Venous thoracic outlet syndrome is a rare type of thoracic outlet disorder that is often overlooked. When an upper extremity deep vein thrombosis (UEDVT) occurs due to thoracic outlet compression, it is commonly referred to as Paget-Schroetter syndrome (PSS). The space between the first rib and the clavicle where the subclavian vein passes through is highly vulnerable to compression and injury. This space often undergoes repetitive trauma due to extrinsic compression which ultimately results in scarring and clot formation. This case report reviews the case of a 26-year-old white male who presented with the chief complaint of right arm swelling and soreness after strenuous bench pressing. He went to urgent care and the initial diagnosis was a strained muscle. An ultrasound was ordered, revealing multiple UEDVTs. At this time, the patient was referred to vascular surgery for further management. Recommended management for PSS is to initiate anticoagulation or thrombolytic therapy depending on the timing between the onset of symptoms and diagnosis. Although there is some disagreement on the next steps after thrombolysis, most physicians agree that decompression of the thoracic outlet with first rib resection is the logical next step to prevent clot recurrence. The patient received the above-mentioned therapy and is progressing well with recovery. Recognizing the thoracic outlet as a potential location for pathology and keeping in mind those who have a presentation similar to this case study is extremely important.

UNASSIGNED: Axillary-subclavian venous thrombosis (ASVT) is a type of upper extremity deep vein thrombosis (UEDVT). UEDVTs are classified as either primary or secondary depending on their etiology. Although uncommon, clinicians should be aware of the clinical presentation of UEDVT as timely diagnosis and early treatment is critical in preventing possible post-thrombotic complications.
UNASSIGNED: We report a rare case of axillary-subclavian and internal jugular vein thrombosis in the absence of clear risk factors in a 78-year-old male weightlifter who presented to the office with two-week duration of left upper extremity pain and swelling following strenuous exercise at the gym.
UNASSIGNED: The combination of unusual thrombi location, in addition to the unusual absence of existing thoracic-outlet compression or indwelling medical hardware, makes our case of UEDVT especially uncommon. Clinicians should be aware of this rare disease due to the debilitating effects both in the short and long term.
Thrombose veineuse axillaire-sous-clavière à la suite d’un exercice intense chez un patient âgé: un rapport de cas.
UNASSIGNED: La thrombose veineuse axillaire-sous-clavière (TVAS) est un type de thrombose veineuse profonde du membre supérieur (TVPMS). Les thromboses veineuses profondes du membre supérieur sont classées comme primaires ou secondaires selon leur étiologie. Bien qu’elles soient peu fréquentes, les cliniciens doivent connaître la présentation clinique de la thrombose veineuse profonde du membre supérieur, car un diagnostic et un traitement précoces sont essentiels pour prévenir d’éventuelles complications postthrombotiques.
UNASSIGNED: Nous présentons un cas rare de thrombose de la veine axillaire-sous-clavière et de la veine jugulaire interne en l’absence de facteurs de risque clairs chez un haltérophile de 78 ans qui s’est présenté à la clinique avec une douleur et un gonflement du membre supérieur gauche survenus deux semaines après un exercice physique intense à la salle de sport.
La combinaison de la position inhabituelle des thrombus, en plus de l’absence inhabituelle de compression de l’orifice inférieur du thorax ou de matériel médical à demeure, rend notre cas de thrombose veineuse profonde du membre supérieur particulièrement rare. Les cliniciens doivent connaître cette maladie rare en raison de ses effets débilitants à court et à long terme.

Paget-Schroetter syndrome, the venous variant of thoracic outlet syndrome, is an uncommon presentation of deep vein thrombosis. In patients with Paget-Schroetter syndrome, the subclavian vein is compressed within the thoracic outlet as a result of repetitive and vigorous arm motions. Repeated endothelial injury leads to stasis in flow and eventual thrombus formation in the subclavian vein and its tributaries. This report highlights the case of an active and otherwise healthy 46-year-old patient who presented with swelling and pain of his right upper extremity after a run and was found to have multiple, effort-induced thrombi involving the right subclavian, axillary, brachial, and basilic veins. The unusual clinical picture of Paget-Schroetter syndrome and its presentation commonly in the demographic of young, healthy individuals make it a diagnosis likely overlooked and unfamiliar to many in the clinical setting.

Paget-Schroetter syndrome (PSS) is a rare form of spontaneous upper extremity deep vein thrombosis associated with vigorous activity of the upper extremities. We present a rare case of a young swimmer who presented with a painful right upper extremity swelling, with compression ultrasound (CUS) revealing extensive venous clots in the basilic, axillary, and subclavian veins. Venous duplex revealed extrinsic compression of the subclavian vein, and catheter-based contrast venography confirmed our diagnosis of PSS. The patient was started on a therapeutic dose of subcutaneous enoxaparin and referred to a higher center for further intervention.

Paget-Schroetter syndrome, also known as venous thoracic outlet syndrome, is primarily an effort-induced thrombosis of the subclavian and axillary veins. Treatment modalities involve systemic anticoagulation, catheter-directed thrombolysis (CDT), and surgical decompression. Early endovascular intervention is noted to improve outcomes and result in symptomatic relief. Here we implore the usage of the novel mechanical aspiration thrombectomy device as an adjunct to CDT for the management of peripheral venous thrombosis and highlight it as a treatment option resulting in substantial radiological and symptomatic improvement.

Paget-Schroetter syndrome (PSS) is a primary deep venous thrombosis of the subclavian-axillary vein complex occurring after repetitive and strenuous use of the shoulders and arms. Here, we report the case of a 24-year-old man who presented with left subclavian and axillary vein thrombosis after loading and unloading labor, who was diagnosed with PSS confirmed with Doppler ultrasound, and treated with anticoagulation. By comparing our case with 45 published case reports, we also aim to analyze patient characteristics, diagnostic methods, and treatment options for the disorder.

A young male waiter presented with left shoulder pain, with ultrasound showing thrombosis of the left subclavian vein. After exclusion of hypercoagulability, a dynamic MRI upper limb venogram was performed, confirming Paget-Schroetter syndrome (PSS). Our case is unusual as Paget Schroetter syndrome are seldom reported in non athletes. This is also the first report to show dynamic MRI images of PSS.

Paget-Schroetter syndrome (PSS) is a primary upper extremity deep vein thrombosis (DVT) that occurs with no significant risk factors, mostly in a young and healthy patient. Treatment of this disease is discussed heavily in the literature and the optimal treatment method is still being debated. Here, we present a patient with PSS treated with balloon angioplasty, thrombolysis and treatment with an oral thrombin inhibitor (apixaban) who developed recurrence of PSS. A 38-year-old white male with no past medical history, presented to an urgent care center with sudden onset axillary pain and an axillary lump that was treated with outpatient antibiotics. Extensive deep venous thrombosis was diagnosed with computed tomography (CT) and ultrasound. He underwent percutaneous pharmacomechanical thrombectomy. Postprocedural angiogram showed significant improvement in the caliber of the axillary and subclavian veins where they crossed the first rib. He was discharged on apixaban and underwent removal of his first rib 1 month later. He returned 3 weeks later with recurrence of right arm pain and swelling. Repeat ultrasound showed thrombus in the right arm and venogram confirmed 80% stenosis at the subclavian vein as it enters the innominate vein. He was again treated with placement of a thrombolytic catheter and overnight thrombolysis of the central venous circulation on the right-side upper extremity balloon angioplasty of the subclavian vein, axillary vein, and basilic vein. He is disease-free for 6 months. Recurrence of PSS after surgical removal of rib, thrombectomy, thrombolysis while using apixaban is very rare. This is the first case to our knowledge presented with recurrent PSS treated with apixaban, early rib resection, balloon angioplasty and thrombectomy.

BACKGROUND: Venous thoracic outlet syndrome resulting in the upper limb deep venous thrombosis is known as Paget-Schroetter syndrome or effort thrombosis. A general treatment algorithm includes catheter-directed thrombolysis followed by surgical thoracic outlet decompression. There are limited data regarding endovascular treatment of rethrombosis presenting early after the surgery.
METHODS: Two cases of early rethrombosis successfully treated with percutaneous mechanical thrombectomy by two different techniques are described. In both cases, rethrombosis was diagnosed soon after thrombolysis and first rib resection with scalenectomy. After 12 months, both patients remain symptom-free, with patent subclavian veins confirmed by duplex ultrasonography.
CONCLUSIONS: Percutaneous mechanical thrombectomy devices may offer a safe treatment option for patients with recurrent thrombosis after thoracic outlet surgery, even when thrombolytic therapy is contraindicated.

Deep venous thrombosis (DVT) of the upper extremities is usually secondary to inflammatory processes, malignancy, immobility from trauma, and inherited or acquired thrombophilias. This is a case of a young man who presented to our facility complaining of upper extremity pain and swelling. Imaging results showed thrombosis in the deep venous system of the left upper extremity, consistent with Paget-Schroetter syndrome.