Paget‐Schroëtter syndrome: What to do?

Sevestre, Marie‐Antoinette; Irwin, William T.; Ahari, Heideh K.; Schainfeld, Robert M.

doi:10.1002/ccd.10539

Cited by 13 publications

(6 citation statements)

References 19 publications

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“…Anticoagulation is the cornerstone of therapy and early thrombolysis is generally recommended to restore venous patency, minimize damage to the endothelium and reduce the risk of long term complications especially post-thrombotic syndrome. 3,6,7 Besides, many surgeons are in favor of early correction of anatomy, in case extrinsic compression is unmasked. 7 In our patient, as anticoagulant and antiaggregant therapy sufficed to resolve the thrombus, thrombolysis was not performed.…”

Section: Discussionmentioning

confidence: 99%

“…3,6,7 Besides, many surgeons are in favor of early correction of anatomy, in case extrinsic compression is unmasked. 7 In our patient, as anticoagulant and antiaggregant therapy sufficed to resolve the thrombus, thrombolysis was not performed. Herein, the use of an antiaggregant would be questioned; we prescribed acetylsalicylic acid because the possibility of a concomitant thrombotic event of arterial origin could not be definitely ruled out at the time of initial diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Paget-Schroetter Syndrome Forerunning the Diagnoses of Thoracic Outlet Syndrome and Thrombophilia

Özçakar

Dönmez

Yörübulut

et al. 2009

Clin Appl Thromb Hemost

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Reported here is a 22-year-old professional wrestler who was diagnosed to have Paget-Schroetter syndrome after Greco-Roman wrestling. On substantial neuromuscular examination and laboratory testing, he was found to have also thoracic outlet syndrome and heterozygous mutations for factor V Leiden and methyltetrahydrofolate reductase genes. To the best knowledge of the authors, the concomitance of these pathologies is discussed for the first time in the literature.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Paget-Schroetter Syndrome Forerunning the Diagnoses of Thoracic Outlet Syndrome and Thrombophilia

Özçakar

Dönmez

Yörübulut

et al. 2009

Clin Appl Thromb Hemost

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“…The best timing for surgical decompression has been debated and remains controversial, with the options being immediate surgery during the initial hospitalization or thrombolysis and several months of warfarin therapy combined with delayed surgical treatment. 9 The proposed advantages of immediate surgery include a shorter period of anticoagulation therapy, less chance of rethrombosis, and a potential quicker return to athletic activities. In our case, timely surgical decompression was undertaken 8 weeks after thrombolysis (with a preoperative venogram confirming no recurrent thrombus formation).…”

Section: Discussionmentioning

confidence: 99%

Paget-Schroetter Syndrome in a Collegiate Football Player

Hendrickson

Godek²,

Schmidt³

2006

Clinical Journal of Sport Medicine

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E ffort-induced venous thrombosis of the upper extremity (Paget-Schroetter syndrome) occurs in young, athletic individuals who routinely engage in strenuous upper extremity exercise. 1 A recently published case report by Chaudhry and Hajarnavis 2 in this journal outlined the conservative management of a 40-year-old male diagnosed with this syndrome. Our case highlights aggressive management with prompt thrombolytic therapy, short-term anticoagulation, and subsequent surgical decompression resulting in successful return to sports activity (Division IA football). CASE REPORTA 20-year-old male football player first presented to the training room with a 2-day history of persistent left axillary pain and swelling. He noted the pain was exacerbated by weight-lifting activities. He denied fevers, rash, or left arm numbness, and there was no history of direct trauma. His symptoms persisted for 2 days despite ibuprofen and a significant reduction in his upper extremity resistance training (he remained an active participant at football practice).Physical examination revealed a well-developed, muscular black male in no distress. He was afebrile with a normal pulse and respiratory rate. A localized area of swelling and tenderness was noted in the left axilla with some firmness on palpation at the tender site. No increased warmth or erythema was evident, and the overlying skin was intact. Range of motion of the left upper extremity was full, and discomfort was noted with abduction and forward flexion greater than 90°. Arm strength was good. The distal pulses were strong, and sensation was intact. When supine, the prominent superficial venous structures noted in both extremities at baseline were questionably slightly more dilated in the left upper extremity.A duplex ultrasound study revealed axillosubclavian vein thrombosis, with extension into the basilar vein. A subsequent venogram confirmed the duplex results, with evidence of extrinsic compression at the thoracic outlet. A chest x-ray was normal, with no evidence of cervical ribs.Intravenous thrombolytic therapy was initiated (retaplase infusion). Intravenous infusions of a platelet aggregation inhibitor (abciximab) and an anticoagulant (heparin) were also added, and follow-up venograms (12 hours and 36 hours after treatment initiation) showed some interval lysis of the thrombus. The patient was transitioned to warfarin before discharge and returned 8 weeks later for surgical decompression (modified scalenectomy and first rib resection). A presurgery venogram showed the left subclavian vein to be patent with moderate residual narrowing and no acute thrombus in the neutral position (arm touching the chest wall). With the arm at 90°o f abduction, the subclavian vein became completely occluded with the appearance of collaterals (Fig. 1).After successful surgical decompression, anticoagulation was resumed. Gradual reintroduction of upper extremity strength training began 1 month after surgery. Two months after surgery, the warfarin was stopped, and clearance was given for full...

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“…Postthrombotic syndrome is a common consequence associated with chronic venous hypertension, with incidence estimates of 27.3% to 49.0%. 16,22,23 Symptoms may range from mild discomfort and edema to significant pain and dysfunction, although severe complaints are rare. 2 The incidence of postthrombotic syndrome remains problematic even years after thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of a Rare Source of Upper Extremity Symptoms in a Healthy Female After Weight Lifting

Hegedus

Cooper²,

Cook³

2006

J Orthop Sports Phys Ther

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3Study Design: Resident's case problem. Background: The popularity of weight training has increased dramatically during the past 20 years. With the increase in popularity of weight training, the rate of injury has also increased dramatically. The types of injuries range from benign to life threatening. Diagnosis: The patient was a 21-year-old woman originally referred for pelvic pain who presented with new complaints of right upper extremity swelling, discomfort, and cyanosis after recently beginning a comprehensive weight-lifting program. Additional signs, including paresthesias, decreased pulses, and venous distension, warranted a timely referral by the physical therapist back to the referring physician. Discussion: The primary injury in this case report was hypothesized to have been induced by the recent start of a weight-lifting program, with no other significant contributing risk factors. A comprehensive examination by the physical therapist revealed clinical signs of an upper extremity deep vein thrombosis, leading to a same-day referral back to the referring physician. Further research, resulting in a clinical decision rule for upper extremity deep vein thrombosis or estimates of diagnostic accuracy of clinical signs and symptoms, would improve the diagnostic process.

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Paget‐Schroëtter syndrome: What to do?

Cited by 13 publications

References 19 publications

Paget-Schroetter Syndrome Forerunning the Diagnoses of Thoracic Outlet Syndrome and Thrombophilia

Paget-Schroetter Syndrome Forerunning the Diagnoses of Thoracic Outlet Syndrome and Thrombophilia

Paget-Schroetter Syndrome in a Collegiate Football Player

Diagnosis of a Rare Source of Upper Extremity Symptoms in a Healthy Female After Weight Lifting

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