Sunday, February 25, 2007

Paget-von Schrötter Syndrome

Interesting piece on thoracic outlet syndrome as a cause for pulmonary embolus was presented today in the New York Times. As such, this was not thoracic outlet syndrome, but rather thoracic "inlet" syndrome (veins bring blood flow into the thorax, after all), also known as Paget-von Schrötter syndrome:
Three potential compression sites responsible for thoracic outlet syndrome include:

1. Interscalene triangle - borders include anterior and medial scalene muscles and the first rib.
2. Costoclavicular space - between clavicle and first rib.
3. Pectoralis minor tunnel - space between pectoralis minor tendon anteriorly and coracoid process of scapula.

The majority of patients have one of the following congenital or acquired conditions in one or more of the potential compression sites:

Congenital lesion include cervical ribs, scalenus minimus muscle, wide insertion or hypertrophy of anterior scalene muscle, anomalous first rib, slender body habitus with a long thin neck. Acquired lesions include extreme muscular build, fractures to clavicle or first thoracic rib with nonanatomic alignment or exuberant callus formation, supraclavicular tumors or lymphadenopathy.

Effort thrombosis is a form of post-traumatic thrombosis of the axillary vein, usually observed in younger individuals following exercise or occupational activity. The etiology is compression of the axillary vein by either subclavian muscle or costocoracoid ligament during forced abduction. This is known as Paget-von Schrötter syndrome.
Physical exam: the lost art of medicine.

-Wes

Photo credit.

4 comments:

Stefan D. Tarlow MD said...

I am an orthopedic surgeon specializing in the knee in Scottsdale, Arizona. I followed doctor blogs for the past year and recently started my own. I recently came across your blog and wanted to touch base with other Drs with more experience. I wanted to invite you to visit my blog at http://tarlowmd.blogspot.com and would enjoy hearing any comments that you have. Keep up the good work.
-Dr. Tarlow

DrWes said...

Dr. Tarlow -

Welcome to the blog-o-sphere!

Blogs are like people - tons of variations - each with their own flavor and personality. Some are literary, some informative, some an eclectic collection of all things disconnected. Whatever yours turns out to be, it will add a voice to an incredibly rich and vibrant electronic ethos.

One word I'd advise - do it because you like it and be genuine. I have found blogging makes me more current w/medical affairs, but can take a significant amount of time - so pace yourself. Learn about RSS feeds and use them - then consider syndicating yourself if you do enough writing. Irrespective of MY thoughts - do what moves you - post once a month, once a week, or once a day. But be consistent - that way people will know when to come back and see what's new.

Best of luck to you!

-Wes

Dr Dork said...

As a physician once spoke unto me..and I tell all my students nowadays:

"If you don't look, you don't find"

el said...

I had this clot almost five years ago. It was accompanied by a PE, both of which were very difficult diagnose. Without going into detail, a definite source of extrinsic compression was never found (despite the use of positional venography etc). I believe I got the clot from sleeping in an unusual position with my arm extended above 90 deg.

I never had the surgery, only thrombolysis then warfarin for six months and am totally fine, and continue to be physically active.

One thing that's bugged me about this whole episode is that I was told that PEs from this clot are rarely significant enough to be fatal. However, as the NYT article seems to suggest, PEs from this clot can be serious. know anything about the stats on this clot?