The n e w e ng l a n d j o u r na l of m e dic i n e

images in clinical medicine

Paget–Schroetter Syndrome

Marcus Seeger, M.D.

Burkhard Bewig, M.D.
University Hospital Schleswig-Holstein
Kiel, Germany
mseeger@1med.uni-kiel.de

A
47-year-old woman with no medical history presented with swelling, pain, and reddish dis-
coloration of the right arm and hand after strenuousICM effort.
AUTHOR Findings
Seeger on ultrasonography,
RETAKE 1st
computed tomog-
REG F FIGURE a 2nd
raphy, and magnetic resonance imaging were normal. CASE
The patient’s symptoms persisted. One
3rd week after presen-
TITLE
tation, she underwent ultrasonography with a microconvexEMail probe that allowed Line better visualization
4-C
Revised beneath the clavicle.

This test revealed a subtotal occlusion in the subclavian vein

Enonclose to the
ARTIST: mstclavicle,
H/T caused H/T by a small thrombus fixed on
SIZE
a venous valve (video). Blood-clot formation in the deep veins of the arms is known as the Paget–Schroetter syndrome.
FILL Combo 267pts

This rare condition often occurs in young, healthy patients. Figure

Smallhasthrombotic
AUTHOR, PLEASEsegments
NOTE: causing clinically significant
been redrawn and type has been reset.
vaso-occlusion can be easily missed with standard diagnostic procedures, Please particularly
check carefully. if thrombi are located immedi-
ately beneath the clavicle. The patient was treated with oral anticoagulation. One month after the initiation of anti-
coagulation, she no longer had swelling and discolorationJOB: 36303
of the right arm and hand ISSUE: 7-15-10
at rest, although the symptoms
reappeared with strenuous use of the arm. At the 2-month follow-up, her symptoms and thrombosis had fully resolved.
Copyright © 2010 Massachusetts Medical Society.

e4 n engl j med 363;3 nejm.org july 15, 2010

The New England Journal of Medicine

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