Paget-Schroetter Syndrome

Paget-Schroetter syndrome, also known as effort-induced axillary-subclavian vein thrombosis, is characterized by acute-onset swelling in the upper extremity, typically in young, active individuals (usually men). It is often precipitated by trauma or strenuous exercise involving arm abduction, cervical extension, and shoulder depression. The effects of such movements are magnified in the presence of a mechanical abnormality at the thoracic inlet, resulting in compression of the axillary-subclavian vein between a hypertrophied anterior scalene muscle or subclavius tendon and the first rib or a cervical rib.

Venography may show patent axillary and subclavian veins with no evidence of thrombus; however, venous collaterals may be seen. Venography during Adson maneuver (neck extension, head away from affected side, and a deep breath) can reveal dynamic obstruction of the axillary or subclavian veins.

Conservative management with rest, arm elevation, and anticoagulation have unacceptably high complication rates: pulmonary embolism (12%), venous distention (18%), and residual symptoms of swelling, pain, and superficial thrombophlebitis (70%). Therefore, thrombolysis with surgical decompression (e.g., resection of a cervical or first rib) is the favored treatment.

References

• Shah AD, Bajakian DR, Olin JW, Lookstein RA. Power-pulse spray thrombectomy for treatment of Paget-Schroetter syndrome. AJR Am J Roentgenol. 2007 May;188(5):1215-7.
• Yan BP, Kiernan TJ, Gupta V, Schainfeld RM, Garasic JM. Images in cardiovascular medicine. Over rehearsed: a cellist with Paget-Schroëtter. Circulation. 2008 Sep 16;118(12):e160-1.