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Primary spontaneous upper extremity deep vein thrombosis is characterised by thrombosis within deep veins draining the upper extremity due to anatomical abnormalities of the thoracic outlet causing axillosubclavian compression and subsequent thrombosis. It is an uncommon condition that typically presents with unilateral arm swelling in a young male following vigorous upper extremity activity. The diagnosis of this condition is usually made by Doppler ultrasound, but other investigations are mandatory to exclude the secondary causes of upper extremity DVT. Different treatment options are available including anticoagulation, thrombolysis, and surgery. We report the case of a young healthy male with athletic physique who presented with pain and swelling of his dominant arm after weightlifting in the gym.

We herein report on two male patients (age, 22 and 44 years) who were referred to our department with swelling of the upper right arm after attending other hospitals. Right subclavian vein thrombosis was demonstrated by ultrasonography and they were then further evaluated by contrast-enhanced computed tomography (CT). Successful treatment involved venous thrombectomy in one patient and anticoagulant therapy in the other. Paget-Schhroetter syndrome was confirmed using standard vascular ultrasonography. Despite the accuracy of this method for diagnosing Paget-Schroetter syndrome, some cases are difficult to confirm. We reviewed 29 previously published case reports of Paget-Schroetter syndrome and analyzed the patient baseline characteristics, time to diagnosis, and the diagnostic methods used.

Paget–Schroetter syndrome (PSS) is an upper extremity thrombosis occurring in the axillary and subclavian veins. PSS is also known as “effort thrombosis,” because it is usually associated with repetitive and strenuous activities of the upper limbs. We present 2 patients with atypical PSS, so-called “non-effort thrombosis,” who were not involved in vigorous activities. They underwent thoracic outlet decompression through the infraclavicular approach without concomitant venoplasty. They were discharged without postoperative anticoagulant therapy. Venography and computed tomography after surgery revealed successful recanalization of the subclavian vein in each case. We highlight the characteristic pathophysiology of “non-effort thrombosis,” an atypical PSS entity.

Patients that have undergone treatment for venous TOS generally have excellent clinical outcomes, but a proportion of individuals may present with persistent, progressive, or recurrent upper extremity symptoms. The purpose of this chapter is to outline the spectrum of conditions that should be considered in evaluation of such patients and a systematic approach to classify and address these problems. It can be expected that with comprehensive evaluation and appropriate treatment, the majority of patients with persistent or recurrent venous TOS can experience decreased symptoms and restoration of normal upper extremity function. Evaluation of the deficiencies found during reoperations for venous TOS is informative with regard to the optimal approaches to be taken during primary operation for this condition.

Venous thoracic outlet syndrome (VTOS) is the second most common form of TOS. While seemingly easy to diagnose, there are some pitfalls and differences of opinions regarding classification. Treatment varies according to the underlying cause, so a clear understanding of etiology is vital for proper care of these patients. VTOS (with several subtypes) generally describes a patient with axillosubclavian pathology secondary to extrinsic compression at the costoclavicular junction. This diagnosis guides treatment, and while subtle differences of opinion exist, is recommended for all to agree upon.

Venous thoracic outlet syndrome is a disease process characterized by mechanical compression of the axillosubclavian vein as it exits the thoracic outlet. This chapter will review management considerations of venous thoracic outlet syndrome with respect to the efficacy of pre-operative thrombolysis. To date, clinical experience strongly favors surgical decompression of extrinsic compression of the subclavian-axillary vein, with adjunctive use of thrombolysis being a matter of some controversy.

A 23-year-old, right hand-dominant, male active-duty Marine self-referred to physical therapy with dull right anterior shoulder pain. The physical therapist referred the patient for a diagnostic ultrasound to rule out effort thrombosis of the axillary and subclavian veins. Same-day Doppler ultrasonography revealed an occlusive thrombus in the middle subclavian and axillary veins.

Paget-Schroetter syndrome, also known as effort thrombosis, is a relatively rare disease process characterized by primary thrombosis to the subclavian and axillary veins. It usually presents in younger individuals, commonly affecting the dominant side upper extremity, and the diagnosis relies on a combination of imaging, laboratory tests, and clinical presentation. Upper extremity deep vein thrombosis can also lead to pulmonary emboli, as in this case of a 20-year-old female discovered to have right sided Paget-Schroetter syndrome.

Primary effort thrombosis is a noniatrogenic deep vein thrombosis of the upper extremity. The incidence of this condition is 1 to 2 in 100,000 per year. The risk factors and typical patient population differ from other thrombotic events. Patients with primary effort thrombosis are typically young, athletic, and lack comorbidities. Due to its low incidence and unique risk factors, primary effort thrombosis often is misdiagnosed as a musculoskeletal injury. However, early recognition, initial testing with Doppler ultrasound, and immediate referral to a vascular center is essential to achieve optimal outcomes. This article reviews risk factors, pathogenesis, presentation, diagnosis, and acute management of primary effort thrombosis for primary care providers.

Introduction: The Paget–Schroetter syndrome or “effort thrombosis” is a deep venous thrombosis of subclavian-axillar vein at the costoclavicular junction . It affects predominately young and athletic people with an inherent anatomic variant at the costoclavicular junction that triggers the formation of a primary thrombosis. It is important to identify this syn-drome in order to prevent further complications, such as post-thrombotic syndrome, pulmonary embolism (PE), or even death. We present a clinical case in which a young professional basketball player developed a subclavian venous thrombosis and was managed with new oral anticoagulant.

Effort thrombosis, or Paget-Schroetter Syndrome, is an activity-induced upper extremity deep vein thrombosis affecting the axillary and/or subclavian vein. It is a rare disorder affecting 2 per 100,000 person years and mainly occurring in young, active individuals after repetitive upper extremity exertion. Effective diagnosis and management of this disorder has been difficult to study given the syndrome's rarity.We discuss and evaluate the case of a 38-year-old muscular male Marine who presented to the primary care clinic following an incorrect diagnosis during an emergency room visit where he was evaluated and treated for a right pectoralis muscle strain while having symptoms suggestive of upper extremity vascular congestion, including pain and edema.Given this presentation in a concentrated population such as the military, the primary care provider's suspicion of effort thrombosis was heightened. This patient was directed for lab and radiology examination followed by vascular surgery evaluation to be treated with catheter-directed thrombolysis, anticoagulation, and a first rib resection.Though rare, effort thrombosis is of particular importance in our relatively young, athletic population. A missed or delayed diagnosis could lead to lifelong disability. Awareness of this condition's presentation, inciting factors, and potential sequelae is important to minimize mortality and morbidity.

Background Incidence of primary upper extremity DVT (UEDVT) or effort thrombosis is increasing now a days. It is about 0.4–1 per 10,000 persons per year which accounts for 10% of all DVT Cases. We present a case of primary UEDVT in a non-dominant limb of a male person in an uncommon profession of its occurrence. Case presentation A 40 years male teacher presented to our hospital with 3 months history of pain and swelling of his left upper limb. After multiple consultations he consulted us for his unresolved symptoms. Doppler study showed left subclavian and axillary vein thrombosis. Diagnosis of primary/effort UEDVT (Paget-Schroetter syndrome (PSS)) was made after all the secondary causes were ruled out and there are no bony abnormalities. Patient was started upon anti coagulants. His symptoms got subsided. Follow up scan after 6 months shows minimal residual thrombosis in paired brachial vein. Conclusion As primary UEDVT occurs in young, functional adults early recognition and treatment requires high index of suspicion to prevent complications and morbidity of disease.

ABSTRACT INTRODUCTIONPaget-Schroetter syndrome, or effort thrombosis, refers to a deep venous thrombosis in an upper extremity. It is most commonly located in the axillary or subclavian veins and is associated with vigorous repetitive movements and anatomic abnormalities. CASE PRESENTATIONThis case study describes an 18-year-old Division 1 soccer player who presented with worsening axillary swelling and pain. He was found to have subclavian stenosis at the level of the thoracic inlet between the clavicle and first rib, with deep venous thrombosis in his right axillary, subclavian, proximal brachial, and basilic veins. It was diagnosed with ultrasound and confirmed with venography. He was treated initially with enoxaparin and warfarin before having mechanical thrombolysis, balloon venoplasty, infusion of tissue plasminogen activator, and a right first rib resection. CONCLUSIONAs Paget-Schroetter syndrome is rare, early recognition and management leads to fewer long-lasting sequelae and less morbidity. Left untreated, it can result in pulmonary embolism and residual upper extremity obstruction.

[Purpose] Paget-Schroetter syndrome (PSS) is an uncommon deep vein thrombosis of the axillary and subclavian veins which may occur spontaneously, but is usually caused by excessive upper limb activity. PSS is clinically similar to other upper limb musculoskeletal disorders and soft tissue infections, and this may lead to delay in correct diagnosis in its early stages. The aim of our case report is to discuss this rare condition with reference to the available literature. [Subjects and Methods] Here we report the case of a doner kebab chef who complained of swelling and pain in his right arm around the biceps muscle. The initial diagnosis was biceps tendon rupture, for which the patient underwent magnetic resonance imaging (MRI) of the right arm and shoulder. Since the MRI revealed no pathological findings, right upper limb venous Doppler ultrasound analysis was performed. Subacute thrombosis materials were detected in the subclavian, axillary, and brachial veins. [Results] With rapid anticoagulant therapy, the patient's symptoms quickly improved. [Conclusion] Early diagnosis and treatment of PSS is critical for preventing potentially fatal complications such as pulmonary embolism. Prophylaxis is important for preventing recurrent thrombosis and for avoiding the development of post-thrombotic syndrome. PSS should be considered a possible cause of painful swelling of the upper limbs, especially in young, active patients who use their arms excessively.

This case study describes a Major League Baseball player who was diagnosed with an axillary artery thrombosis due to arterial compression from throwing. The purpose of this article is to create awareness as to the signs and symptoms associated with arterial positional compression and the rehabilitative implications to surgical intervention.

Das Paget-von-Schroetter-Syndrom (PvSS) entwickelt sich uberwiegend infolge von Risikofaktoren, wie zentralvenosen Kathetern. Meist sind altere Patienten mit hoher Komorbiditat betroffen. Es betrifft aber auch junge Patienten nach ausergewohnlicher Kraftanstrengung des Arms. In diesen Fallen spielt eine Venenkompression im „Thoracic inlet“ eine wesentliche Rolle. Im vorliegenden Beitrag wird ein Algorithmus fur die Diagnose und Therapie bei den beiden unterschiedlichen Formen des PvSS vorgestellt.

In brief: Using hand weights during aerobic exercise has been recommended for increasing upper-body strength and calorie expenditure, but this practice can lead to a rare complication-effort thrombosis, as discussed in this case report. Physicians need to consider this complication when a runner complains of muscle strain. The patient history is important; physical examination should include arm measurement comparisons and neurologic, vascular, and musculoskeletal evaluations.

Approximately 10% of all cases of deep vein thrombosis (DVT) occur in the upper extremities. The most common secondary cause of upper-extremity DVT (UEDVT) is the presence of a venous catheter. Primary UEDVT is far less common and usually occurs in patients with anatomic abnormalities of the costoclavicular space causing compression of the subclavian vein, called venous thoracic outlet syndrome (VTOS). Subsequently, movement of the arm results in repetitive microtrauma to the vein and its surrounding structures causing apparent ‘spontaneous’ thrombosis, or Paget-Schrötter syndrome. Treatment of UEDVT aims at elimination of the thrombus, thereby relieving acute symptoms, and preventing recurrence. Initial management for all UEDVT patients consists of anticoagulant therapy. In patients with Paget-Schrötter syndrome the underlying VTOS necessitates a more aggressive management strategy. Several therapeutic options exist, including catheter-directed thrombolysis, surgical decompression through first rib resection, and percutaneous transluminal angioplasty of the vein. However, several controversies exist regarding their indication and timing.

Of 79 patients seen at the University of Minnesota with symptomatic chronic obstruction of the axillary subclavian or innominate vein, 65 were considered surgical candidates. Etiology of the obstruction was as follows: Group A (n=45), previous subclavian effort thrombosis; Group B (n=14), stenosis caused by occupation or sport activities; and Group C (n=6), long segments (4–7.2 cm) of obstruction caused by chronic intraluminal placement of devices (catheters, pacemaker, or defibrillator leads).

Paget-Schroetter syndrome (PSS), or effort thrombosis, refers to axillary and/or subclavian vein thrombosis associated with repetitive effort of the superior limbs, and is rare in the pediatric population. We report the case of a previously healthy 15-year-old boy who presented with a painful and swollen right arm after throwing firecrackers. Doppler ultrasound showed extensive right subclavian and axillary vein thrombosis. Anticoagulation therapy was started and had favorable evolution. We emphasize that PSS must be included in the differential diagnosis of a swollen arm.

Context: Effort thrombosis, or Paget-Schroetter’s syndrome, is a rare subset of thoracic outlet syndrome in which deep venous thrombosis of the upper extremity occurs as the result of repetitive overhead motion. It is occasionally associated with pulmonary embolism. This case of effort thrombosis and pulmonary embolus was in a 25-year-old major league professional baseball pitcher, in which the only presenting complaints involved dizziness and shortness of breath without complaints involving the upper extremity—usually, a hallmark of most cases of this condition. The patient successfully returned to play for 5 subsequent seasons at the major league level after multimodal treatment that included surgery for thoracic outlet syndrome. Objective: Though rare, effort thrombosis should be included in the differential diagnosis of throwing athletes with traditional extremity-focused symptoms and in cases involving pulmonary or thoracic complaints. Rapid diagnosis is a critical component of successful treatment.

Effort thrombosis, also known as Paget-Schroetter Syndrome and venous thoracic outlet syndrome (VTOS), refers to primary thrombosis of the subclavian-axillary vein at the costoclavicular space. Most patients present after experiencing axillo-subclavian vein thrombosis, and the thrombosis often results from vigorous athletic activities requiring repetitive arm and shoulder motions (e.g., weight lifting, swimming)as well as occupations that require repetitive motions with elevated upper extremities This review covers effort thrombosis in detail, examining its clinical and diagnostic evaluations, treatment, operative and postoperative management, and complications. An algorithm details the approach to the patient with effort thrombosis. Figures include the anatomy of the costoclavicur space, B-mode and duplex color-flow imaging of the proximal left subclavian vein, crossed occlusive thrombus, anatomic landmarks for planning infraclavicular approach incision, rib resection, venoplasty with an 8 × 40 mm balloon, completion venogram postvenoplasty, the supraclavicular approach using a self-retaining retractor system, post resection of the anterior scalene muscle, and post left first rib decompression chest x-ray. Tables list common clinical findings in VTOS, less frequent clinical findings in VTOS, and postoperative complications. This review contains 15 highly rendered figures, 3 tables, and 40 references.

Upper extremity thrombosis (Paget-Schroetter syndrome) hints already at physical strains with regard to the synonymous term "effort thrombosis". We report two cases of upper extremity thrombosis caused by wrestling. Wrestling as an example of martial arts activity leads to traumatic venous intima lesions with resulting local activation of coagulation as a main reason in pathogenesis of these thromboses. The possibility of a Paget-Schroetter syndrome should be considered in differential diagnosis if upper extremity complaints of unknown origin occur after wrestling matches. This kind of subclavian vein thrombosis should be reported to the accident insurance.

This report of a recreational athlete who had arm discomfort, fever, headache, and emesis frames a discussion of the diagnosis and treatment for primary upper-extremity deep vein thrombosis (PUEDVT). An unusual aspect of the case was sepsis without typical risk factors. Treatment of PUEDVT usually involves immediate anticoagulation and local thrombolysis followed by evaluation for post-thrombosis management; septic thrombophlebitis usually responds to intravenous antibiotics. Postthrombosis management is somewhat controversial, but first-rib resection is frequently recommended for patients who have thoracic outlet compression. This patient returned to unrestricted athletics without surgical intervention.

Deep venous thrombosis (DVT) is common, but only 2%-4% of DVTs involve the upper extremities (Roos in Am J Surg 154:568-73, 1987). Upper extremity DVT has a primary or secondary cause, and primary thrombosis is much rarer than secondary thrombosis. Primary upper extremity DVT comprises effort venous thrombosis and idiopathic thrombosis. Effort subclavian venous thrombosis, also called Paget-Schroetter syndrome, is an uncommon entity, which usually develops after strenuous effort of the upper extremities. Effort thrombosis of the upper extremity has been described in athletes involved in a wide variety of sports, including ball games, combatant sport and heavy athletics, games with rackets or clubs, and aquatic sports (Zell et al. in Angiology 52:337-42, 2001). Push-up exercise is a strengthening exercise for building up strength and endurance in the muscles of the upper arm and shoulders. It is also considered to be a core exercise in shoulder rehabilitation programs to activate the serratus anterior muscle in people with shoulder dysfunction (Ludewig et al. in J Sports Med 32:484-93, 2004). We report what to our knowledge is the first case of effort DVT of an upper extremity caused by push-up exercise.

VTOS in the pediatric patient is usually due to either positional obstruction or effort thrombosis. Children may present with acute symptoms of arm swelling and discomfort and some may present with chronic symptoms associated with dilated collateral veins. All patients should undergo hypercoagulable workup and duplex imaging of the axillo-subclavian vein to confirm the diagnosis. Further imaging of the thoracic outlet for soft tissue or osseous abnormalities should be also be performed. Those patients with acute thrombosis can undergo thrombolysis, followed by surgical decompression and anticoagulation. Patients who present with chronic symptoms should undergo decompressive surgery and adjunctive venolysis or repair followed by anticoagulation. Prognosis following decompression is superior to anticoagulation alone. Available evidence suggests a higher rate of bony abnormalities in this group, and that treatment should be identical to that of this condition in adults.

Venous thoracic outlet syndrome (VTOS) requires imaging to confirm the diagnosis and assess the extent of involvement and chronicity. In patients who present with acute effort thrombosis, thrombolysis is typically the first step. Tools for performing pharmacomechanical thrombolysis and strategies for their use will be discussed. Angioplasty and occasionally stenting are important techniques for managing residual stenoses after operative decompression of the thoracic outlet.

Athletes who carry out competitive sporting activities often complain of symptoms, especially pain, which in most cases are related to musculoskeletal injuries. However, when the sporting activity involves frequent and repetitive movement of the upper or lower limbs, the same clinical manifestations may be a result of an arterial disease, causing ischemia which is induced by muscular exercise [1].

Effort thrombosis refers to axillary-subclavian vein thrombosis associated with strenuous and repetitive activity of the upper extremities. Effort thrombosis usually follows sporting activities, such as wrestling, playing ball, gymnastics and swimming, which involve vigorous andnsustained upper extremity movements. Heretofore, We report a case of Paget-Schroetter syndrome characterized by hand knitting triggered thrombosis of the subclavian vein.

Background Effort thrombosis refers to axillosubclavian vein thrombosis secondary to physical activities of the upper extremity. Methods This report describes the clinical presentation of effort thrombosis in a millwright and reviews the literature for occupational reports of this condition. Results While there is a paucity of literature reporting an occupational association, work related physical demands on the upper extremity appears to increase the risk of axillosubclavian impingement and thrombosis in certain patients. Conclusion Effort thrombosis is a rare vascular condition of the upper extremity that may be seen in workers with repetitive, forceful, or overhead arm activities. Am. J. Ind. Med. 54:244–247, 2011. © 2010 Wiley-Liss, Inc.

Effort thrombosis of the subclavian vein (Paget-Schroetter syndrome) has long been considered a primary thrombotic process, but recent experience suggests that it may commonly result from repeated mechanical compression. Increased awareness of the pathophysiology of this syndrome can allow timely, improved diagnostic screening and the use of specific surgical intervention to relieve the venous consequences. During the past 15 years we have treated six patients with mechanical compression in the thoracic outlet causing surgically correctable venous occlusive problems. There were four men and two women with an average age of 38 years (range 26 to 53 years). All patients exhibited pain, swelling, and cyanosis of the upper extremity, with worsening venous congestion on abduction of the arm. Five of six patients were originally treated for effort thrombosis of the subclavian vein with arm elevation and anticoagulation; two also underwent immediate thrombolytic therapy with urokinase. Venography was prompted in each case by positional symptoms during follow-up and showed irregular stenosis of the subclavian vein adjacent to the first rib. All patients underwent extended first rib resection and circumferential venolysis (one patient underwent bilateral procedures); one was performed through a transaxillary approach, two through a supraclavicular approach, and four through a new, "paraclavicular" approach. All subclavian veins appeared normal after venolysis. Five of six patients also underwent complete scalenectomy and brachial plexus neurolysis. In each patient, venous and neurogenic symptoms resolved and venography confirmed a patent subclavian vein, with follow-up ranging from 11 months to 13 years (mean 3.8 years).

Objective: To advise athletic trainers on the potential for effort thrombosis to occur in nonthrowing athletes and to underscore the importance of early recognition and treatment. Background: An 18-year-old offensive lineman presented with a 1-day history of diffuse shoulder pain with no specific history of injury; swelling and erythema involved the entire left upper extremity. He was immediately referred to the team physician, who suspected deep vein thrombosis and sent the athlete to an imaging center. Duplex ultrasound was obtained on the day of presentation, and he was admitted to the hospital that evening. Differential Diagnosis: Deep vein thrombosis, thoracic outlet syndrome, shoulder tendinitis. Treatment: Anticoagulation with heparin was administered at the hospital, and he was sent home the next day on subcutaneous enoxaparin sodium, followed by a 5-mg daily dose of oral warfarin sodium. Oral anticoagulants were continued for a total of 4 weeks. The athlete began upper body lifting and was released 5 weeks postinjury to gradually return to football without restrictions. Uniqueness: Effort thrombosis is typically seen in the dominant arm of athletes, and the current treatment protocol calls for thrombolysis or surgical intervention. This athlete, whose position required repeated elevation of his arms in forward flexion, sustained the injury in his nondominant arm, was treated with anticoagulation only, and had a full return to football. At 18-month follow-up, he had no recurrence of symptoms. Conclusions: Early recognition and treatment of athletes with effort thrombosis is paramount to a successful clinical outcome and prompt return to play.

Primary axillary-subclavian vein thrombosis (effort thrombosis) is a unique variant of thoracic outlet syndrome that effects young, active adults. The majority of cases have been demonstrated to be secondary to contriction of the axillary- subclavian vein junction between the interval of the clavicle and the first thoracic rib. Owing to the limited clinical experience with this disorder, prevention of long-term disability has resulted in several proposed surgical procedures that have not always decreased late morbidity. Recently the availability of fibrinolytic agents has improved therapeutic results in primary thrombotic syndromes. The authors report 4 cases involving both acute and chronic effort thrombosis treated either by (1) sequential therapy involving fibrinolytic agents, anticoagulation, then decompressive surgery (first rib resection), (2) anticoagulation and first rib resection or (3) fibrinolytic agents and long term anticoagulation without surgery. Their experience with both acute and chronic effort thrombosis has resulted in sustained venous patency without the need for chronic anticoagulation in those patients who ultimately underwent rib resection as part of their treatment. The authors believe that this sequential therapy is the treatment of choice in the management of both phases of this syndrome and will eliminate the need for long-term anticoagulation and drastically reduce long-term disability.

Spontaneous thrombosis of the axillary and subclavian venous segments in young, healthy adults (effort thrombosis or Paget-Schroetter syndrome) is a rare but potentially disabling affliction. The diagnosis should be suspected in any young patient presenting with unilateral arm swelling. Typically, the dominant arm is affected, and frequent, repetitive arm use is a common component of the patients' history. Although the diagnosis can often be confirmed with a venous duplex evaluation, the central location of the venous abnormality occasionally mandates cross-sectional imaging or contrast venography to confirm the diagnosis. The underlying pathophysiology of this disorder is felt to be repetitive venous trauma owing to arm motion in the narrow anatomic space between the clavicle and first rib. The treatment of Paget-Schroetter syndrome is controversial and varies according to individual, institutional, and regional preferences. In general, the trend is toward more aggressive endovascular treatment. Prompt anticoagulation is generally accepted as the minimal treatment offered. Catheter-directed thrombolysis has also acquired a prominent role in reestablishing venous patency. The importance of relieving the anatomic compression of the subclavian vein by first rib resection remains controversial, with some experts advocating surgical intervention in all affected patients, whereas others perform this procedure selectively in cases of persistent venous stenosis or ongoing symptoms. Angioplasty with or without stenting is generally discouraged in the absence of anatomic decompression but may play an adjunctive role in patients undergoing first rib resection.

To the Editor: This letter regards the article by Dr Martinelli et al,1 “Risk factors and recurrence rate of primary deep vein thrombosis of the upper extremities.” Although the focus of the study published by these authors is in reference to the possible coagulopathy that patients may have as a predominant risk factor to develop upper vein thrombosis, as well as the possible influence of oral contraceptives, there is no reference to the Paget-Schroetter syndrome, also known as “effort thrombosis of the subclavian vein,” that some of their patients seemed to have. A strenuous muscular effort with the arms was recorded in one fourth of their patients. The current acceptable treatment for that condition is lytic therapy followed by surgery. The patients were followed up to investigate the rate of recurrence. …

Acute symptomatic effort thrombosis in a 33-year-old male necessitated an aggressive approach consisting of thrombolysis, angioplasty, and surgical thoracic outlet release. The patient required postoperative placement of a Wallstent and was placed on anticoagulation. He has remained symptom free for the past 10 months, both clinically and sonographically.

Effort thrombosis of the axillary and subclavian veins is an uncommon cause of upper extremity swelling. Prompt recognition and treatment of this disorder is important in order to minimize the complications of pulmonary embolism and postphlebitic syndrome that can occur with this condition. This can be very challenging while underway or in the field. A sailor who developed effort vein thrombosis while underway on board the aircraft carrier USS Abraham Lincoln is presented to review the presentation and management of this disorder, particularly as it applies to active duty military personnel.

Paget-Schroetter syndrome is the spontaneous thrombosis of the axillary/subclavian vein. A 16-year-old male presented with acute onset of right upper limb swelling after vigorous weight training. A venogram confirmed the diagnosis of Paget-Schroetter syndrome. He was started on intravenous thrombolytics followed by oral anticoagulation therapy. His symptoms resolved and he was symptom free at six-month follow-up. Thrombolytics and anticoagulation is the most widely accepted first-line therapy for this syndrome. Defining any anatomical anomaly as the predisposing factor in this condition is essential in the selection of which patients will benefit from thoracic outlet decompression.

A rare case of primary upper-extremity deep vein thrombosis or Paget-Schroetter syndrome is reported. It is effort thrombosis usually affecting young healthy individuals and is a rare condition. Our patient was a middle aged male daily laborer with history of exertion using the right upper limb. He responded to limb elevation and anticoagulation. No other cause for thrombosis was found.

Color Doppler sonography is a useful technique for rapid, noninvasive evaluation of venous disease in the upper extremity. It has been used successfully to evaluate thrombosis related to indwelling central catheters. In addition, Doppler sonography shows promise for monitoring thrombolytic therapy after "effort thrombosis" and detecting intermittent venous compression related to thoracic outlet syndrome.

A case of lower limb venous thrombosis occurring in a young male after playing American football is described. The features are compared to the more widely recognized effort thrombosis of the upper limb veins. The possibility of effort thrombosis needs to be considered in athletes presenting with leg injuries.