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Paget-Schroetter Syndrome

Paget-Schroetter syndrome is the spontaneous thrombosis of the deep veins of the upper limb – axillary or subclavian vein. Earliest description was by Cruveilhier in 1816. A detailed description was given by James Paget in 1875. von Schroetter discovered vessel trauma from muscle overactivity as a potential cause of the thrombosis in 1884. Paget-Schroetter syndrome is also known as effort thrombosis because it is often associated with activities involving hyperabduction of the upper limbs. Sudden jerky movements cause axillary vein to be crushed between clavicle and the first rib. This can damage the intima of the vein and initiate thrombosis. The syndrome is also associated with thoracic outlet syndrome due to similar compressive reasons. Painful swelling of the limb is an important manifestation of the Paget-Schroetter syndrome. The diagnosis is confirmed by compression ultrasonography or venography. Other diagnostic modalities used are CT venography and MR venography. Treatment is by thrombolysis and anticoagulation. Catheter directed thrombolysis is another option. Surgical options are needed only for those with persistent symptoms of thoracic outlet compression. Important differential diagnoses include lymphangitis, lymphatic obstruction and intramuscular hemorrhage. Web: https://johnsonfrancis.org/profession...