Case Report A Paget-Schroetter Syndrome: Case Report and Literature Review
by Roeykens Amandine1*, De Decker Natacha1, Vincent Pol1, Cavenaile Jean Christophe2
1Emergency Care Department, HELORA Sint Joseph Hospital, Mons, Belgium
2Emergency Care Department, CHU Brugmann Hospital, Brussels, Belgium
*Corresponding author: Roeykens Amandine, Emergency Care Department, HELORA Sint Joseph Hospital, Mons, Belgium
Received Date: 04 March 2025
Accepted Date: 07 March 2025
Published Date: 10 March 2025
Citation: Amandine R, Natacha DD, Pol V, Christophe CJ (2025) A Paget-Schroetter Syndrome: Case Report and Literature Review. Ann Case Report. 10: 2210. https://doi.org/10.29011/2574-7754.102210
Abstract
Paget-Schroetter Syndrome (PSS), also known as 'effort thrombosis,' is a form of primary thrombosis affecting the subclavian vein at the costoclavicular junction. It is typically observed in young patients following repetitive and intense physical activities involving the shoulders and arms. Management often involves not only anticoagulation but also catheter-directed thrombolysis, along with first rib resection to prevent recurrence and complications [1]. Physiotherapy and rehabilitation should also be part of the management. This case report of Paget-Schroetter syndrome highlights the importance of anamnesis and physical examination for the appropriate management of the patient.
Keywords: Paget-Schroetter Syndrome (PSS); Urschel’s Sign, Thoracic Outlet Syndrome; Subclavian Vein Thrombosis; Pulmonary Embolism; Post-Thrombotic Syndrome (PTS); Thoracic Outlet Decompression (TOD); Axillary-Subclavian Vein Thrombosis (ASVT).
Introduction
Paget-Schroetter Syndrome (PSS), also known as 'effort thrombosis,' is a form of primary thrombosis affecting the subclavian vein at the costoclavicular junction. It is typically observed in young patients following repetitive and intense physical activities involving the shoulders and arms [2].
We are going to talk about a young man of 22 years old, that presented himself to the emergency room, with a problem of pain, swelling and cyanosis of his right upper limb.
The diagnosis of Paget-Schroetter Syndrome was made.
The outcome for the patient was favorable, but this case report highlights a clinical situation that can mistakenly be downplayed and misdiagnosed as a muscle tear. Given the serious complications of an undiagnosed subclavian vein thrombosis, such as pulmonary embolism [3], it is crucial to emphasize the importance of a thorough clinical examination in the emergency room and to avoid trivializing pain that is too quickly classified as muscular.
Case Report
A 22-years-old man visited the emergency department, on the first of December 2024, with complain of swelling and pain of the right upper arm. The pain started five days ago, when he was at the gym, and was carrying heavy loads. He first felt the pain, then his half right upper arm became blue. He did not lose strength or sensitivity of his right upper arm. The symptoms involved after 30 minutes, and came back the morning of his admission at the emergency department, five days later.
His vital signs upon arrival were as follows: Blood pressure 116/65 mm Hg, Heart rate 57 beats per minute, Temperature 36.5°C, Respiratory rate: 18/min, Oxygen saturation: 98%. The patient did not present with dyspnea, cough or hemoptysis.
The clinical examination reveals diffuse edema of the right upper limb and the presence of dilated collateral venous circulation of his shoulder and arm (known as Urschel's sign) (Figure 1 and 2). Cardiopulmonary auscultation was normal. The patient has no notable medical past, and was taking no medication at that time. The patient regularly attended the gym, 5 times a week.
Figure 1: Urschel’s sign: Dilated collateral venous circulation of the shoulder and upper limb.
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