Inadvertent injury to the underlying venous circulation can occur when the upper extremity is subjected to an unaccustomed repetitive action. The resultant intimal damage may become a nidus for thrombus development. The population at risk includes young, active, and otherwise healthy individuals who engage in overuse of an upper extremity common to athletic pursuits or manual labor. Accompanying the gains in diagnosis and treatment of effort thrombosis has been the introduction of sports medicine as a clinical discipline. Examination of athletes on a large scale has promoted recognition of additional patients with spontaneous axillary and subclavian vein thromboses, thereby questioning the rarity of this condition.2-6 Signs and symptoms include nonedematous swelling, discoloration, pain, and distention of the cutaneous veins of the involved upper limb.
Definitive diagnosis is confirmed by imaging the thrombus.
The presence of an upper extremity thrombus has historically been considered benign and amenable to conservative therapy. Currently, conservative treatment is giving way to more liberal use of fibrinolytic agents in order to avoid long-term morbidity that may result from the acute phlebitic process. Pulmonary thromboembolism has not emerged as a major concern in patients with spontaneous upper extremity veno-occlusion. We report a case of significant pulmonary embolism attributed to an upper limb vein thrombus. We hope this observation will lead to consideration of thrombolytic therapy in this setting and encourage systematic investigation into the risks and benefits of thrombolysis in the early stages of the Paget-Schroetter syndrome.