PDF(Pubmed)
Abstract：
An adolescent female presented to the emergency room with pain, swelling and a palpable lump in the right axilla following activity on a rowing ergometer. The differential diagnosis at the time of presentation was deep vein thrombosis, mass compression and cellulitis. An ultrasound scan revealed an occlusive thrombus of the right axillary and subclavian veins, basilic vein and proximal cephalic vein. The patient underwent pharmacomechanical thrombolysis followed by catheter-directed thrombolysis. Dynamic venogram testing revealed venous thoracic outlet syndrome (VTOS) and a transaxillary first rib resection was performed to decompress the costoclavicular space. Genetic testing revealed the patient was heterozygous for factor V Leiden. Two rounds of balloon dilatation plasty were performed to relieve recurring symptoms due to scarring and persisting compression, 1 and 3 years post rib resection. After extensive shared decision-making, the patient returned to sport, reporting only intermittent symptoms of post-thrombotic syndrome. This case sheds light on the importance of early diagnosis of VTOS for successful return to sport.
摘要：
一名少女痛苦地出现在急诊室，在划船测功机上活动后，右腋下肿胀和明显的肿块。就诊时的鉴别诊断为深静脉血栓形成,质量压迫和蜂窝织炎。超声扫描显示右腋下和锁骨下静脉有闭塞性血栓，贵重静脉和近端头静脉。患者接受了药物机械溶栓，然后进行导管溶栓。动态静脉造影检查显示静脉胸腔出口综合征（VTOS），并进行了经腋窝第一肋骨切除术以减压锁骨间隙。基因检测显示该患者是因子VLeiden的杂合子。进行了两轮球囊扩张成形术，以缓解由于疤痕和持续压迫而引起的反复症状。肋骨切除后1年和3年。经过广泛的共同决策，病人恢复运动，仅报告血栓后综合征的间歇性症状。此病例阐明了早期诊断VTOS对于成功恢复运动的重要性。
