Paget-Schroetter Syndrome

摘要

Background: Paget Schroetter syndrome or venous thrombosis of the axillary subclavian axis is a rare condition often misdiagnosed as cellulitis by the primary care physician.Case Report: A case of Paget Schroetter syndrome misdiagnosed as cellulitis by the primary care physician leading to delay in arriving at a definitive diagnosis and thereby commencement of treatment is presented.Discussion: The anatomical and pathophysiological basis of Paget Schroetter syndrome along with various treatment options is discussed.Conclusion: Awareness of this rare condition is essential for primary care physicians to avoid delay in diagnosis and treatment. Introduction Deep vein thrombosis is commonly associated with the veins of lower limb. Thrombosis involving deep veins of upper extremity namely the axillary-subclavian axis or Paget Schroetter syndrome is quite uncommon. As there are ill defined predisposing factors and variable symptoms, diagnosis of venous thrombosis affecting the upper limb, always poses a dilemma leading to delay in commencing treatment. A case of Paget Schroetter syndrome (PSS) is presented along with a review of literature. Case Report A 58 year old patient, a manual laborer by occupation was referred by his primary care physician with history of sudden onset of swelling of left arm and forearm accompanied by pain. Patient gave history of sudden onset of symptoms without any specific inciting cause. There was no history of fever. Patient was treated as a case of cellulitis by his primary care physician. The response to treatment was poor.Physical examination revealed a grossly swollen and tender left upper extremity. (Figure 1) The swelling involved the left arm, forearm and hand. The movements of the shoulder, elbow and wrist joints were restricted due to edema and were extremely painful. There were no areas of softening or fluctuation anywhere over the affected extremity. There were no distal focal neurological deficits in left upper extremity. Peripheral pulses could not be appreciated due to edema.