Martínez-Gil JC, Bahamon-Rivera H, Jimenez-Salazar S, Buitrago-Toro K, Baldovino-Chiquillo AM, Andrés-Arango J

Language: Spanish
References: 15
Page: 374-381
PDF size: 718.64 Kb.

ABSTRACT

Background: venous thromboembolic disease is a frequent clinical illness, associated with multiple risk factors already identified. There are presentations with atypical locations such as thrombosis in the upper limb. The etiology in the 30% of cases is the hypertrophy of the scapular waist muscles (Paget-Schroetter syndrome), which should always be suspected in healthy patients that practice sports to their maximum level, where both pharmacological and surgical treatment will offer an adequate alternative.
Objective: to present a young patient with venous thrombosis of unusual site in the upper limb.
Presentation of the case: we present the case of a 20-year-old healthy patient, previously a high-performance athlete, who went to consultation for a sub-acute symptomps of inflammatory signs and collateral circulation in the left upper limb, with subsequent confirmation of unusual site venous thrombosis. The common etiologies are ruled out and, finally, scalene hypertrophy known as Paget-Schroetter syndrome is confirmed. Given the duration of the symptoms, the anticoagulation is initially handled and subsequently he is surgically treated with an adequate response.
Conclusions: the presence of unusual site venous thrombosis in upper limb in young, healthy and athletic patients forces us to be suspicious about the Paget-Schroetter syndrome as the main etiology allowing the correct handling and prognosis.

REFERENCES

1. Koonarat A, Rattarittamrong E, Tantiworawit A, Rattanathammethee T, Hantrakool S, Chai-Adisaksopha C, et al. Clinical characteristics, risk factors, and outcomes of usual and unusual site ve-nous thromboembolism. Blood Coagul Fibrinolysis. 2018;29(1):12-18.

2. Ma K, Wells P, Guzman C, Anderson D, Blostein M, Hirsch A, et al. A multicenter prospective study of risk factors and treatment of unusual site thrombosis. Thromb Res. 2016 Aug;144:100-105.

3. Hattab Y, Küng S, Fasanya A, Ma K, Singh AC, DuMont T. Deep venous thrombosis of the upper and lower extremity. Crit Care Nurs Q. 2017;40(3):230-236.

4. Wells PS, Ihaddadene R, Reilly A, Forgie MA. Diagnosis of venous thromboembolism: 20 years of progress. Ann Intern Med. 2018;168(2):131-140.

5. Ibrahim R, Dashkova I, Williams M, Kozikowski A, Abrol N, Gandhi A, et al. Paget-Schroetter syn-drome in the absence of common predisposing factors: a case report. Thromb J. 2017;15(1):20.

6. Rosa Salazar V, Otálora Valderrama SP, Hernández Contreras ME, García Pérez B, Arroyo Tristán A, García Méndez M. Multidisciplinary management of Paget-Schroetter syndrome. A case series of eight patients. Arch Bronconeumol. 2015 Aug;51(8):e41-e43.

7. Pinar-Pérez M, Toledo-Pastor R, Viana-Broseta L, del Pozo-García JS. Deep Vein Thrombosis in Up-per Limb in a Weightlifter. Open Access Maced J Med Sci. 2017 Apr;5(2):228-230.

8. Yagi S, Mitsugi M, Sangawa T, Akaike M, Sata M. Paget-Schroetter Syndrome in a Baseball Pitcher. Int Heart J. 2017;58(4):637-640.

9. Chu AS, Harkness J, Witmer CM. Spontaneous subclavian vein thrombosis in a healthy adolescent cheerleader: A case of Paget-Schroetter syndrome. Pediatr Emerg Care. 2017 Oct;33(10):e92-e94.

10. Ringhouse B, Jackson C. Bringing to Light Symptoms and Treatments of Effort Thrombosis (Paget–Schroetter Syndrome) in the Military Population, a Case Study. Mil Med. 2017 May;182(5-6):e1826-e1829.

11. Lawless SM, Samson R. Urschel's Sign in Paget Schroetter Syndrome. Am J Med. 2017;130(12):e537.

12. Kraaijpoel N, van Es N, Porreca E, Büller HR, Di Nisio M. The diagnostic management of upper extremity deep vein thrombosis: A review of the literature. Thromb Res. 2017;156(8):54-59.

13. Samoila G, Twine C, Williams I. The infraclavicular approach for Paget–Schroetter syndrome. Ann R Coll Surg Engl.2018;100(2):83-91.

14. Dronkers C, Klok F, Huisman M. Current and future perspectives in imaging of venous thrombo-embolism. J Thromb Haemost. 2016 Sep;14(9):1696-1710.

15. Mahmoud O, Sihvo E, Räsänen J, Vikatmaa L, Vikatmaa P, Venermo M. Treatment of Paget-Schroetter syndrome with a three-stage approach including thoracoscopic rib resection at the second stage. J Vasc Surg Venous Lymphat Disord. 2018;6(1):75-82.