Abstract
Primary "spontaneous" upper extremity deep vein thrombosis is uncommon and is defined as thrombosis of the deep veins draining the upper extremity due to anatomic abnormalities of the thoracic outlet causing axillosubclavian compression and next thrombosis. The syndrome is accurately termed venous thoracic outlet syndrome but is likewise called Paget-Schroetter syndrome, and rather as "effort" thrombosis.1 An aggressive treatment technique that consists of anticoagulation, catheter-directed thrombolysis or thoracic outlet decompression is done towards relieving acute signs and symptoms and minimizing complications, like recurrent thromboembolism and post-thrombotic syndrome. Here we report a 45 old female, a coolie by profession, came with complaints of left arm swelling and pain for one month duration. On evaluation, patient found to have substantial thrombosis of subclavian, axillary and basilic veins, without any other cause and diagnosed to be primary spontaneous in nature. Patient was then managed with anticoagulants and discharged with the advice of regular follow up.
References
- Illig KA, Doyle AJ. A comprehensive review of Paget-Schroetter syndrome. J Vasc Surg 2010; 51:1538 10. Lindblad B, Tengborn L, Bergqvist D. Deep vein thrombosis of the axillary-subclavian veins: epidemiologic data, effects of different types of treatment and late sequelae. Eur J Vasc Surg 1988; 2:161.
- Isma N, Svensson PJ, Gottsäter A, Lindblad B. Upper extremity deep venous thrombosis in the populationbased Malmö thrombophilia study (MATS). Epidemiology, risk factors, recurrence risk, and mortality.
- Thromb Res 2010; 125:e335.Sajid MS, Ahmed N, Desai M, BakerD, Hamilton G. Upper limb deep vein thrombosis: a literature review to streamline the protocol for management. Acta Haematol 2007;118:10-8.
- Alla VM, Natarajan N, Kaushik M, et al. Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. West J Emerg Med 2010; 11:358.
- Aziz S, Straehley CJ, Whelan TJ Jr. Effort-related axillosubclavian vein thrombosis. A new theory of pathogenesis and a plea for direct surgical intervention. Am J Surg 1986; 152:57.
- Bahm J. Critical review of pathophysiologic mechanisms in thoracic outlet syndrome (TOS). Acta Neurochir Suppl 2007; 100:137.
- Mustafa S, Stein PD, Patel KC, et al. Upper extremity deep venous thrombosis. Chest 2003; 123:1953.
- Paget, J. Clinical lectures and essays. Longmen Green and Co, 1875.
- Von Schroetter, L. Erkrankungen der Gefasse. In: Nathnagel Handbuch der Pathologie und Therapie, Anonymous Wein, Holder, 1884.
- HUGHES ES. Venous obstruction in the upper extremity; Paget-Schroetter's syndrome; a review of 320cases. Surg Gynecol Obstet 1949; 88:89.
- Drapanas T, Curran WL. Thrombectomy in the treatment of "effort" thrombosis of the axillary and subclavian veins. J Trauma 1966; 6:107.
- Lindblad B, Tengborn L, Bergqvist D. Deep vein thrombosis of the axillary-subclavian veins: epidemiologicdata, effects of different types of treatment and late sequelae. Eur J Vasc Surg 1988; 2:161.
- Horattas MC, Wright DJ, Fenton AH, et al. Changing concepts of deep venous thrombosis of the upper extremity--report of a series and review of the literature. Surgery 1988; 104:561.
- Flinterman LE, Van Der Meer FJ, Rosendaal FR, Doggen CJ. Current perspective of venous thrombosis in the upper extremity. J Thromb Haemost 2008; 6:1262.
- Swinton NW Jr, Edgett JW Jr, Hall RJ. Primary subclavian-axillary vein thrombosis. Circulation 1968;38:737.
- Fisher JB, Granson MA. Congenital venous web causing subclavian vein obstruction: a case report. J VascSurg 1989; 10:460.
- Johansen KH, Thomas GI. Late thoracic outlet syndrome secondary to malunion of the fractured clavicle:case report and review of the literature. J Trauma 2002; 52:607.
- Jain S, Monbaliu D, Thompson JF. Thoracic outlet syndrome caused by chronic retrosternal dislocation of the clavicle. Successful treatment by transaxillary resection of the first rib. J Bone Joint Surg Br 2002;84:116.
- Duane TM, O'Connor JV, Scalea TM. Thoracic outlet syndrome resulting from first rib fracture. J Trauma2007; 62:231.
- Peivandi MT, Nazemian Z. Clavicular fracture and upper-extremity deep venous thrombosis. Orthopedics2011; 34:227.
- Primary (spontaneous) upper extremity deep vein thrombosis Author: Kaoru Goshima, MD Section Editors: John F Eidt, MD, Joseph L Mills, Sr, MD Deputy Editor: Kathryn A Collins, MD, PhD, FACS. Jul 2017.
- Héron E, Lozinguez O, Emmerich J, et al. Long-term sequelae of spontaneous axillary-subclavian venousthrombosis. Ann Intern Med 1999; 131:510.
- Urschel HC Jr, Razzuk MA. Paget-Schroetter syndrome: what is the best management? Ann Thorac Surg2000; 69:1663.
- DiFelice GS, Paletta GA Jr, Phillips BB, Wright RW. Effort thrombosis in the elite throwing athlete. Am JSports Med 2002; 30:708.
- Gross CM, editor. Gray's anatomy, Anatomy of the Human Body. 28th American ed. Philadelphia: Lea and Febiger; 1966. p. 730.
- Pandolfi M, Robertson B, Isacson S, Nilsson IM. Fibrinolytic activity of human veins in arms and legs. Thromb Diath Haemorrh. 1968; 20:247–56. [PubMed]
- Robertson BR, Pandolfi M, Nilsson IM. Response of local fibrinolytic activity to venous occlusion of arms and legs in healthy volunteers. Acta Chir Scand. 1972;138:437–40. [PubMed]
- Hill SL, Berry RE. Subclavian vein thrombosis: A continuing challenge. Surgery. 1990;108:1–9.[PubMed]
- Prandoni P, Polistena P, Bernardi E, Coga A, Casara D, Verlato F, et al. Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Arch Intern Med. 1997;157:57–62. [PubMed]
- Marinella MA, Kathula SK, Markert RJ. Spectrum of upper-extremity deep venous thrombosis in a community teaching hospital. Heart Lung. 2000;29:113–7. [PubMed]
- Prescott SM, Tikoff G. Deep vein thrombosis of the upper extremity: A reappraisal. Circulation. 1979;59:350–5. [PubMed]
- Deep-Vein Thrombosis of the Upper Extremities Nils Kucher, M.D. N Engl J Med 2011;364:861-9. © 2011 Massachusetts Medical Society.
Corresponding Author
Dr B. Nandini Priyanka
Post Graduate, Department of Medicine,
RMMCH, Chidambaram-608002,Tamilnadu
DOI: https://dx.doi.org/10.18535/jmscr/v5i10.129
