Venous Thoracic Outlet Syndrome in a Young Student

Area of Science:

• Vascular Surgery
• Emergency Medicine
• Radiology

Background:

• Venous thoracic outlet syndrome (VTOS) involves compression and thrombosis of the axillosubclavian vein.
• Primary effort thrombosis, a VTOS subtype, arises from repetitive compression leading to axillosubclavian vein scarring, stenosis, and thrombosis.
• This condition is an uncommon presentation of upper extremity deep vein thrombosis.

Observation:

• A 23-year-old male student presented with a year-long history of intermittent right upper arm swelling and discoloration, exacerbated by overhead arm use.
• Symptoms worsened over recent weeks, with no significant past medical history or family history of clotting disorders.
• Computed tomography angiogram confirmed findings consistent with VTOS.

Findings:

• The patient underwent multiple surgical procedures and initiated anticoagulation therapy within two weeks of diagnosis.
• VTOS often presents in individuals lacking typical prothrombotic risk factors.
• Prompt diagnosis and treatment are essential for favorable functional outcomes.

Implications:

• Emergency physicians should consider VTOS in their differential diagnosis for upper extremity deep vein thrombosis, especially in young patients without risk factors.
• Early recognition and referral to vascular surgery are critical for timely management.
• Surgical intervention is frequently required for effective treatment of VTOS.