Paget-Schroetter syndrome: Difference between revisions
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==Background== | ==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)<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> | *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 | *May be acute, subacute or chronic | ||
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==Evaluation== | ==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== | ==Management== | ||
[[File:PSS.jpg|thumb|Paget-Schroetter syndrome treatment]] | |||
*Catheter-directed thrombolysis is first-line treatment for acute disease (<2-6 weeks duration)<ref name="Alla" /> | |||
*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== | ==Disposition== | ||
*Admit | |||
==See Also== | ==See Also== | ||
Revision as of 00:18, 10 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
- 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
- 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