Paget-Schroetter Syndrome

Correspondence To the Editor: A 40‑year‑old male working as a manual labor with a history of smoking presented with a swelling in the neck and right upper extremity with the breathlessness since 5 days. The swelling in the neck region was acute in onset, pain associated with the generalized swelling in a right upper extremity. Breathlessness was acute in onset but was not associated with chest pain. There was no history of cough, fever, trauma and family history of other coagulopathies. On physical examination, there was tender swelling in right supraclavicular region, around 4 cm × 5 cm in size with cord‑like structure extends toward the angle of mandible [Figure 1a] and generalized edema of right upper limb, which was nonpitting in nature [Figure 1b]. Movements of the limb were slightly restricted. Measurements of the right upper limb at the time of presentation was arm – 34 cm, forearm – 22 cm and left upper limb was arm – 30 cm, forearm – 18 cm. Radial pulse in the right upper limb, and other peripheral pulses were felt. Blood pressure was normal. The left upper limb was normal. Examination of other system revealed normal. Routine blood investigations, electrocardiogram, echocardiography and chest X‑ray were normal. Contrast‑enhanced computerized tomography (CECT) of the chest and soft tissue neck showed the thrombus present in the right subclavian and brachiocephalic vein [Figure 1c and 1d]. It was also known as effort induced thrombus. To confirm it, ultrasonography (USG) Doppler was done, which showed the thrombus in right subclavian vein [Figure 1e]. The patient was started on low molecular weight heparin and planned to put on oral anticoagulant (warfarin) for 6 months with PT‑INR monitoring. The patient was improved symptomatically on discharge. Paget‑Schroetter syndrome is a rare condition characterized by the presence of axillo‑subclavian thrombus vein in an otherwise normal individual. Primary upper extremity deep vein thrombosis (DVT) comprises of two categories (a) Paget‑Schroetter syndrome, and (b) idiopathic. In contrast to the patient with Paget‑Schroetter syndrome, the patient with idiopathic upper extremity DVT has no known trigger or obvious underlying disease. Primarily there is no difference between Paget‑Schroetter syndrome and DVT except that former is an idiopathic thrombosis of the axillary or subclavian vein in the upper limb, whereas DVT can occur either in both upper or lower limb. It is a venous syndrome associated with the thoracic outlet compression. The subclavian vein rests in the …