Ringhouse Brendan, Jackson Cody
Medical Clinic, Marine Corps Air Station Miramar, 2496 Bauer Road, San Diego, CA 92145.
Mil Med. 2017 May;182(5):e1826-e1829. doi: 10.7205/MILMED-D-16-00359.
Effort thrombosis, or Paget-Schroetter Syndrome, is an activity-induced upper extremity deep vein thrombosis affecting the axillary and/or subclavian vein. It is a rare disorder affecting 2 per 100,000 person years and mainly occurring in young, active individuals after repetitive upper extremity exertion. Effective diagnosis and management of this disorder has been difficult to study given the syndrome's rarity.
We discuss and evaluate the case of a 38-year-old muscular male Marine who presented to the primary care clinic following an incorrect diagnosis during an emergency room visit where he was evaluated and treated for a right pectoralis muscle strain while having symptoms suggestive of upper extremity vascular congestion, including pain and edema.
Given this presentation in a concentrated population such as the military, the primary care provider's suspicion of effort thrombosis was heightened. This patient was directed for lab and radiology examination followed by vascular surgery evaluation to be treated with catheter-directed thrombolysis, anticoagulation, and a first rib resection.
Though rare, effort thrombosis is of particular importance in our relatively young, athletic population. A missed or delayed diagnosis could lead to lifelong disability. Awareness of this condition's presentation, inciting factors, and potential sequelae is important to minimize mortality and morbidity.
用力性血栓形成,即佩吉特-施罗特综合征,是一种由活动诱发的上肢深静脉血栓形成,累及腋静脉和/或锁骨下静脉。它是一种罕见疾病,每10万人年中有2人患病,主要发生在年轻、活跃的个体,常在反复上肢用力之后。鉴于该综合征罕见,其有效诊断和管理一直难以研究。
我们讨论并评估了一名38岁肌肉发达的男性海军陆战队队员的病例,他在急诊室就诊时被误诊为右胸肌拉伤,当时他接受了评估和治疗,但同时有提示上肢血管充血的症状,包括疼痛和水肿,之后他前往初级保健诊所就诊。
鉴于在军队这样一个集中人群中的这种表现,初级保健提供者对用力性血栓形成的怀疑增加。该患者被安排进行实验室和放射学检查,随后接受血管外科评估,接受导管定向溶栓、抗凝治疗及第一肋骨切除术。
尽管用力性血栓形成罕见,但在我们相对年轻、活跃的人群中尤为重要。漏诊或延迟诊断可能导致终身残疾。了解这种疾病的表现、诱发因素和潜在后遗症对于降低死亡率和发病率很重要。