This patient presented with shortness of breath and was diagnosed with a pulmonary embolism using CTA. Ultrasonography identified a DVT in the right axillary vein which was resumed to be the origin of the embolus. The vein was non-compressible during the scan with an area of echogenic distension and severely reduced blood flow consistent with DVT. To assess for thoracic outlet syndrome (TOS) and further characterize the axillary DVT a CT evaluation was performed using a TOS protocol. After the diagnosis of effort thrombosis (Paget-Schrötter syndrome) was confirmed by CT, this patient underwent right anterior scalenectomy to treat the subclavian vessel compression.

Neurogenic thoracic outlet syndrome (nTOS) is by far the most common subtype of TOS accounting for 90% of cases, whereas venous (vTOS) and arterial thoracic outlet syndromes (aTOS) comprise 3% and 1% of cases respectively ¹. Paget-Schrötter syndrome is activity-induced deep vein thrombosis of the upper extremity which affects 1 in 50,000 people annually ². This patient developed the DVT in the setting of activity (i.e. tennis, yard work, etc.) with no other comorbidities. Definitive treatment of Paget-Schrötter syndrome or thoracic outlet syndrome is decompression of the thoracic outlet, which was successful in this patient.

This case was contributed by Derrick L. Barr, and Bradley S. McDonald