Paget-Schroetter Syndrome: The Role of Diagnostic and Interventional Radiology in Spontaneous Upper Extremity Deep Vein Thrombosis in Young Athletes

Purpose or Learning Objective: This study examines a cohort of six young and physically active athletes diagnosed with spontaneous upper extremity deep vein thrombosis. We highlight the role of diagnostic imaging, particularly computed tomography angiography and Doppler ultrasound, in early detection and management. Additionally, we emphasize the impact of interventional radiology techniques, such as thromboaspiration, in optimizing patient outcomes and preventing long-term complications.

Methods or Background: Upper extremity deep vein thrombosis is a rare but serious condition in young active individuals, often associated with venous thoracic outlet syndrome. Effort-induced thrombosis, or Paget-Schroetter syndrome, can result from venous thoracic outlet syndrome. Early diagnosis and treatment are critical to prevent complications such as postthrombotic syndrome or pulmonary embolism. The diagnostic approach included clinical assessment for swelling, heaviness, and pain in the affected limb, followed by confirmation with computed tomography angiography. Initial treatment involved low-molecular-weight heparin administration. If inadequate symptom resolution was observed within 24 hours, vascular interventional radiologists performed thromboaspiration within 15 days. Postprocedural monitoring included Doppler ultrasound at 7 and 30 days. If Doppler findings were negative, patients underwent physical therapy and 3 months of anticoagulation. After 3 months, electromyography, magnetic resonance imaging, and Doppler ultrasound were performed to assess venous patency. First rib resection was performed to address the anatomical compression.

Results or Findings: All six patients presented with acute upper extremity deep vein thrombosis and were initially treated with low-molecular-weight heparin. In four cases, thromboaspiration was required due to insufficient response to anticoagulation. The procedure resulted in significant thrombus reduction, with immediate symptom relief. No procedural complications were recorded. Follow-up Doppler ultrasound at 7 and 30 days confirmed vessel patency in all cases. After completing anticoagulation and rehabilitation, five patients underwent surgical decompression; one patient improved with physical therapy. All patients regained full limb function, with no recurrence at the 6-month follow-up.

Conclusion: Upper extremity deep vein thrombosis in young active individuals requires a structured diagnostic and therapeutic approach. Although anticoagulation is the first-line treatment, persistent thrombus burden may require thromboaspiration. Long-term management often requires surgical intervention to prevent recurrence. A multidisciplinary strategy combining interventional radiology, surgery, and rehabilitation optimizes patient outcomes.

Publication History

Article published online:
02 June 2025