Superior vena cava thrombosis secondary to thoracic outlet syndrome - Case report

A case of superior vena cava thrombosis secondary to the thoracic outlet syndrome is reported. The diagnosis was revealed by CT-scan and confirmed by phlebography performed to insert a catheter for intrathrombotic infusion of urokinase. The thrombolytic treatment was followed by complete clot lysis. A hyperabduction manoeuvre confirmed costoclavicular compression as the cause of the subclavian-axillary vein thrombosis for which the patient underwent first rib resection. Axillary-subclavian vein thrombosis (or Paget-von Schroetter syndrome) is a relatively frequent complication of the thoracic outlet syndrome often treated with anticoagulants on the basis of a duplex examination. Involvement of the superior vena cava is not readily detected by duplex ultrasound so a partial thrombosis, with a possible fatal outcome could remain undiagnosed. Full investigation by phlebography or CT-scan is therefore recommended. In addition, transcatheter thrombolytic therapy has a lower incidence of follow-up complications than heparin.