Intermittent upper limb cyanosis revealing Paget–Schroetter syndrome: the value of patient-provided photographs

Background Paget-Schroetter Syndrome (PSS) is a rare condition referring to primary upper extremity deep vein thrombosis occurring in the context of venous thoracic outlet syndrome (vTOS) The diagnosis is rarely considered in the emergency department (ED) and is difficult to establish when symptoms are intermittent or absent at presentation. Case presentation A healthy 20-year-old woman presented three times in the ED, describing exertional right arm swelling and cyanosis. During consultations, she was slighty symptomatic. Duplex ultrasound showed axillary–subclavian thrombosis and computerized tomography scan (CT) phlebography revealed bilateral dynamic vTOS. Anticoagulation and thrombectomy were performed, with planned surgical decompression. The diagnosis was triggered by patient-provided photographs capturing intermittent symptoms. Conclusion PSS may be missed in mild to moderate symptomatic ED presentations. Early vascular imaging and careful history-taking, including patient photographs, can enable timely treatment and prevent complications.