An Unusual Presentation of Paget-Schroetter Syndrome: A Reminder on the Importance of Clinical Judgment

We discuss the case of a 36-year-old woman who presented with persistent right upper limb swelling and pain. A previous negative D-dimer (434 µg/L (normal range <500 µg/L)) resulted in an inappropriate discharge, despite a significant past medical history. The patient was sent for a right upper limb ultrasound Doppler scan due to persistent pain, and a clot in the right supraclavicular subclavian vein was observed, confirming the diagnosis of Paget-Schroetter syndrome (PSS). The clot was successfully removed under the vascular team in Cardiff without any post-op complications. The literature review demonstrates that PSS should be suspected mostly on a clinical basis; the literature does not support the use of a D-dimer to support a suspected upper limb deep vein thrombosis (DVT), as this could delay vital treatment for the patient, as demonstrated in this case.