Introduction: Paget-Schroetter Syndrome (PSS), or effort thrombosis, is an uncommon but serious form of upper extremity deep vein thrombosis (UEDVT), typically resulting from repetitive arm motion or heavy lifting that compresses the subclavian vein at the thoracic outlet. This condition may be underrecognized, especially in otherwise healthy individuals. Pulmonary embolism (PE), although rare in PSS, can occur as a life-threatening complication. Description: A 24-year-old healthy male presented with acute-onset left upper extremity pain and swelling, two days after heavy weightlifting. He had no trauma or prior thrombosis history. Vital signs were stable, with mild axillary tenderness and visible arm edema. Labs revealed an elevated D-dimer. CT angiography demonstrated a segmental right upper lobe PE without right heart strain. Duplex ultrasound confirmed thrombosis in the left subclavian, axillary, and brachial veins, consistent with PSS. Anticoagulation with heparin was initiated. The patient underwent catheter-directed thrombolysis followed by venous stenting. Due to recurrent thrombosis, first rib resection was performed to relieve thoracic outlet compression. A postoperative hemothorax was managed conservatively with chest tube drainage. The patient was discharged on apixaban with instructions to avoid heavy lifting. At follow-up, he remained symptom-free with no DVT or PE recurrence. Discussion: This case highlights the need to consider PSS in young, active patients presenting with upper extremity swelling and pain, particularly after strenuous activity. Early diagnosis is crucial to prevent complications like PE. While anticoagulation is essential, definitive management often requires surgical decompression. This case underscores the importance of multidisciplinary care and pulmonary vigilance, especially when complications like PE or hemothorax arise. Greater awareness of PSS can improve outcomes by ensuring timely intervention
Bansal et al. (Sun,) studied this question.