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?

Image shown under Creative Commons Attribution Share-Alike License.
at

6 comments:

  1. SarahMay 2, 2013 at 1:42 PM

    Venous thoracic outlet syndrome?

    ReplyDelete
  2. UnknownMay 2, 2013 at 5:25 PM

    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.

    ReplyDelete
  3. sibogoxMay 2, 2013 at 5:38 PM

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

    ReplyDelete
  4. sibogoxMay 2, 2013 at 5:40 PM

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

    ReplyDelete
  5. CraigMay 7, 2013 at 10:45 AM

    great comments - yes is thoracic outlet syndrome
    -
    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.

    ReplyDelete
  6. AlexMay 27, 2013 at 6:25 PM

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

    ReplyDelete

Comments on this blog are moderated so they will not show up until after the solution to the case is posted.

Note: Only a member of this blog may post a comment.