The diagnosis and management of Paget-Schroetter syndrome (primary effort thrombosis) in the emergency department

Introduction: Paget-Schroetter syndrome, also known as primary effort thrombosis, is a subtype of deep venous thrombosis in the subclavian vein at the costoclavicular junction. If recognized and treated appropriately, this condition has few long-term complications, but can lead to significant morbidity if undiagnosed. Patient concerns: A 40-year-old male bodybuilder presented to an urban emergency department for evaluation of right upper extremity swelling and plethora. Diagnosis: A duplex venous ultrasound of the right upper extremity showed an occlusive thrombus of the subclavian vein. Interventions: Upon discovery of the right upper extremity thrombus, the patient was started on a heparin drip and was admitted to the vascular surgery service where he underwent thrombolysis and venoplasty of his right subclavian vein. Outcomes: The patient had a successful outcome and was discharged home, with improvement of his symptoms after treatment. He was instructed to continue on oral anticoagulation. Conclusion: The management of this syndrome differs significantly from that of lower extremity deep venous thrombosis and can cause providers to mistakenly treat it similarly to its more common cousin. This case highlights the need for emergency medicine providers to be aware of this pathology in order to make timely diagnosis and management decisions.