Case Report Elmer Press J Clin Med Res • 2009;1(3):178-180 Subclavian Vein Thrombosis Extending into the Internal Jugular Vein: Paget-von Schroetter Syndrome Enver Ilhana, d, Mehmet Tureb, Cengiz Yilmazc, Muhammed Arslanc Abstract Paget-von Schroetter syndrome refers to spontaneous throm- bosis of the subclavian vein and constitutes 0.5-1% of all venous thromboses. It is prevalent among young and healthy adult males who engage in sports. Early diagnosis and treatment is essential to avoid long-term sequelae. Herein, we report a 42-year-old male weightlifter who presented with swelling of the left arm, pain and a feeling of tightness in the anterior chest wall. At Doppler US and MR angiography, subclavian vein thrombosis extending into the in- ternal jugular vein was detected. Thrombolytic treatment ensured continuous venous flow and the patient’s complaints decreased. Keywords: Veins; Thrombosis; Thorombolytic therapy Introduction Effort thrombosis or Paget-Schroetter Syndrome (PSS) most often develops among young adults engaging in sport activities and those who work in jobs that require repeated arm movements which cause axillo-subclavian vein trauma and facilitate the development of deep vein thrombosis [1]. It frequently occurs as a result of the chronic compression of the subclavian vein at the thoracic outlet level, the cos- toclavicular junction [2, 3]. With a high prevalence among young people and active adults, this syndrome has a consid- Manuscript accepted for publication June 24, 2009 aDepartment of General Surgery, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey bDepartment of Cardiovascular Surgery, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey cDepartment of Radiology, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey dCorresponding author: 46/27 sokak no: 24 / 12 Esentepe-Karabaglar, Izmir, Turkey. Email: enver.lhan@gmail.com doi:10.4021/jocmr2009.07.1248 erably high probability of morbidity in later decades unless it is diagnosed on time and properly treated [1]. In this report, we aimed to underline the importance of early diagnosis and treatment for this rare disease. Case report A 42-year-old male presented with pain and swelling of the left arm after a sequence of intense, repetitive weight- lifting exercises. Upon questioning, he disclosed that he had been engaged with weightlifting for a long time and had com- plaints for a while. His medical history was unremarkable. Laboratory tests were positive for antithrombin 3 and fac- tor leiden, agents that facilitate coagulation. Based on these findings, upper-extremity effort thrombosis was suspected. Thereafter, contrast enhanced upper-extremity venous MR angiography (MRA) and color Doppler US (CDUS) were performed to verify the diagnosis. Contrast–enhanced MRA revealed near-complete occlusion of the proximal left sub- clavian vein and distal collateral formations (Fig. 1). CDUS Figure 1. Coronal maximum-intensity-projection contrast-en- hanced MR angiogram obtained after left antecubital vein injec- tion reveals near-complet occlusion of the left proksimal subcla- vian vein (arrow) and distal venous collaterals( arrowhead). 178 Articles © The authors, Journal compilation © J Clin Med Res and Elmer Press™, www.jocmr.org