American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Medical Case Reports. 2016, 4(9), 315-318
DOI: 10.12691/ajmcr-4-9-6
Open AccessCase Report

Paget-Schroetter: Primary Axillo-subclavian Vein Thrombosis in a Young Patient

Cesar Gentille1, , Michael Arriaga1 and Christopher Peckins1

1Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas, United States of America

Pub. Date: October 20, 2016

Cite this paper:
Cesar Gentille, Michael Arriaga and Christopher Peckins. Paget-Schroetter: Primary Axillo-subclavian Vein Thrombosis in a Young Patient. American Journal of Medical Case Reports. 2016; 4(9):315-318. doi: 10.12691/ajmcr-4-9-6


Upper extremity (UE) deep venous thrombosis (DVT) is much less common than lower extremity DVT. Primary UE DVT, that which occurs in the absence of known risk factors is quite rare. We present a case of Paget-Schroetter Syndrome (PSS) also known as “Effort Thrombosis,” in a healthy young woman likely brought on by thoracic outlet syndrome (TOS). Our patient developed an UE DVT with minimal symptoms. Ultrasound, and then angiogram demonstrated a dense, long clot in the axillo-subclavian vein. Symptoms improved after catheter-directed thrombolysis although it was only partially successful. A narrowed region of the subclavian vein persists where it exits the thoracic outlet. Clinicians need to be aware of the unusual diagnosis as treatment can improve symptoms and facilitate recovery.

venous thrombosis thrombolysis

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


Figure of 3


[1]  Alla V, Natarajan N, Kaushik M, Warrier R, Nair C. Paget-schroetter syndrome: Review of pathogenesis and treatment of effort thrombosis. West J Emerg Med 11(4): 358-362. 2010; 11(4): 358.
[2]  Chin EE, Zimmerman PT, Grant EG. Sonographic evaluation of upper extremity deep venous thrombosis. J Ultrasound Med. 2005; 24(6): 829-38; quiz 839-40.
[3]  Feugier P, Chevalier J. The paget-schroetter syndrome. Acta chir belg. 2005: 256.
[4]  Goss SG, Alcantara SD, Todd GJ, Lantis JC,2nd. Non-operative management of paget-schroetter syndrome: A single-center experience. J Invasive Cardiol. 2015; 27(9): 423-428.
[5]  Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuunemann HJ, American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive summary: Antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012; 141(2 Suppl): 7S-47S.
[6]  Illig KA, Doyle AJ. A comprehensive review of paget-schroetter syndrome. J Vasc Surg. 2010; 51(6): 1538-1547.
[7]  Joffe HV, Goldhaber SZ. Upper-extremity deep vein thrombosis. Circulation. 2002; 106(14): 1874-1880.
[8]  Kidd M, Broderick V. An unusual presentation of a swollen arm: A case report. J Med Case Rep. 2014; 8: 22-1947-8-22.
[9]  Koury J, Burke C. Endovascular management of acute upper extremity deep venous thrombosis and the use of superior vena cava filters. Semin Intervent Radiol. 2011(28): 3.
[10]  Mall N, Van Thiel G, Heard W, Paletta G, Bush-Joseph C, Bach BJ.  Paget- schroetter syndrome: A review of effort thrombosis of the upper extremity from a sports medicine perspective. . Sports Health. 2013; 5(4): 353.
[11]  Molina JE, Hunter DW, Dietz CA. Paget-schroetter syndrome treated with thrombolytics and immediate surgery. J Vasc Surg. 2007; 45(2): 328-334.
[12]  Rosa Salazar V, Otalora Valderrama Sdel P, Hernandez Contreras ME, Garcia Perez B, Arroyo Tristan Adel A, Garcia Mendez Mdel M. Multidisciplinary management of paget-schroetter syndrome. A case series of eight patients. Arch Bronconeumol. 2015; 51(8): e41-3.
[13]  Thiruchelvam N, Mbuvah F, Kistangari G, Anumandla AK. Upper-limb deep vein thrombosis in paget-schroetter syndrome. Cleve Clin J Med. 2015; 82(10): 658-659.
[14]  Thompson JF, Winterborn RJ, Bays S, White H, Kinsella DC, Watkinson AF. Venous thoracic outlet compression and the paget-schroetter syndrome: A review and recommendations for management. Cardiovasc Intervent Radiol. 2011; 34(5): 903-910.
[15]  Urschel HC, Jr, Patel AN. Surgery remains the most effective treatment for paget-schroetter syndrome: 50 years' experience. Ann Thorac Surg. 2008; 86(1): 254-60; discussion 260.
[16]  Vedantham S. Endovascular procedures in the management of DVT. Hematology Am Soc Hematol Educ Program. 2011; 2011: 156-161.
[17]  Young K, Tunstall O, Mumford A. Subclavian vein thrombosis in an otherwise healthy 9-year-old boy. BMJ Case Rep. 2014.