Paget-Schrotter syndrome

Paget-Schrotter syndrome is the spontaneous thrombosis of the deep veins of the upper limb – axillary or subclavian vein.The syndrome was described independently by Von-Schrotter in 1884 and by Paget in 1875.  Paget-Schrotter syndrome is also known as effort thrombosis because it is often associated with activities involving hyperabduction of the upper limbs. Sudden jerky movements cause the axillary vein to be crushed between the clavicle and the first rib. This can damage the intima of the vein and initiate thrombosis. The syndrome is also associated with thoracic outlet syndrome due to similar compressive reasons. Painful swelling of the limb is an important manifestation of the Paget-Schrotter syndrome. The diagnosis is confirmed by compression ultrasonography or venography. Treatment is by thrombolysis and anticoagulation. Surgical options are needed only for those with persistent symptoms of thoracic outlet compression. Important differential diagnoses include lymphangitis, lymphatic obstruction and intramuscular hemorrhage.