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| __NOTOC__
| | #REDIRECT [[Paget-Schroetter disease]] |
| {{Infobox disease
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| | Name = Paget-Schrotter disease
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| | Image = Gray576.png
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| | Caption = Anterior view of right upper limb and thorax
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| | DiseasesDB = 34349
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| | ICD10 = {{ICD10|I|82|8|i|80}}
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| | ICD9 = {{ICD9|453.8}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus =
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| | eMedicineSubj = med
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| | eMedicineTopic = 2772
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| | MeshID =
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| }}
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| {{SI}}
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| {{CMG}} '''Assosciate Editor(s)-In-Chief:''' [[User: Prashanthsaddala|Prashanth Saddala M.B.B.S]]
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| {{SK}} Paget-von Schrotter disease; effort-induced thrombosis; Subclavian vein thrombosis; Paget-von Schrötter syndrome
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| ==Overview==
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| '''Paget-Schroetter disease''' is a form of upper extremity [[deep vein thrombosis]] (DVT), a medical condition in which [[blood clot]]s form in the deep [[vein]]s of the [[arm]]s. These DVTs typically occur in the [[axillary vein|axillary]] or [[subclavian vein]]s.
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| ==Historical Perspective==
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| The condition is named after two men. [[James Paget]]<ref name=WhoNam>{{WhoNamedIt|synd|1924|Paget-von Schrötter disease}}</ref> first proposed the idea of venous thrombosis causing upper extremity pain and swelling,<ref name=Paget>{{cite journal |author=Paget J |title=On gouty and some other forms of phlebitis |journal=St. Bartholomew's Hospital Reports |volume=2 |issue= |pages=82–92 |year=1866}}</ref> and [[Leopold von Schrötter]] later linked the clinical syndrome to thrombosis of the axillary and subclavian veins.<ref name=vonSch>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.</ref> 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.<ref>{{cite journal |last1=Reina |first1=Nick J. |last2=Honet |first2=Joseph C. |last3=Brown |first3=William |last4=Beitman |first4=Max |last5=Chodoroff |first5=Gary |title=Paget-Schroetter syndrome in a viola player |journal=Medical Problems of Performing Artists |volume=3 |number=1 |pages=24 |year=1988}}</ref> The syndrome also became known as "effort-induced thrombosis" in the 1960s,<ref>{{cite journal | author = Drapanas, T; Curran, WL | title = Thrombectomy in the treatment of "effort" thrombosis of the axillary and subclavian veins | journal = Journal of Trauma | year = 1966 | page = 107 |issue = 6}}</ref> as it has been reported to occur after vigorous activity,<ref>{{cite journal | title = Current perspective of venous thrombosis in the upper extremity | author = Flinterman LE; Van Der Meer FJ; Rosendaal FR; Doggen CJ | journal = Journal of Thrombosis and Haemostasis | year = 2008 | month = Aug | volume = 6 | pages = 1262–6 | pmid = 18485082 | issue = 8 | doi = 10.1111/j.1538-7836.2008.03017.x}}</ref> though it can also occur spontaneously.
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| ==Pathophysiology==
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| The pathophysiology of the syndrome involves compressive changes in the vessel wall, stasis of blood, and hypercoagulability.
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| ==Causes==
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| *Strenuous, repetitive, upper extremity activity
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| *Indwelling central venous catheter.
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| *[[Thoracic outlet syndrome]].
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| ==Risk Factors==
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| *Vigorous repetitive arm activity such as playing baseball or tennis.
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| ==Epidemiology and Demographics==
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| The condition is relatively rare.<ref>{{cite journal | last = Hughes | first = ES | title = Venous obstruction in the upper extremity; Paget-Schroetter's syndrome; a review of 320 cases | journal = Surg Gynecol Obstet | year = 1949 | page = 89 | issue = 2 | pmid=18108679 | volume = 88 | pages = 89–127}}</ref> It usually presents in young and otherwise healthy patients. It occurs more often in males than females.
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| ==Natural history, Complications and Prognosis==
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| These DVTs rarely cause fatal [[pulmonary embolism]].
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| ==Diagnosis==
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| ===Symptoms===
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| *Sudden onset of pain in the dominant arm that is worsened with activity
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| *Warmth, redness, blueness and swelling in the arm.
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| ==Treatment==
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| The traditional treatment for thrombosis is the same as for a lower extremity DVT, and involves [[anticoagulation]] with [[heparin]] (generally [[low molecular weight heparin]]) with a transition to [[warfarin]].
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| Alternative treatment is thrombolytic therapy to open up the vein followed by first-rib resection during the same hospital admission and not waiting for a repeat episode.
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| Ultrasonography is the screening test of choice. It is not very sensitive. If negative, but strong clinical suspicion remains, other imaging modalities should be used.
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| Venography is the most sensitive and specific study for diagnosis. One should be mindful of the risks of contrast-induced side effects.
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| Acute thrombosis is treated aggressively with thrombolysis 5 – 7 days after presentation. Conservative measures are associated with greater residual disability. Chronic thrombosis, however, does not respond well to thrombolysis and is better treated with conservative measures or bypass vice thrombectomy. In addition to bed rest and limb elevation this may include anticoagulation with warfarin. Serial venography with balloon angioplasty and/or stenting of the subclavian vein may reduce symptoms in these patients. In the presence of anatomic abnormalities surgery may be a preferred treatment option.
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| Complications: Pulmonary embolism occurs in 20 – 36% of patients. Other complications include Superior vena cava syndrome, thoracic outlet obstruction, pulmonary hypertension and chronic venous insufficiency.
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| ==See also==
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| * [[Thoracic outlet syndrome]], a possible cause of blood clots in arms
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| ==References==
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| {{Reflist|2}}
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| {{WH}}
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| {{WS}}
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| [[Category:Vascular diseases]]
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| [[Category:Diseases of veins, lymphatic vessels and lymph nodes]]
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| [[Category:Disease]]
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| [[Category:Cardiology]]
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