Abstract Proceedings EROC 2011 - New York Osteopathic Medical ...

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EROC 2011 Abstract Proceedings – March 4, 2011 Case Report Abstracts 24
EROC 2011 Abstract Proceedings – March 4, 2011 Dept. of Emergency Medicine, Good Samaritan Hospital Medical Center, West Islip, NY Title: ―Pumped Up! A Case Report of a Subclavian DVT in a Weight Lifter‖ Authors: Joseph Artale DO, Cynthia Rosenthal DO, Jonathan Golden MD, David Levy DO Emergency Medicine Residency Program, Good Samaritan Hospital Medical Center, West Islip, NY Introduction: We present a case of a patient who presented with clinical findings of an arm deep venous thrombosis (DVT). Initial work-up was negative; however subsequent work-up revealed a subclavian DVT secondary to mechanical vascular compression. Case description: A 17 year old male with no medical history presented with a three day complaint of right arm swelling. He denied history that could be the cause. He is a lacrosse player who works out daily. On exam, the only significant findings were swelling to the right arm from the shoulder to the fingertip. Plain radiographs and ultrasound of the arm and contrast CT of the chest were normal. Labs revealed elevated CPK of 441 and CK-MB of 8.4. The patient eventually had an MRI of the right shoulder revealing a 4.4cm clot in the subclavian vein possibly in an area of hypertrophy of the scalene. Thrombolysis was performed and warfarin therapy optimized. Discussion: Paget-von Schrotter syndrome or spontaneous axillo-subclavian venous thrombosis (ASVT), usually appears in healthy individuals. An underlying compressive anomaly at the thoracic outlet frequently due to compression of the subclavian vein between the first rib and the scalene or subclavius tendon is the etiology. Hypercoagulable states can also be a risk factor. These thrombi are common with catheter-related ASVT but unusual in Paget-von Schrotter syndrome. Embolic complications occur in as many as 36% of patients. In patients where the maximal chance of unrestricted arm use is of paramount, authors recommend venography and interventional thrombolysis. Patients with residual stenosis can have surgical correction. Stenting has been shown to have a high rate of complications. 25
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