Paget-Schroetter disease pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

It is thought that Paget-Schroetter disease (also known as Effort Thrombosis) is a form of Subclavian vein thrombosis resulted from the Subclavian vein compression. This condition is more common in athletes and/or manual labors. Some studies link Paget-Schroetter disease with anatomical defects involving the thoracic outlet.

Pathophysiology

Physiology

The Subclavian vein passes through a space surrounded by the first rib, the Scalenus anterior muscle and the Subclavius muscle and tendon.

Pathogenesis

It is though that Paget-Schroetter disease (ie, Effort Thrombosis) is the result of Subclavian vein compression and subsequent thrombosis, and is more common in athletes and/or manual labors. Sports related to higher chance for this condition are baseball, softball, wrestling, playing ball, gymnastic, swimming, hockey, martial arts, backpacking and billiards which require repetitive and constant upper extremity activities. Even with normal anatomical structure the Subclavian vein can be compressed through hyper-abduction (more prominent in arm abducted over 90 degrees), extension and/or external rotation."A comprehensive review of Paget-Schroetter syndrome - ScienceDirect". Furthermore compression could be seen in hypertrophied Scalenus anterior or Subclavius muscle. In addition to compression, these activities can put tension on the Subclavian vein which lead to micro-trauma of the endothelium and initiate the coagulation cascade. Increased bulk of muscles like Pectoralis minor and Subscapularis muscles and presence of Osseous Exostoses or fibrous bands, as well as congenital or post-trauma bone deformities can cause further compression.

Genetics

[Disease name] is transmitted in [mode of genetic transmission] pattern.

OR

Genes involved in the pathogenesis of [disease name] include:

• [Gene1]
• [Gene2]
• [Gene3]

OR

The development of [disease name] is the result of multiple genetic mutations such as:

• [Mutation 1]
• [Mutation 2]
• [Mutation 3]

Associated Conditions

Conditions associated with [disease name] include:

• [Condition 1]
• [Condition 2]
• [Condition 3]

Gross Pathology

On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Microscopic Pathology

On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].