Lung Cancer: Thoracic Malignancies |

Paget-Schroetter Syndrome in a Wrestler With Subsequent Diagnosis of Diffuse Large B-Cell Lymphoma FREE TO VIEW

Bibek Pannu, MBBS; Nissy Philip, MBBS; Vivek Iyer, MD
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Mayo Clinic Rochester, Calgary, AB, Canada

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A334. doi:10.1016/j.chest.2016.02.347
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SESSION TITLE: Thoracic Malignancies

SESSION TYPE: Case Report Slide

PRESENTED ON: Sunday, April 17, 2016 at 04:00 PM - 05:00 PM

INTRODUCTION: Paget-Schroetter syndrome (PSS), also known as effort thrombosis, is a rare syndrome of subclavian-axillary vein deep venous thrombosis (DVT) typically occurring in younger men after heavy upper extremity exertion. Anatomic abnormalities resulting in thoracic outlet syndrome (TOS) are commonly seen. We present a case of PSS in a young wrestler who was later found to have Diffuse Large B-Cell Lymphoma (DBCL) 2 months later.

CASE PRESENTATION: A 17 year old high school wrestler, presented with one day history of dull pain, swelling and bluish discoloration of the left arm occurring after a wrestling match the day before. Patient denied any recent history of trauma, surgery, cancer, drug or steroid use as well as personal or family history of thrombophilia. Ultrasound revealed a non-occlusive thrombus in the left subclavian vein and he was started on IV heparin. A venogram demonstrated left subclavian vein occlusion with acute thrombus throughout the innominate vein. He then underwent catheter-directed thrombolytic therapy with alteplase and daily venograms. Due to persistent clot burden, balloon angioplasty was undertaken four days later. He was subsequently discharged on 3 months of warfarin and enoxaparin bridge therapy, and was scheduled for TOS investigations as an outpatient. 2 months after this episode, a diagnosis of DBCL was made during investigations for persistent cough.

DISCUSSION: Our case highlights the typical presentation of PSS occurring in a young male after heavy exertion. Our case has several distinguishing features including persistence of the thrombus with need for multiple invasive procedures. In addition, the diagnosis of DBCL 2 months after the diagnosis of PSS highlights the need for continued surveillance after any episode of venous thromboembolism, even in cases with an obvious explanation.

CONCLUSIONS: PSS is a rare cause of upper extremity DVT. Treatment should be individualized and most patients require a combination of immediate anticoagulation/thrombolytic and mechanical thrombectomy therapy with subsequent surgery aimed at relieving the underlying cause of the TOS. The presence of underlying malignancy should be ascertained at the time of diagnosis and subsequent follow up.

Reference #1: Thompson, J. F., et al., Venous thoracic outlet compression and the Paget-Schroetter syndrome: a review and recommendations for management. Cardiovasc Intervent Radiol, 2011. 34(5): p. 903-10.

Reference #2: Urschel, H. C., Jr. and M. A. Razzuk, Paget-Schroetter syndrome: what is the best management? Ann Thorac Surg, 2000. 69(6): p. 1663-8.

Reference #3: Joffe, H. V. and S. Z. Goldhaber, Upper-extremity deep vein thrombosis. Circulation, 2002. 106(14): p. 1874-80.

DISCLOSURE: The following authors have nothing to disclose: Bibek Pannu, Nissy Philip, Vivek Iyer

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