Paget-Schröetter Syndrome in an Active Adolescent: A Case Report

Paget-Schröetter syndrome, or primary effort thrombosis, is a rare form of thoracic outlet syndrome defined by spontaneous upper extremity deep vein thrombosis associated with repetitive activity. We describe an otherwise healthy 16-year-old male who presented to his primary care physician with acute right upper extremity pain following repetitive exercises. Initially diagnosed with a nonspecific right-arm musculoskeletal strain, he re-presented 6 days later with persistent symptoms and was found to have an occlusive thrombosis of the subclavian, axillary, and brachial veins on ultrasonography. He was managed as an outpatient with rivaroxaban and demonstrated appropriate clinical improvement. Workups for thrombophilia and thoracic outlet abnormalities were unremarkable. This case highlights the diagnostic challenges in the setting of subtle symptoms and the importance of considering venous thrombosis in the differential diagnosis of otherwise healthy adolescents.