Paget-Schroetter Syndrome With Focal Subclavian Arterial Stenosis Following Repetitive Overhead Activity: A Case Report.
- 1Acute Medicine, NHS Humber Health Partnership, Northern Lincolnshire, GBR.
- 2Acute Medicine, Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe, GBR.
- 3Acute Medicine, Hull Royal Infirmary, Scunthorpe, GBR.
Abstract
Paget-Schroetter syndrome (PSS), also known as effort thrombosis, is a rare form of upper extremity deep vein thrombosis resulting from mechanical compression of the subclavian vein at the thoracic outlet. It typically occurs in young, active individuals performing strenuous upper limb exercises and presents with pain, swelling, and discoloration of the affected limb. Early diagnosis and specialist management are important for optimizing outcomes. In selected patients, management may include a combined endovascular and surgical approach to restore venous patency and reduce the risk of recurrence and post-thrombotic complications. A 46-year-old woman who was neither an athlete nor a manual laborer presented with a four-day history of right upper-limb pain and swelling following repetitive overhead activity. She reported progressive swelling, positional bluish discoloration on arm elevation, and episodic pallor of the thumb and index finger. No secondary provoking factor for venous thromboembolism was identified. Physical examination revealed a swollen right arm with prominent superficial veins and bluish discoloration provoked within 10-15 seconds of arm elevation. Initial duplex ultrasonography identified right subclavian vein thrombosis, with the axillary and brachial veins reported as patent. However, computed tomography (CT) venography performed the following day demonstrated thrombosis involving both the right axillary and subclavian veins. CT angiography additionally demonstrated focal stenosis of the right subclavian artery at the thoracic outlet. The patient underwent catheter-directed thrombolysis followed by first rib resection for thoracic outlet decompression. This case documents PSS outside its typical demographic in a patient presenting with upper limb swelling and discoloration following repetitive overhead activity. The discordant axillary vein findings emphasize the importance of interpreting sequential vascular imaging studies in the context of their timing and modality. The accompanying episodic digital pallor and CT finding of focal subclavian arterial stenosis highlight the importance of considering possible arterial involvement in a predominantly venous presentation. Following treatment, the symptoms resolved, and venous patency was maintained at four-week follow-up.
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BibTeX
@article{tebaig2026pagetschroetter,
title = {{Paget-Schroetter Syndrome With Focal Subclavian Arterial Stenosis Following Repetitive Overhead Activity: A Case Report.}},
author = {Badria Tebaig and Aiman Balouch and Mahboob Ur Rahman and Muhammad Asad Raza},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117355},
url = {https://europepmc.org/article/MED/42968971},
note = {CC BY},
}
RIS
TY - JOUR
TI - Paget-Schroetter Syndrome With Focal Subclavian Arterial Stenosis Following Repetitive Overhead Activity: A Case Report.
AU - Badria Tebaig
AU - Aiman Balouch
AU - Mahboob Ur Rahman
AU - Muhammad Asad Raza
PY - 2026
DA - 2026/10/02
JO - Cureus
DO - 10.7759/cureus.117355
UR - https://europepmc.org/article/MED/42968971
AB - Paget-Schroetter syndrome (PSS), also known as effort thrombosis, is a rare form of upper extremity deep vein thrombosis resulting from mechanical compression of the subclavian vein at the thoracic outlet. It typically occurs in young, active individuals performing strenuous upper limb exercises and presents with pain, swelling, and discoloration of the affected limb. Early diagnosis and specialist management are important for optimizing outcomes. In selected patients, management may include a combined endovascular and surgical approach to restore venous patency and reduce the risk of recurrence and post-thrombotic complications. A 46-year-old woman who was neither an athlete nor a manual laborer presented with a four-day history of right upper-limb pain and swelling following repetitive overhead activity. She reported progressive swelling, positional bluish discoloration on arm elevation, and episodic pallor of the thumb and index finger. No secondary provoking factor for venous thromboembolism was identified. Physical examination revealed a swollen right arm with prominent superficial veins and bluish discoloration provoked within 10-15 seconds of arm elevation. Initial duplex ultrasonography identified right subclavian vein thrombosis, with the axillary and brachial veins reported as patent. However, computed tomography (CT) venography performed the following day demonstrated thrombosis involving both the right axillary and subclavian veins. CT angiography additionally demonstrated focal stenosis of the right subclavian artery at the thoracic outlet. The patient underwent catheter-directed thrombolysis followed by first rib resection for thoracic outlet decompression. This case documents PSS outside its typical demographic in a patient presenting with upper limb swelling and discoloration following repetitive overhead activity. The discordant axillary vein findings emphasize the importance of interpreting sequential vascular imaging studies in the context of their timing and modality. The accompanying episodic digital pallor and CT finding of focal subclavian arterial stenosis highlight the importance of considering possible arterial involvement in a predominantly venous presentation. Following treatment, the symptoms resolved, and venous patency was maintained at four-week follow-up.
SN - 2168-8184
ER -