A 47-year-old woman with no medical history presented with swelling, pain, and reddish discoloration of the right arm and hand after strenuous effort. Findings on ultrasonography, computed tomography, and magnetic resonance imaging were normal. The patient's symptoms persisted. One week after presentation, she underwent ultrasonography with a microconvex probe that allowed better visualization beneath the clavicle. This test revealed a subtotal occlusion in the subclavian vein close to the clavicle, caused by a small thrombus fixed on a venous valve (video). Blood-clot formation in the deep veins of the arms is known as the Paget–Schroetter syndrome. This rare condition often occurs in young, healthy patients. Small thrombotic segments causing clinically significant vaso-occlusion can be easily missed with standard diagnostic procedures, particularly if thrombi are located immediately beneath the clavicle. The patient was treated with oral anticoagulation. One month after the initiation of anticoagulation, she no longer had swelling and discoloration of the right arm and hand at rest, although the symptoms reappeared with strenuous use of the arm. At the 2-month follow-up, her symptoms and thrombosis had fully resolved.
NEJM Volume 363:e4 July 15, 2010 Number 3
Keine Kommentare:
Kommentar veröffentlichen