Discussion
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,