Unraveling effort thrombosis: a comprehensive case report on page-schroetter syndrome

Abstract

Background: Page-Schroetter Syndrome (PSS) is a rare variant of thoracic outlet syndrome which requires early intervention to prevent formation of deep vein thrombosis in the upper limbs. Development of PSS depends on risk factors such as young-aged athletes, typically of male sex, who exercises using repetitive arm movements such as swimming, muscle building exercises, and handball, aggravating microtrauma to venous intima leading to activation of coagulation cascade. Case Presentation: A case of 33-year-old Saudi male was presented to the emergency department on an acute onset of right arm swelling, redness, and pain. Following calisthenics exercises where he was doing push-ups on an open door. The patient was hemodynamically stable, negative for signs and symptoms of pulmonary embolism, and he denied any history of thrombus-forming events. The patient was diagnosed with PSS after detecting filling defect on Doppler ultrasound, and severe stenosis of the right subclavian vein on venogram. The patient was treated accordingly and was discharged on long-term oral direct anticoagulants. Conclusion: PSS is easily missed due to scarce number of reported cases, and unfamiliarity from the medical personnel with the approach to detect and treat upper limb deep vein thrombosis.