Q:  24 year old male is admitted to ICU because of  huge load of deep vein thrombosis (DVT) of right upper arm. Symptoms started after playing long session of racquetball. Patient is c/o severe arm pain, and on exam extremity is reddish-blue, tender, warm and swelled. Your diagnosis?  



Answer: Paget–von Schrötter disease

Paget–von Schrötter disease, is a form of upper extremity deep vein thrombosis (DVT), involving axillary or subclavian veins. It is also known as "effort-induced thrombosis" as it mostly occurs after repetitive upper arm movements, putting excessive pressure against the brachiocephalic and external jugular veins. In some cases may occur without any repetitive movements or after clavicular trauma. It is an expression of thoracic outlet syndrome. It is important to understand that they are not catheter related.



Reference:

1.  Flinterman LE; Van Der Meer FJ; Rosendaal FR; Doggen CJ (Aug 2008). "Current perspective of venous thrombosis in the upper extremity". Journal of Thrombosis and Haemostasis 6 (8): 1262–6

2. Peivandi, Mohammad Taghi; Nazemian, Zohreh. "Clavicular Fracture and Upper-Extremity Deep Venous Thrombosis". Orthopedics 34 (3): 227–227

3. Thompson, J. F.; Winterborn, R. J.; Bays, S.; White, H.; Kinsella, D. C.; Watkinson, A. F. (2011-10-01). "Venous thoracic outlet compression and the Paget-Schroetter syndrome: a review and recommendations for management". Cardiovascular and Interventional Radiology 34 (5): 903–910