Paget–Schroetter disease

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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W8MD medical weight loss NYC and sleep center NYC

Paget–Schroetter disease
Illustration of the subclavian vein
Synonyms	Effort thrombosis
Pronounce	N/A
Specialty	Vascular surgery, Cardiology
Symptoms	Swelling, pain, cyanosis of the affected limb
Complications	Pulmonary embolism, post-thrombotic syndrome
Onset	Sudden
Duration
Types	N/A
Causes	Repetitive overhead arm activity, anatomical abnormalities
Risks	Athletes, manual laborers
Diagnosis	Ultrasound, venography
Differential diagnosis	Deep vein thrombosis, thoracic outlet syndrome
Prevention	Avoidance of repetitive overhead activities
Treatment	Anticoagulation, thrombolysis, surgery
Medication	Heparin, warfarin
Prognosis	Generally good with treatment
Frequency	Rare
Deaths	N/A

Paget–Schroetter disease, also known as effort thrombosis, is a form of deep vein thrombosis (DVT) that affects the upper extremity. It is characterized by the formation of a blood clot in the subclavian vein or axillary vein, often associated with strenuous activity or repetitive motion of the arm.

Pathophysiology

Paget–Schroetter disease occurs when there is compression of the subclavian vein at the thoracic outlet, leading to venous stasis and subsequent thrombosis. This condition is often seen in young, healthy individuals who engage in activities that involve repetitive overhead arm movements, such as weightlifting, swimming, or baseball pitching.

Clinical Presentation

Patients with Paget–Schroetter disease typically present with sudden onset of swelling, pain, and cyanosis of the affected arm. There may also be visible collateral circulation on the chest wall due to the obstruction of the main venous outflow.

Diagnosis

The diagnosis of Paget–Schroetter disease is usually confirmed through imaging studies. Doppler ultrasound is often the first-line investigation, but venography or magnetic resonance imaging (MRI) may be used for more detailed assessment.

Treatment

Treatment of Paget–Schroetter disease involves a combination of anticoagulation therapy, thrombolysis, and sometimes surgical intervention. The goal is to dissolve the clot, relieve the venous obstruction, and prevent recurrence. In some cases, thoracic outlet decompression surgery may be necessary to relieve the compression on the subclavian vein.

Prognosis

With appropriate treatment, the prognosis for Paget–Schroetter disease is generally good. However, there is a risk of post-thrombotic syndrome and recurrence if the underlying anatomical abnormalities are not addressed.

See also

• Deep vein thrombosis
• Thoracic outlet syndrome
• Venous thrombosis