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Approach to Paget-Schroetter Syndrome: A Case Study & Treatment Guidelines

Learn about the presentation, etiology, diagnosis, and treatment of Paget-Schroetter Syndrome, with a focus on a real case study. Understand the importance of a multi-disciplinary team approach in managing this condition.

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Approach to Paget-Schroetter Syndrome: A Case Study & Treatment Guidelines

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<?xml version="1.0"?><AllAnswers /> Spontaneous Upper Extremity Venous Thrombosis: The Approach to a Patient With Paget-Schroetter Syndrome James Ocampo, MD, and Andre Sofair, MD Primary Care Internal Medicine Residency, New Haven, CT • Learning Objectives • Understand the presentation of Paget-Schroetter Syndrome (PSS) • Review etiology of PSS • Discuss the diagnostic evaluation of PSS • Become familiar with the different treatment approaches • Recognize that treatment requires a multi-disciplinary team approach Case Presentation • 38 yo right-handed male p/w 2 days of RUE pain and swelling • Plays in a bowling league and works in construction • Noticed blue veins in his right chest and right shoulder • Family Hx: Sister has APLS • Labs: +ACL Ab, heterozygous mutation for MTHFR gene Etiology of PSS • AKA spontaneous axillosubclavian vein thrombosis • Often occurs after strenuous use of the arm or shoulder • Anatomic predisposition • Hypercoagulable state Diagnostic Testing Treatment • Case Continued • 16 days later, the patient has worsening right arm swelling • Ulltrasound revealed subclavian vein stenosis with further extension of clot • He was re-admitted to the hospital for administration of TPA • Flow was restored and symptoms improved • Patient was discharged home • Patient then underwent surgery for right scalene muscle release • He is currently being maintained on Warfarin and is doing well • Discussion • The etiology of his PSS is likely multi-factorial: hypercoagulable state and anatomic predisposition • Patients present with dull pain in the shoulder and axilla with swelling of the arm • Dilation of collateral veins may be noted on physical exam • Ultrasound, venograms, and CT scans are useful in the diagnosis of PSS • Therapeutic options include anti-coagulant therapy, fibrinolytic therapy, and surgical therapy • Treatment decisions should be made by a multi-disciplinary team of specialists

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