Paget-Schroetter syndrome: Difference between revisions
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==Background== | ==Background== | ||
*axillary or subclavian vein | *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)<ref name="Alla">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.</ref> | ||
**Usually affects dominant arm | |||
*May be acute, subacute or chronic | |||
==Clinical Features== | ==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<ref name="Alla" /> | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==See Also== | ==See Also== | ||
*[[Deep venous thrombosis]] | |||
*[[DVT ultrasound]] | *[[DVT ultrasound]] | ||
==References== | ==References== | ||
<references/> | |||
[[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
Revision as of 23:49, 9 July 2017
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
- Lymphatic obstruction
- Necrotizing fasciitis
- Superficial thrombophlebitis
- SVC Syndrome
- Thoracic outlet obstruction/Pancoast tumor
Evaluation
- CBC, CMP, coags
- consider D-dimer
- Chest X-ray
- To rule out anatomic abnormalities or lung masses that might cause thoracic outlet obstruction
- Ultrasound with color Doppler
- Preferred initial test (sensitivity 78-100%, specificity 82-100%)
- MRI venography
- noninvasive, but expensive and limited availability
- Gold standard = contrast venography
- Use when ultrasound findings are equivocal but still have high clinical suspicion
Management
- Anticoagulation
- LMWH, Fondaparinux, Unfractionated Heparin
- Choice depends on further plans for intervention and disposition
- Bridge to Coumadin
- LMWH, Fondaparinux, Unfractionated Heparin
- Thrombolysis
- Catheter directed infusion of alteplase or urokinase
- For moderate to severe cases
- Surgical decompression
- For moderate to severe cases
Disposition
- Depends on the severity of symptoms and the acuity of presentation
- Mild/intermittent/chronic (>2weeks) symptoms
- Outpatient management with LMWH bridging to Coumadin
- Severe/acute presentation
- Admit, consult vascular surgery for thrombectomy or thrombolysis
- Mild/intermittent/chronic (>2weeks) symptoms