Presentation
Edema and numbness of left arm while combing her hair (elevation of the arm).
Patient Data
Bilateral compression of the subclavian veins when the patient hyperabducts her arms, compression at the costoclavicular space, conditioned by the clavicle and the first rib.
In the left subclavian vein, there is echogenic material visualized with partial flow when seen with color Doppler, consistent with thrombus.
Right subclavian vein, with adequate flow, without compression when arm not elevated. Right subclavian vein compression in dynamic exploration (elevation of the arm)
Case Discussion
Effort thrombosis, also known as Paget-Schroetter syndrome, is due to repetitive activity of the upper extremities with compression and thrombosis of the axillary-subclavian veins.
Any anatomical abnormality at the thoracic outlet and repetitive trauma are predisposing factors for its initiation.
This patient has bilateral thoracic outlet syndrome with a thrombus at the left subclavian vein, the costoclavicular space, which is anatomically limited superiorly by the clavicle, anteriorly by the subclavian muscle and posteriorly by the first rib and middle scalene muscle.
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