Paget-Schroetter disease

Paget-Schroetter disease, also known as effort thrombosis, is a rare condition characterized by the development of a deep vein thrombosis (DVT) in the upper extremity, particularly affecting the subclavian or axillary veins. This condition is a form of thoracic outlet syndrome and is most commonly seen in young, active individuals. The disease is named after Sir James Paget and Leopold von Schrötter, who first described the condition in the 19th century.

Causes and Risk Factors

Paget-Schroetter disease is primarily caused by repetitive strenuous activities that involve the upper limbs, leading to compression and damage to the veins within the thoracic outlet. This compression can result in thrombosis. Risk factors include activities such as weight lifting, rowing, and baseball pitching. Anatomical abnormalities, such as a cervical rib, can also predispose individuals to this condition.

Symptoms

The symptoms of Paget-Schroetter disease typically include:

• Sudden onset of swelling in the affected arm
• Pain and tenderness along the path of the involved vein
• Bluish discoloration of the skin (cyanosis)
• Prominent superficial veins due to venous collaterals forming

Diagnosis

Diagnosis of Paget-Schroetter disease involves a combination of clinical assessment and imaging studies. Doppler ultrasonography is the first-line imaging modality due to its non-invasive nature and high sensitivity for detecting upper extremity DVT. Other imaging studies, such as MRI or CT venography, may be used for further assessment or when ultrasound results are inconclusive.

Treatment

The treatment of Paget-Schroetter disease is multidisciplinary and may involve:

• Anticoagulation therapy to prevent clot propagation
• Thrombolytic therapy to dissolve the existing clot
• Catheter-directed thrombolysis for more extensive clots
• Surgical intervention, such as thrombectomy or decompression of the thoracic outlet, may be considered in severe cases or when conservative management fails.

Prognosis

With prompt and appropriate treatment, the prognosis for individuals with Paget-Schroetter disease is generally good. However, timely diagnosis is crucial to prevent complications such as post-thrombotic syndrome or pulmonary embolism.

Prevention

Preventive measures for Paget-Schroetter disease focus on minimizing risk factors, especially in individuals engaged in activities that predispose them to the condition. This may include technique modification, avoiding repetitive strenuous activities, and physical therapy exercises to strengthen the shoulder girdle muscles.

See also

• Venous thrombosis
• Thoracic outlet syndrome
• Deep vein thrombosis

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