THE ONE EXCESSIVE EXERCISE CAUSED PULMONARY EMBOLISM!

TOPIC: Pulmonary Vascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: The annual incidence of upper extremity deep venous thrombosis (DVT) is 0.4 in 10,000 people annually accounting for 4-10% all DVT. Upper DVT divided into primary and secondary. Around 80% the cases consist secondary caused by indwelling catheters, cardiac hardwares, cancer. One causes Paget-Schroetter Syndrome. This development clot strenuous activity like rowing, baseball, heavy lifting. We present a young farmer with acute pulmonary thromboembolism due to CASE PRESENTATION: A 26-year-old male presented right arm throbbing pain edema week. It was aggravated abduction extension above 90 degrees alleviated resting. associated weakness resulting difficulty holding his phone or brushing teeth. Vital signs were within normal limits. Physical examination significant 1+ on axilla. Pulses 2+ extremities. Pain reproducible passive extension. Chest CTA showed thrombus segmented vessel lower lobe arterial segment lobe. Right Doppler occlusive vein subclavian, axillary, brachial veins. Venogram confirmed axillary occlusion. focal concentric narrowing subclavian artery at junction clavicle first rib. Patient underwent balloon angioplasty catheter directed thrombolysis EKOS. He discharged Rivaroxaban plans rib resection outpatient setting. DISCUSSION: syndrome (PSS) also known as Effort an axillary-subclavian activity. Those repetitive movements cause microtrauma endothelium triggering coagulation cascade. can be accompanied stasis anatomical thoracic outlet obstruction from cervical rib, scalenus tendon hypertrophy, costoclavicular ligament. major complication this disease Embolism which has been reported up 10% presentations. CONCLUSIONS: important identify PSS PE, since it requires more aggressive treatment beside anticoagulation, includes thrombolysis, decompression, physical therapy. Conservative management anticoagulation itself could lead disability. Increasing awareness will ensure early recognition proper treatment. REFERENCE #1: Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK. Paget-schroetter syndrome: review pathogenesis effort thrombosis. West J Emerg Med. 2010;11(4):358-362. #2: Heil J, Miesbach W, Vogl T, Bechstein WO, Reinisch A. Deep Vein Thrombosis Extremity. Dtsch Arztebl Int. 2017;114(14):244-249. doi:10.3238/arztebl.2017.0244 DISCLOSURES: No relevant relationships Sarah Nuzzo, source=Web Response Joshuam Ruiz Vega, Amtul Shafi,