Paget-von Schrötter syndrome: upper extremity deep vein thrombosis after heavy exercise

Abstract

We present a 52-year-old man with swelling, tightness, heaviness, and redness in the right half of his neck, face, upper arm, and right precordial area after repetitive exercises. No etiological factors such as trauma, venous catheter, malignancy, hematologic disorder history, or any chronic disease were noted. A Doppler ultrasound of the upper extremities was performed, which showed a complete thrombotic occlusion in the right internal jugular vein, partial occlusion in the right brachiocephalic and subclavian veins with thrombosis, and chronic thrombosis occluding the left brachial vein. Complete blood cell count, coagulation profiles, and rheumatologic and tumor markers were normal. The patient reported that he had taken spinning classes for the last 18 months, and for the past 4 days he reported that he had done his spinning exercises harder and more frequently. The swelling and redness regressed partially on the 3rd day of therapy with enoxaparin sodium. In the first month follow-up visit we performed a control Doppler ultrasound and it showed partially thrombosed areas in the right brachiocephalic and internal jugular veins. Also, chronic thrombosis persisted in the left brachial and basilic veins. Computed tomography images showed no evidence for malignancy and some sections showed filling defects in the vena cava superior, which was attributed to thrombotic materials. The patient was successfully treated with anticoagulants for 6 months.