Yin Jingjing, Qi Zhenhong, Chen Yu, Chen Yuexin
Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Ultrasonography, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Transl Med. 2021 Jan;9(1):78. doi: 10.21037/atm-20-2862.
Patients presenting with periodic swelling of the upper extremity without thrombosis are diagnosed with McCleery syndrome. There have been sporadic cases reported over the past decades. Due to the rarity of this disease, no standard consensus on diagnosis and treatment of McCleery syndrome was established. Subclavius tendon and anterior scalene muscle compression were proposed as the primary cause of McCleery syndrome. Partial resecting muscle, tendon or ligament was recommended as therapies. We report one rare case of membranous occlusion of the subclavian vein (SCV) that leads to periodic swelling of upper extremity and diagnosis of McCleery syndrome was made. This 21-year-old man complained of swelling and pain in the right upper extremity after strenuous exercise lasting for 3 months. Physical examination, spinal X-ray and magnetic resonance imaging showed no signs related to classic venous thoracic outlet syndrome (VTOS). Duplex ultrasonography demonstrated membranous occlusion without thrombosis at the proximal end of the right SCV. The lesion was confirmed by venography. Treated by balloon dilation alone, the patient recovered uneventfully during 18 months of follow-up. Repeated duplex ultrasonography revealed patency of the SCV. To our best knowledge, our case provides the first reported membranous occlusion of the SCV. Excluding the presence of thrombosis in SCV, he was diagnosed with McCleery syndrome and was cured by balloon dilation alone. We can learn from this rare case that membranous occlusion of veins can be a rare cause of McCleery syndrome and is worthy of careful consideration and differentiation of VOTS.
出现上肢周期性肿胀且无血栓形成的患者被诊断为麦克利里综合征。在过去几十年里有散发病例报道。由于这种疾病罕见，关于麦克利里综合征的诊断和治疗尚未达成标准共识。锁骨下肌腱和前斜角肌受压被认为是麦克利里综合征的主要病因。建议采用部分切除肌肉、肌腱或韧带的方法进行治疗。我们报告了一例罕见的锁骨下静脉膜性闭塞病例，该病例导致上肢周期性肿胀，并被诊断为麦克利里综合征。这名21岁男性在剧烈运动后右侧上肢肿胀疼痛3个月。体格检查、脊柱X线和磁共振成像均未发现与典型静脉胸廓出口综合征（VTOS）相关的体征。双功超声检查显示右侧锁骨下静脉近端膜性闭塞且无血栓形成。静脉造影证实了病变。仅通过球囊扩张治疗，患者在18个月的随访中顺利康复。重复双功超声检查显示锁骨下静脉通畅。据我们所知，我们的病例是首次报道的锁骨下静脉膜性闭塞。排除锁骨下静脉存在血栓形成后，他被诊断为麦克利里综合征，仅通过球囊扩张就治愈了。从这个罕见病例中我们可以了解到，静脉膜性闭塞可能是麦克利里综合征的罕见病因，值得对VTOS进行仔细考虑和鉴别。
