Paget-von-Schroetter syndrome
| Classification according to ICD-10 | |
|---|---|
| I80.8 | Thrombosis, phlebitis and thrombophlebitis in other locations |
| ICD-10 online (WHO version 2019) | |
The Paget von Schroetter syndrome (synonym: arm and shoulder girdle vein thrombosis ) , named after the English surgeon Sir James Paget and the Austrian internist Leopold Schrötter von Kristelli , is a thrombosis of the deep arm, axillary or collarbone vein. The Latin names of the vessels loud brachial vein , axillary vein and subclavian vein . This is why one speaks of a brachial, axillary or subclavial thrombosis, depending on the extent of the occlusion. It occurs predominantly in young adult men and mostly affects the right side. About 2% of all thromboses are localized in the area of the arm and shoulder girdle.
Symptoms
The thrombosis usually causes no pain. Other symptoms of the disease are swelling of the arm with red to bluish discoloration, increased visibility of the surface veins with blotchy skin (as a sign of bypassing circuits), a feeling of pressure in the armpit and a feeling of tightness. As a complication, pulmonary embolism can occur if the thrombus loosens . In this case, other symptoms such as shortness of breath and pain in the chest area may occur.
root cause
In a number of the affected patients, even after closer examination, no cause is found: the thrombosis developed spontaneously. The clavicle vein is fixed between the collarbone and the first rib and can be more easily damaged mechanically or compressed here. Therefore, this point is usually the starting point of the thrombosis.
A common cause of the development of Paget-von-Schroetter syndrome is thoracic outlet syndrome , in which the veins are constricted by bones (neck rib, collarbone fractures) or muscles. Another cause is the forced strain on the arm in question (so-called thrombosis par effort ) through sports such as tennis or weightlifting or working over the head, such as painting blankets. Even when sleeping or driving a car, the veins can be compressed for a long time , which promotes the development of this thrombosis. In addition, medical measures such as placing a central venous catheter can cause irritation in the vessel wall and then thrombosis. Older patients in particular must consider an increased tendency to thrombosis in the context of a previously unknown cancer.
Diagnosis
The ultrasonography with color Doppler is now the method of choice for diagnosis. Arm vein phlebography is the older method . Contrast agent is injected into a vein in the arm and the process via the veins to the heart is observed under fluoroscopy and documented as an X-ray image.
treatment
Medical therapy
If the thrombosis does not resolve spontaneously, medication should be used. This primarily includes taking anticoagulants or, in severe cases, lysing agents . Heparins or "oral anticoagulants" ( coumarins ) are usually used for a few weeks . With thrombolysis , which is rarely used , there is a risk of cerebral haemorrhage . Another therapy option is the local dissolution of the clot through a catheter inserted into the vein , but this can lead to embolism .
Operative therapy
If the compression has a tangible cause, surgical treatment is indicated. For example, cervical ribs or exostoses of the first rib can be removed , the subclavian muscle can also be mobilized or the anterior and posterior scalenus muscle can be disinserted .
course
Overall, the course of the arm and shoulder girdle vein thrombosis is usually quite favorable. The vessel usually reopens after a few weeks. The tendency of the arm to swell soon subsides again. The pulmonary embolism risk is present, but considerably lower than in the leg and pelvic vein thrombosis:
- Subclavial thrombosis Pulmonary embolism rate about 3%
- Leg vein thrombosis Pulmonary embolism rate about 10–15%
swell
- ↑ H. Renz-Polster , S. Krautzig: Basic textbook internal medicine. 4th edition. Urban & Fischer-Verlag, Munich 2008, ISBN 978-3-437-41053-6 .
- ↑ GL Oktar, EG Ergul: Paget-Schroetter syndrome. In: Hong Kong Med J. 2007 Jun; 13 (3), pp. 243–245. PMID 17548917
- ^ G. Roche-Nagle, R. Ryan, M. Barry, D. Brophy: Effort thrombosis of the upper extremity in a young sportsman: Paget-Schroetter syndrome. In: Br J Sports Med. 2007 Aug; 41 (8), pp. 540-541; discussion p. 541. Epub 2007 Feb 8. PMID 17289856
literature
- V. Hylton et al.: Upper extremity deep vein thrombosis. A prospective registry of 592 patients . In: Circulation. 110, 2004, pp. 1605–1611 (English)
