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Paget Schroetter Syndrome, not just a disorder affecting active young adults.
EP30650
Poster Title: Paget Schroetter Syndrome, not just a disorder affecting active young adults.
Submitted on 25 Sep 2019
Author(s): Sanjana Kamath, Shirish Prabhudesai.
Affiliations: Ashford and St. Peters Hospitals
This poster was presented at British Institute of Radiology Annual Congress 2019
Poster Views: 557
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Poster Information
Abstract: Introduction

Paget Schroetter Syndrome (PSS) is primary thrombosis of the axillary-subclavian venous axis predominantly affecting healthy young adults often associated with repeated upper extremity strenuous activity. We describe this rare condition in a 62-year-old man.

Case Report
 
A 62-year-old man who stocked overhead shelves in a local supermarket presented with a 2-day history of unprovoked left arm pain and swelling. On examination, he had a swollen, blue arm with reduced range of movement.

Coagulation screen was negative. Doppler ultrasound demonstrated thrombus in the left subclavian, axillary and brachial veins. IV Heparin infusion was commenced followed by catheter directed tpA thrombolysis via an US guided left basilic vein puncture.

Check angiographic runs, 18 hours later confirmed clearance of most thrombus, however residual thrombus with extrinsic compression persisted within the subclavian vein raising the suspicion of PSS.

He underwent surgical resection of the left first rib followed by Angiojet catheter thrombectomy for residual thrombus clearance followed by angioplasty and stenting of the left subclavian vein. The patient was commenced on oral anticoagulation and made full recovery, with 1-year follow up scan showing complete recanalisation of the left arm veins.

Discussion

Paget Schroetter Syndrome although described in young adults, can occur in the elderly as was in our case. Appropriate history including patient’s occupation, unprovoked DVT and angiographic findings, should raise the suspicion of this condition. Surgical decompression followed by stenting of the subclavian vein must be considered, especially in cases of recurrent thrombus/compression of the subclavian vein post catheter directed tpA thrombolysis.
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