Man with swollen arm

Clinical Introduction A previously healthy 39-year-old male presented to the emergency department with intermittent right arm swelling for 1 month, which worsened over 4 days (figure 1). He is a right-handed chef and often raised his right arm at work. He denied fever or recent trauma. On examination, radial artery pulse was palpable. There was no cervical or axillary lymphadenopathy. His vital signs were stable, while the other physical and neurologic examinations were unremarkable. Question What is the most likely diagnosis? Compartment syndrome. Lymphedema. ‘Paget-Schroetter’ syndrome. Dermatomyositis. Answer: C Paget-Schroetter syndrome, also known as venous thoracic outlet syndrome (TOS), is a form of upper extremity deep vein thrombosis due to effort-induced thrombosis of the axillosubclavian vein at the thoracic outlet. It typically manifests as acute upper extremity pain and swelling in the dominant arm following strenuous activity.
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: EMJ Image Challenge Source Type: research