Paget-Schroetter syndrome was coined in 1949 by E.S.R. Hughes, MD, MS, who compiled multiple cases of upper extremity thrombosis. He created the eponym in honor of Sir James Paget and Leopold von Schroetter, who described symptoms of upper extremity thrombosis and the relationship of thromboses and physical strain, respectively.
3,7
This condition is more commonly found in people involved in sports such as rowing, wrestling, weight lifting, and swimming, as these sports require repetitive motions of the upper extremity.
4 It is a rare occurrence and is more commonly found in men and in the dominant arm.
3
The criterion standard of diagnosis had previously been contrast venography; however, ultrasonographic imaging of the upper extremity with color flow Doppler has become more commonly used because of cost, availability, and lack of radiation exposure. Timely treatment of this condition is paramount, as there can be significant disability if the diagnosis is delayed, missed, or not managed appropriately.
4 Management of this condition involves both anticoagulation and catheter-directed thrombolysis. Additionally, surgical thoracic outlet decompression may be required, which can involve resection of the first rib, as well as the scalene muscles and costoclavicular ligament.
2 In some instances, the syndrome can present with pulmonary embolism.
2 Historically, treatment was anticoagulation and elevation of the affected extremity, but morbidity has decreased with the availability of thrombolytics and surgical decompression of the thoracic outlet.
5 According to Molina et al,
6 patients had significant improvement in outcomes with thrombolysis and thoracic outlet decompression. This study was carried out over 20 years and found excellent long-term results. However, if the condition is not diagnosed promptly, with aggressive and timely therapy, the veins will have irreversible fibrotic damage.
6
In the current patient, a thrombus likely developed secondary to the repetitive nature of arm movements in swimming. The condition was initially misdiagnosed by the ED because of the rarity of the disease, which is commonly missed on initial early presentation. The patient was treated at the time of diagnosis with both anticoagulation and thrombolysis and was offered thoracic outlet decompression. Patients who have chronic thrombosis will have significant collateral vessels and may present with engorgement of those vessels; however, this patient did not have those signs on presentation.