Paget-Schroetter disease

Infobox_Disease
Name = Paget-Schroetter disease


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 =

Paget-Schroetter disease (Paget-von Schrötter disease) refers to deep vein thrombosis of an upper extremity vein, including the axillary vein or subclavian vein.

Presentation

The syndrome is also known as “effort-induced thrombosis” as it has been reported to occur after vigorous activity, though it can also occur spontaneously.

It usually presents in young and otherwise healthy patients, males more often than females.

Symptoms include sudden onset of pain, warmth, redness, 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: [cite web |url=http://www.circ.ahajournals.org/cgi/content/full/111/9/e118#R2-160023 |title=Letter Regarding Article by Martinelli et al, "Risk Factors and Recurrence Rate of Primary Deep Vein Thrombosis of the Upper Extremities" * Response -- Molina et al. 111 (9): e118 -- Circulation |accessdate=2007-07-02 |format= |work=] "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. [WhoNamedIt|synd|1924] [J. Paget. On gouty and some other forms of phlebitis.St. Bartholomew’s Hospital Reports, London, 1866, 2: 82-92.] [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.] 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

It is named for James Paget [WhoNamedIt|synd|1924] [J. Paget. On gouty and some other forms of phlebitis.St. Bartholomew’s Hospital Reports, London, 1866, 2: 82-92.] and Leopold von Schrötter. [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.]

ee also

* Thoracic outlet syndrome, a possible cause of blood clots in arms

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". [Cite journal
author = Hangwi Tang & Jennifer Hwee Kwoon Ng
title = Googling for a diagnosis—use of Google as a diagnostic aid: internet based study
journal = BMJ
volume = 333
pages = 1143–1145
month = December
year = 2006
doi = 10.1136/bmj.39003.640567.AE
pmid = 17098763]

References

External links

* [http://rad.usuhs.mil/medpix/medpix.html?mode=single&comebackto=mode%3Dcat_browse&recnum=4200 Overview] at Uniformed Services University of the Health Sciences