Mattox Ross, Trager Robert J, Kettner Norman W
Department of Radiology, Logan University, Chesterfield, Missouri.
Legacy Medical Centers, Pittsburgh, Pennsylvania.
J Chiropr Med. 2019 Sep;18(3):213-218. doi: 10.1016/j.jcm.2019.01.004. Epub 2020 Aug 21.
This case series describes the clinical presentation of effort thrombosis and the utility of sonography in its diagnosis.
Two young male athletes presented to separate chiropractic clinics with suspected musculoskeletal shoulder injury. The first complained of dull shoulder pain after pitching in a baseball game and had no other signs or symptoms. The second presented after performing a weighted plank exercise and had prominent edema and discoloration of the affected extremity.
In the first patient, who had no physical signs to suggest thrombosis, a normal sonographic musculoskeletal shoulder exam prompted imaging in the abduction-external rotation position. This provided visualization of a thrombus in the axillosubclavian vein. Emergent referral followed, and treatment was initiated with thrombolysis and surgery, which resolved his condition. The second patient had physical signs consistent with effort thrombosis and was also referred to the emergency department, where sonography was performed and revealed thrombosis of the axillary and basilic veins. He responded to anticoagulants and thrombolysis and avoided surgery.
Effort thrombosis has a variable presentation that can mimic common musculoskeletal disorders and has a poorly defined diagnostic pathway. Acute shoulder pain in an athlete, especially with extremity edema after repetitive exertion, warrants urgent imaging such as sonography and emergent referral. Clinicians should understand the importance of a timely evaluation and diagnosis of effort thrombosis and that imaging may include sonography as a first-line imaging tool.
本病例系列描述了用力性血栓形成的临床表现以及超声检查在其诊断中的作用。
两名年轻男性运动员因疑似肌肉骨骼肩部损伤分别就诊于不同的整脊诊所。第一名患者在一场棒球比赛投球后诉说肩部钝痛，无其他体征或症状。第二名患者在进行负重平板支撑运动后就诊，患侧肢体有明显水肿和变色。
第一名患者无提示血栓形成的体征，正常的超声肌肉骨骼肩部检查促使在外展-外旋位进行成像。这显示了腋-锁骨下静脉内的血栓。随后紧急转诊，并开始进行溶栓和手术治疗，病情得以缓解。第二名患者有与用力性血栓形成相符的体征，也被转诊至急诊科，在那里进行了超声检查，显示腋静脉和贵要静脉血栓形成。他对抗凝剂和溶栓治疗有反应，避免了手术。
用力性血栓形成表现多样，可类似常见的肌肉骨骼疾病，诊断途径尚不明确。运动员出现急性肩部疼痛，尤其是反复用力后伴有肢体水肿，需要紧急进行超声等影像学检查并紧急转诊。临床医生应了解及时评估和诊断用力性血栓形成的重要性，且影像学检查可能包括将超声作为一线成像工具。
