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Effort Thrombosis Provoked by Saxophone Performance.
Leslie A Weaver1, Carolyn R Kanter2, Thomas G Costantino2
1Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
The Journal of Emergency Medicine
|January 15, 2019
Summary
Paget-Schroetter syndrome, a rare cause of internal jugular venous thrombosis, can be triggered by prolonged saxophone playing. Point-of-care ultrasound rapidly diagnosed this unusual case in the emergency department.
Area of Science:
- Emergency Medicine
- Vascular Surgery
- Diagnostic Ultrasound
Background:
- Internal jugular venous thrombosis (IJVT) is rare in outpatient settings but carries significant risks.
- Paget-Schroetter syndrome (PSS), or effort-induced thrombosis, is an under-recognized cause of IJVT.
- Prompt diagnosis and management are crucial for preventing morbidity and mortality.
Purpose of the Study:
- To report a unique case of PSS caused by prolonged saxophone playing.
- To highlight the utility of point-of-care ultrasound (POCUS) in diagnosing PSS.
- To review the clinical presentation, etiology, and diagnostic criteria for PSS.
Main Methods:
- Case presentation of a 79-year-old male with acute neck pain after prolonged saxophone playing.
- Diagnosis confirmed using point-of-care ultrasound (POCUS).
- Literature review of PSS presentation, causes, and diagnostic standards.
Main Results:
- POCUS confirmed PSS extending from the subclavian to the internal jugular vein.
- The patient's PSS was attributed to prolonged Valsalva maneuver and vascular trauma from playing the saxophone.
- This represents a novel etiology for PSS.
Conclusions:
- Emergency physicians should consider PSS in patients with neck pain and swelling, especially after strenuous activity.
- POCUS is an effective tool for rapid diagnosis of IJVT and PSS.
- Awareness of unusual triggers like musical instrument playing is important for recognizing PSS.
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