A Case of Paget-Schroetter Syndrome in a Young, Healthy Woman

This report discusses a case of a 33-year-old healthy woman who presented with upper extremity swelling and pain, which she attributed to an injury sustained during her work as a professional dancer. Given her persistent symptoms, she was eventually referred to the emergency room for evaluation of possible thrombosis. She was found to have an elevated D-dimer, and a CT angiogram of the chest revealed narrowing of the bilateral subclavian veins suggestive of venous thoracic outlet syndrome (VTOS). A right upper extremity deep vein thrombus was subsequently confirmed on ultrasound imaging. The patient was started on anticoagulation, vascular surgery was consulted, and the patient was diagnosed with Paget-Schroetter syndrome. She underwent thrombolysis and venoplasty with symptomatic improvement. Decompressive surgery of the thoracic outlet was recommended to the patient as a means of definitive treatment to avoid recurrent thrombosis; however, the patient elected to defer at this time due to her active occupation. This case illustrates how this condition is diagnosed, the pathophysiology behind it, and the various treatment options available. It highlights the importance of shared decision-making between patient and physician in determining management that best fits the patient's lifestyle and goals.