View source for Paget–Schroetter disease

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{{Infobox disease
 | Name            = Paget-Schrotter disease
 | Image           = Gray576.png
 | Caption         = Anterior view of right upper limb and thorax
 | DiseasesDB      = 34349
 | ICD10           = {{ICD10|I|82|8|i|80}}
 | ICD9            = {{ICD9|453.8}}
 | ICDO            =
 | OMIM            =
 | MedlinePlus     =
 | eMedicineSubj   = med
 | eMedicineTopic  = 2772
 | MeshID          =
}}
{{SI}}

{{CMG}} '''Assosciate Editor(s)-In-Chief:''' [[User: Prashanthsaddala|Prashanth Saddala M.B.B.S]]

{{SK}} Paget-von Schrotter disease; effort-induced thrombosis; Subclavian vein thrombosis; Paget-von Schrötter syndrome; Paget-Schroeder syndrome
==Overview==

'''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.

==Historical Perspective==
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.

==Pathophysiology==
The pathophysiology of the syndrome involves compressive changes in the vessel wall, stasis of blood, and hypercoagulability.

==Causes==
*Strenuous, repetitive, upper extremity activity
*Indwelling central venous catheter
*[[Total parenteral nutrition]]
*[[Thoracic outlet syndrome]]

==Risk Factors==
*Vigorous repetitive arm activity such as playing baseball or tennis.

==Epidemiology and Demographics==
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.
==Natural History, Complications and Prognosis==
*[[Pulmonary embolism]] can occur (20% – 36% of patients)
*[[Superior vena cava syndrome]]
*[[Thoracic outlet obstruction]]
*[[Pulmonary hypertension]]
*[[Chronic venous insufficiency]]

==Diagnosis==
===Symptoms===
*Sudden onset of pain in the dominant arm that is worsened with activity
*Warmth, redness, blueness and swelling in the arm.
===Ultrasound===
Ultrasonography is the screening test of choice. It is not very sensitive.  If the test is negative, but a strong clinical suspicion remains, other imaging modalities should be used.
===Venography===
Venography is the most sensitive and specific study for diagnosis.

==Treatment==
===Pharmacologic===
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]].  [[Thrombolytic therapy]] may be used within 5 to 7 days of presentation.

===Surgical Therapy===
If there is an underlying anatomic basis for the syndrome, surgery is preferred.
*First-rib resection
*Balloon angioplasty and/or stenting of the [[ subclavian vein]] may reduce symptoms

==References==
{{Reflist|2}}

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[[Category:Vascular diseases]]
[[Category:Disease]]
[[Category:Cardiology]]