A 22-year-old right-handed male athlete develops sudden swelling and cyanosis of his entire right upper limb after an intensive weightlifting session. Duplex ultrasound confirms axillary-subclavian vein thrombosis. There is no thrombophilia and no central venous catheter. What is the most likely diagnosis?

• A May-Thurner syndrome
• B Paget-Schroetter syndrome ✓
• C Klippel-Trenaunay syndrome
• D Superior vena caval obstruction

Explanation

Effort thrombosis of the axillary-subclavian vein following repetitive strenuous upper limb activity in a young patient defines Paget-Schroetter syndrome, the venous form of thoracic outlet compression. Management involves anticoagulation and consideration of catheter-directed thrombolysis followed by first rib resection. May-Thurner syndrome causes left iliofemoral DVT from iliac vein compression, Klippel-Trenaunay is a congenital overgrowth syndrome, and SVC obstruction produces chronic facial and neck oedema rather than acute limb swelling.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.