Paget–Schroetter disease

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Paget–Schrotter disease
Other namesPaget–von Schrötter disease
Anterior view of right upper limb and thorax
SpecialtyVascular surgery
Named after

Paget–Schroetter disease (which evolved from a venous thoracic outlet syndrome) is a form of upper extremity

blood clots form in the deep veins of the arms. These DVTs typically occur in the axillary and/or subclavian veins.[1]

Signs and symptoms

The condition is relatively rare.[2] It usually presents in young and otherwise healthy patients, and also occurs more often in males than females. The syndrome also became known as "effort-induced thrombosis" in the 1960s,[3] as it has been reported to occur after vigorous activity,[4] though it can also occur due to anatomic abnormality such as clavicle impingement[5] or spontaneously. It may develop as a sequela of thoracic outlet syndrome. It is differentiated from secondary causes of upper extremity thrombosis caused by intravascular catheters.[4] Paget–Schroetter syndrome was described once for a viola player who suddenly increased practice time 10-fold, creating enough repetitive pressure against the brachiocephalic and external jugular veins to cause thrombosis.[6]

Symptoms may include sudden onset of pain, warmth, redness, blueness and swelling in the arm. Diagnosis is usually confirmed with an ultrasound.[7] These DVTs have the potential to cause a pulmonary embolism.[8]

Diagnosis

Duplex ultrasonography MR Venography[citation needed]

Prevention

Prevention of Paget–Schroetter disease can be accomplished by gradual increases in activity and by avoiding strenuous upper extremity activity.[9]

Treatment

The traditional treatment for thrombosis is the same as for a lower extremity DVT, and involves systemic

anticoagulation to prevent a pulmonary embolus.[10] Some have also recommended thrombolysis with catheter directed alteplase or mechanical thrombectomy with a large bore catheter and manual aspiration providing definitive intervention with an endovascular approach.[11] If there is thoracic outlet syndrome or other anatomical cause then surgery can be considered to correct the underlying defect.[12]

History

The condition is named after two men. James Paget[13] first proposed the idea of venous thrombosis causing upper extremity pain and swelling,[14] and Leopold von Schrötter later linked the clinical syndrome to thrombosis of the axillary and subclavian veins.[15]

References

  1. PMID 18108679
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  3. .
  4. ^ .
  5. .
  6. ^ Reina, Nick J.; Honet, Joseph C.; Brown, William; Beitman, Max; Chodoroff, Gary (1988). "Paget-Schroetter syndrome in a viola player". Medical Problems of Performing Artists. 3 (1): 24.
  7. PMID 20141579
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  8. .
  9. ^ Madden CC, Putukian M, Young CC, McCarty EC. Netter's Sports Medicine. Saunders. Philadelphia, 2010.
  10. PMID 22315268
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  11. .
  12. .
  13. Who Named It?
  14. ^ Paget J (1866). "On gouty and some other forms of phlebitis". St. Bartholomew's Hospital Reports. 2: 82–92.
  15. ^ L. von Schrötter. Erkrankungen der Gefässe. Nothnagel’s Handbuch der speciellen Pathologie und Therapie, 1901. Volume XV, II. Theil, II. Hälfte: Erkrankungen der Venen. Wien, Hölder, 1899: 533–535.

External links