Paget-Schroetter syndrome in athletes: a comprehensive and systematic review

Pulmonary embolism following an undiagnosed Paget-Schroetter syndrome: a case report and review of the literature

Paget-Schroetter Syndrome (PSS) is a rare condition characterized by spontaneous thrombosis of the axillary-subclavian vein that occurs predominantly in young athletes engaged in repetitive overhead upper extremity motion, for instance, weightlifting, swimming, baseball, and tennis. PSS is usually a consequence of chronic repetitive microtrauma to the vein intima due to compression of the axillary-subclavian vein by the thoracic outlet structures. This chronic injury can then be acutely exacerbated by vigorous exercise done over a brief period, accelerating thrombus formation. Lack of PSS awareness leads to underdiagnosis, misdiagnosis, or late diagnosis, which can pose life-threatening risks to patients, including pulmonary embolism (PE) and recurrent thrombosis. This case report of a 20-year-old male college athlete exposes a PE caused by PSS, potentially worsened by a delay in diagnosis. Early suspicion and proper management are crucial for optimizing long-term outcomes and facilitating limb rehabilitation. The recommended approach involves early catheter-directed thrombolysis followed by thoracic outlet decompression.

Exercise-induced venous thrombosis of the upper extremity: A case report

Paget-Schroetter syndrome, the venous variant of thoracic outlet syndrome, is an uncommon presentation of deep vein thrombosis. In patients with Paget-Schroetter syndrome, the subclavian vein is compressed within the thoracic outlet as a result of repetitive and vigorous arm motions. Repeated endothelial injury leads to stasis in flow and eventual thrombus formation in the subclavian vein and its tributaries. This report highlights the case of an active and otherwise healthy 46-year-old patient who presented with swelling and pain of his right upper extremity after a run and was found to have multiple, effort-induced thrombi involving the right subclavian, axillary, brachial, and basilic veins. The unusual clinical picture of Paget-Schroetter syndrome and its presentation commonly in the demographic of young, healthy individuals make it a diagnosis likely overlooked and unfamiliar to many in the clinical setting.

Sleep like a bear

Reduced expression of a platelet protein protects against thrombosis during chronic immobilization.

Platelet/Lymphocyte Ratio Predicted Long-Term Prognosis for Acute Upper Extremity Deep Vein Thrombosis from a Retrospective Study

Background

In this study, we aimed to determine the mortality risk factors and whether placement of a vena cava filter improves the prognosis of acute upper extremity deep vein thrombosis (UEDVT).

Methods

Clinical data and follow-up results were retrospectively analyzed. Cox regression analysis was conducted to identify the risk factors associated with all-cause mortality in all patients and subgroups of patients. Results are expressed as hazard ratio (HR) with 95% confidence intervals (95% CI). Receiver operating characteristic curves (ROC) were used to determine the optimal cut-off value. Kaplan-Meier survival curves were constructed and compared by the Log rank test.

Results

The study cohort comprised 109 patients of median age 56 years (47.5, 64.5). The median follow-up time was 25 months (8, 47): 39 patients (35.8%) had died by 12 months, 55 (50.5%) by 36 months, and 60 (55%) by the end of follow-up. Presence of malignancy (HR: 5.882, 95% CI: 2.128-16.667), D-dimer (HR: 1.56, 95% CI: 1.09-1.94), platelet/lymphocyte ratio (PLR; HR: 2.02, 95% CI: 1.15-3.54), and the systemic immune/inflammatory index (SII; HR: 1.471, 95% CI: 1.062-1.991) were identified as independent risk factors for mortality. Subgroup analysis of patients with malignancy determined gender (HR: 2.936, 95% CI: 1.599-5.393) and PLR (HR: 1.427,95% CI: 1.023-1.989) as independent risk factors. Kaplan-Meier analysis showed that the mortality rate was much higher in patients with malignancy, high D-dimer (≥ 0.92ug/mL), high PLR (≥ 291) and high SII (≥ 1487). However, there was no significant difference between patients with and without vena cava filters.

Conclusion

In this study, we identified PLR as an new independent predictor of mortality in patients with acute UEDVT. Emergency placement of a vena cava filter did not improve long-term prognosis.

Dorsalis pedis artery thrombosis in an elite rugby player: an unusual cause of pedal claudication in a high-risk ankle

Vascular thrombosis in young elite athletes is uncommon, usually affecting calf veins and arteries beyond the knee joint. Arterial thrombosis, especially in the dorsalis pedis artery, is very rare without premature atherosclerosis or trauma. Its clinical presentation with progressive claudication of insidious onset is nonspecific and overlaps with the symptoms of deep peroneal nerve compression as a part of anterior ankle impingement, a more common entity in athletes. Ultrasound can evaluate pedal claudication in athletes differentiating vascular and neural causes expediting diagnosis, management and, in turn, return to play. Furthermore, imaging-Doppler ultrasound and MR angiography in particular-plays a vital role in the evaluation of potential aetiology and evolution (i.e., collateral development and recanalization) of the occluded vessel. We present a case of dorsalis pedis artery thrombosis with both MRI and ultrasound findings in a professional rugby player who had no systemic comorbidity, but numerous previous surgical interventions around the ankle joint in both the remote and recent past, putting the adjacent DPA at increased risk for developing thrombosis. In this high-risk ankle, the dorsalis pedis thrombosis may be iatrogenic or due to sports-related, arterial wall injury with superimposed thrombosis.