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Paget-Schrotter disease
Classification and external resources

Anterior view of right upper limb and thorax
ICD-10 I82.8
ICD-9 453.8
DiseasesDB 34349
eMedicine med/2772

Paget-Schroetter disease (Paget-von Schrötter disease) is a medical condition in which blood clots form in the deep veins of the arms. These deep venous thromboses typically occur in the axillary vein or subclavian vein.

Contents

Presentation

The condition is relatively rare.[1] It usually presents in young and otherwise healthy patients, males more often than females. The syndrome also became known as “effort-induced thrombosis” in the 1960s[2] as it has been reported to occur after vigorous activity,[3] though it can also occur spontaneously. May develop as a sequelea of thoracic outlet syndrome

Symptoms may include sudden onset of pain, warmth, redness, blueness and swelling in the arm. These DVT's should be treated as an emergency, but rarely cause fatal pulmonary emboli.

Treatment

The traditional treatment for thrombosis is the same as for a lower extremity deep vein thrombosis, and involves anticoagulation with heparin (generally low molecular weight heparin) with a transition to warfarin.

However, J. Ernesto Molina, MD, a vascular surgeon at the University of Minnesota, has expressed the following opinion:[4]

"The current acceptable treatment for that condition is lytic therapy followed by surgery. The patients were followed up to investigate the rate of recurrence. However, if surgery is not done, the problem will invariably recur.[5][6][7] If patients are treated with only anticoagulants and even thrombolytics but no surgery, I expect the recurrence rate to be high." Because "most of the patients who suffer this condition do not have any abnormality in their coagulation mechanism" and in fact suffer from "a direct injury to the endothelium," the "treatment for Paget-Schroetter syndrome ... entails the use of thrombolytics followed by surgery to decompress the thoracic inlet and widening of the vein, usually with a vein patch."

Eponym

The condition is named after two men. James Paget[5] first proposed the idea of venous thrombosis causing upper extremity pain and swelling,[6] and Leopold von Schrötter later linked the clinical syndrome to thrombosis of the axillary and subclavian veins.[7]

See also

Trivia

The father of a patient used Google to diagnose his son's Paget-Von Schrötter syndrome by querying on the symptoms, and it resulted in one of the first descriptions of "googling for diagnosis".[8]

References

  1. ^ Hughes, ES (1949). "Venous obstruction in the upper extremity; Paget-Schroetter's syndrome; a review of 320 cases". Surg Gynecol Obstet (88): 89. 
  2. ^ Drapanas, T; Curran, WL (1966). "Thrombectomy in the treatment of "effort" thrombosis of the axillary and subclavian veins". Journal of Trauma (6): 107. 
  3. ^ 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. PMID 18485082. 
  4. ^ Molina JE (March 2005). "Letter regarding article by Martinelli et al., "Risk factors and recurrence rate of primary deep vein thrombosis of the upper extremities"". Circulation 111 (9): e118; author reply e118. doi:10.1161/01.CIR.0000153853.50893.61. PMID 15753222. http://www.circ.ahajournals.org/cgi/content/full/111/9/e118#R2-160023. 
  5. ^ a b Paget-von Schrötter disease at Who Named It?
  6. ^ a b Paget J (1866). "On gouty and some other forms of phlebitis". St. Bartholomew’s Hospital Reports 2: 82–92. 
  7. ^ a b 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.
  8. ^ Hangwi Tang & Jennifer Hwee Kwoon Ng (December 2006). "Googling for a diagnosis—use of Google as a diagnostic aid: internet based study". BMJ 333: 1143–5. doi:10.1136/bmj.39003.640567.AE. PMID 17098763. 

External links

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