EMed

Paget Schroetter (arm DVT) syndrome

Background

  • Arm DVT in young fit patients
  • Following exercise

Clinical

  • 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

Differential Dx

  • Lymphatic obstruction
  • Thoracic outlet syndrome
  • Superior vena cava syndrome
  • Cellulitis (or rarely, necrotising fasciitis)

Investigations

  • Doppler ultrasound
  • FBC, U&ER, LFT, Coag screen, Antithrombin 3 (before anticoagulation please)
  • CXR (mass)

Management

  • 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 . Last review Dr ÍOS 21/10/22.