Emergency Medicine: Open Access
Open Access
ISSN: 2165-7548
ISSN: 2165-7548
Nauman Babar
Queen Elizabeth Hospital Birmingham, UK
Posters & Accepted Abstracts: Emerg Med
Introduction: PSS refers to effort induced thrombosis of the axillary and subclavian veins due to repetitive strenuous activity of upper limbs. It accounts for 30-40% of spontaneous axillary-subclavian vein thrombosis and 10-20% of all upper limb DVTs. Its management differs greatly from all other causes of upper limb DVT and is primarily surgical. Case Report: We report on a 42-year-old cabbie who presented to A&E with left arm swelling and erythema. He had been occupied for the past 2 weeks manually fixing his taxi and was otherwise healthy. Patient was initially diagnosed and managed as cellulitis and discharged. However, he presented again in a five day with worsening symptoms. Doppler Ultrasound scans revealed a basilic vein thrombus. CT thorax and MR Venography of the head demonstrated a left sided axillary, subclavian and brachiocephalic vein thrombus extending up to the left internal jugular vein into the sigmoid sinus. Patient had no risk factors of deep vein thrombosis and a negative thrombophilia screen. After vascular surgery, radiology and hematology input, he was discharged with lifelong anticoagulation and hematology follow up. We propose that this gentleman may have had a diagnosis of Paget-Schroetter syndrome and aim to highlight the importance of appropriate investigations for such patients to avoid long term complications of post thrombotic syndrome. Recommendation: It is important to differentiate effort thrombosis from cellulitis in acute settings. American College of Chest Physicians guidelines should be considered while deciding the management plan for patients with UEDVT.
Nauman Babar has graduated from the prestigious institute of Khyber Medical College Peshawar. Currently he is working as a Core Medical Trainee in Queen Elizabeth Hospital Birmingham, United Kingdom.
E-mail: nauman_1987@hotmail.com