Paget Schroetter syndrome imaged in multiple modalities and successfully treated with pharmacomechanical thrombectomy.

To cite: Ryan JW, Murphy A, Wrafter S, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2016-218238 DESCRIPTION A young man in his early 30s presented with a 3-day history of left upper arm swelling and erythema (figure 1). He had no significant medical history. Of note he had a strong family history of deep venous thrombosis (DVT) with both parents having had lower limb DVTs. D-dimers were elevated, and the remaining laboratory investigations were within normal limits. An upper limb Doppler ultrasound scan showed occlusive thrombus in the left subclavian vein (figure 2). A CT venogram further delineated the extent of the thrombus confirming the diagnosis of Paget Schroetter syndrome (figures 3 and 4). Subsequently, a conventional venogram was performed in conjunction with a therapeutic pharmacomechanical thrombectomy, which successfully restored flow in the left subclavian vein (figures 5 and 6). Paget Schroetter syndrome, also known as effort thrombosis, is an uncommon disorder resulting in spontaneous subclavian venous thrombosis. Generally, it occurs in young and healthy adults. The subclavian vein is vulnerable to thrombosis due to its positioning relative to the first rib and clavicle. Signs of upper limb DVT should be investigated by Doppler ultrasound scan. However, if thrombosis is present within the non-compressible region of the clavicle, ultrasound may be falsely negative. MR or CT venogram is recommended if index of suspicion is high after a negative Doppler ultrasound scan. Management options include preadministration of thrombolytics prior to mechanical aspiration in