Paget Schroetter (arm DVT) syndrome
- Arm DVT in young fit patients
- Following exercise
- Vascular and neuro exams
- Signs compartment syndrome?
- Rash (? herpetic with super-imposed cellulitis)
- Adson's sign (loss of the radial pulse by rotating head to the ipsilateral side with extended neck following deep inspiration), sign of thoracic outlet synd.(Video)
- Wright's test (↓ radial pulse with shoulder hyperabduction - arm behind occiput)
- Dissection rare
- Lymphatic obstruction
- Thoracic outlet syndrome
- Superior vena cava syndrome
- Cellulitis (or rarely, necrotising fasciitis)
- Doppler ultrasound
- FBC, U&ER, LFT, Coag screen, Antithrombin 3 (before anticoagulation please)
- CXR (mass)
- Anticoagulation (heparin, LMWH, Xarelto, warfarin)
- Intravenous (local) thrombolysis if progressive / symptomatic ++
- Surgical decompression (esp. if local / respiratory mass).
- Refer to haematology - can be treated in OPD but may admit for initial Ix/Mx.
Content By Dr Íomhar O' Sullivan date. Last review Dr ÍOS 22/11/18.