Thursday, May 2, 2013

Terms of Service

A 30 year old tennis instructor presents with right arm pain. After doing repetitive overhand serves, he gets forearm fatigue. This is accompanied by swelling, pain, and cyanosis. He notes paresthesias in the fingers occasionally. He also says he can see "blood draining from his arm through his shoulder, neck, and chest wall." A duplex ultrasound confirms your diagnosis. You start the patient on anticoagulation and refer to a surgeon.

Challenge: What's the diagnosis?

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6 comments:

Sarah said...

Venous thoracic outlet syndrome?

Sarah Chalk said...

I'm not sure what Dx would be given.
But it definitely sounds like its a hyperextension injury, with neurological and atrial involvement...thrombosis (i want to say axillary, but it doesn't sound completely right to me) if you are starting the patient on an anti-coagulant.
No idea what the overall Dx would be though.

sibogox said...

thoracic outlet syndrome due to hypertrophy of muscle around thoracic outlet i.e. scalene muscle..

sibogox said...

oh, and the obstruction of subclavian vein makes the blood flow stagnant and could lead to emboli formation

Craig Chen said...

great comments - yes is thoracic outlet syndrome
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Terms of Service

This is TOS or thoracic outlet syndrome (also called cervical rib syndrome, scalene anticus syndrome, costoclavicular syndrome, and hyperabduction syndrome) resulting from compression of the neurovascular bundle above the first rib and behind the clavicle. Although the brachial plexus, subclavian artery, or subclavian vein can be affected, venous compression is described in this case.

Sources: UpToDate; Wikipedia.

Alex said...

thought u would also invoke " Paget-Schroetter disease" as one of the AKAs.