Venous TOS (Paget-Schroetter Syndrome)
What is it?
- Venous TOS describes compression and eventual thrombosis of the subclavian vein, which occurs inside of a triangle bordered by the first rib, clavicle and the subclavius muscle/costoclavicular ligament.
What is the cause?
- Venous TOS is a rare problem that results from repeated compression injury to the subclavian vein.
- It is thought to occur with an incidence of 1/100,000 people per year.
- The population most likely to be affected is young active males in their 30s.
- Males are affected with a 2:1 predominance over females.
- Most often the right arm is affected, which is thought to be due to a higher proportion of right-handed dominance in society. Athletes are another population likely to be affected.
- Occupations which require repetitive overhead arm movement can also put patients at risk.
Signs and Symptoms?
- VTOS classically presents with a painful, blue and swollen upper extremity.
- Rarely, a tender palpable cord can be felt in the axilla.
- Dilated superficial veins over the upper arm, neck and chest can sometimes be appreciated, most often with chronic obstruction.
- Many patients will report vigorous exercise or labor preceding the onset of symptoms.
- A patient’s arm can become quite swollen, up to twice its normal diameter in the acute period
Where is the pain referral?
- Pain due to swelling in arm
Diagnostic tool to rule in/out
- Diagnosis of VTOS is accomplished in most patients through an initial history and physical exam followed by a confirmatory imaging study.
- In many patients the diagnosis will be fairly certain with history and physical exam alone.
- A sudden swollen, blue, painful upper extremity in a young active male is the hallmark presentation.
- Duplex ultrasound has become the recommended imaging study for initial diagnostic purposes.
- It has both a high sensitivity (78–100%) and specificity (82–100%) for diagnosis of thrombus
Presentation of the disease
- VTOS classically presents with a painful, blue and swollen upper extremity.