not infrequently, symptoms can be nonspecific and can even mimic a muscular strain. Complications include pulmonary embolism, post-thrombotic syndrome and recurrent thrombosis.
Contemporary management of Paget-Schroetter Syndrome varies widely, and there is no broad consensus as to what constitutes the best approach. Conservative therapy is limb elevation and anticoagulation alone. Aggressive treatment strategies involve thrombolysis, thrombectomy, percutaneous and surgical venoplasty, venous bypass and stents.
References
1. Alla VMMD, Natarajan, NMD, Kaushik, MMD, Warrier RMD, Nair CKMD(2010) Paget-Schroetter Syndrome: Review of Pathogenesis and Treatment of Effort Thrombosis. West J Emerg Med 11(4):0
Keywords
Vascular, Chest wall, Vascular,

No. of Applicants : 108

▶ Correct Answer : 57/108,  52.8%
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Government Medical College, Nagpur, India , India Krishna Prasad Bellam
  • - Otsu Red Cross Hospital , Japan Hirotsugu Nakai
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - CHRU Lille , France Jeremy Hanckowiak
  • - CHRU Lille , France Julien Pagniez
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - CHRU Lille , France Paul Lebert
  • - university of montreal , Canada Andrei Gorgos I
  • - All India Institute of Medical Sciences , India Jitesh Ahuja
  • - Okinawa Kyodo Hospital , Japan Shoko Iraha
  • - CNUH , Korea (South) Noh Hoon
  • - Teaching Hospital, Kandy , Sri Lanka Devanath Premarathna
  • - University of the Ryukyus , Japan Nanae Tsuchiya
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - CH de la C�e Basque , France Paul ARDILOUZE
  • - Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
  • - Hopital du Sacre Coeur , Canada Andrea Ojanguren
  • - 異⑸ , Korea (South) Yunhee Jang
  • - All India Institute of medical sciences , India Justin Moses
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Asan Medical Center , Korea (South) Soyeoun Lim
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Kyung Hee University Hostpital at Gangdong , Korea (South) Jun-Hyung Lee
  • - The University of Tokyo , Japan Eisuke Shibata
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - Pamukkale University, Faculty of Medicine, Dept. of Radiology , Turkey Furkan Ufuk
  • - Pusan national university hostpital , Korea (South) hyunjung kang
  • - VHS medical center , Korea (South) Keuntak Roh
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - Pusan national university hospital , Korea (South) Hie Bum Suh
  • - Asan Medical Center , Korea (South) Jooae Choe
  • - CHU Poitiers , France CHAN paul
  • - IRSA La Rochelle , France Denis Chabassiere
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Gifu Central Hospital , Japan Haruo Watanabe
  • - Fukuyama City Hospital , Japan Mayu Uka
  • - Pusan national university hospital , Korea (South) Minkyu Kwak
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Pusan national university hospital , Korea (South) SeungHyun Lee
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - CNUH , Korea (South) LEE JONE EUN
  • - Ibaraki-gazou-shindan , Japan Shoichi Katoh
  • - Seoul National University Hospital , Korea (South) Sunkyung Jeon
  • - Medicheck health care , Korea (South) Chae Lim
▶ Correct Answer as Differential Diagnosis : 5/108,  4.6%
  • - Kyoto University , Japan Akihiko Sakata
  • - Avrasya Hospital , Turkey Murat Ulusoy
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - Pusan national university hospital , Korea (South) Jin Joo Kim
  • - Pusan national university of hospital , Korea (South) Jo ji eun
▶ Semi-Correct Answer : 36/108,  33.3%
  • - Haeundae Paik Hospital , Korea (South)
  • - radiologist, aditya imaging centre , India vivek patel
  • - Niigata University , Japan Atsushi Uehara
  • - University of British Columbia , Canada Amr Ajlan
  • - , Korea (South) YongSub Song
  • - Isfahan University Of Medical Sciences , Iran johary s
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Chonnam National University Hospital , Korea (South) So yeon Ki
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
  • - i.r.c.c.s.istituto scientifico romagnolo per lo studio e cura dei tumori , Italy Alice Rossi
  • - Severance hospital , Korea (South) SeungHyun Park
  • - Seoul National University Hospital , Korea (South) Hyoung-In Choi
  • - 媛€ , Korea (South) Jo Yeseul
  • - AP-HP , France Amir JAFF
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - kangbuk samsung , Korea (South) jihyun kim
  • - BANHA UNIVERSITY , Saudi Arabia ANAS ALI
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Chonnam national university hospital , Korea (South) INSOO JANG
  • - �stanbul , Turkey Ayhan Yilmaz
  • - KING SALMAN IBN ABDULAZIZ UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
  • - Seoul university hospital , Korea (South) Youngjin Ryu
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
  • - Dong-A University Hospital , Korea (South) Won Jin Choi
  • - , Korea (South) Chan Park
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - 異⑸ , Korea (South) Junghwan Kim
  • - Pusan national university hospital , Korea (South) So Park
  • - 遺€ , Korea (South) LEE JIN
  • - santosh hospital , India Pravin Mahadevappa
  • - GMC & Sir JJ Hospital, Mumbai, India. , India Gaurav Watane
  • - Busan national univercity hospital radiology department , Korea (South) Il-wan Son
  • - CLCC Rennes , France nicolas gautier
  • - Chungbuk national university , Korea (South) Yong Kim
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