Paget-Schroetter in adolescence: A rare form of venous thromboembolism

Abstract

Venous thromboembolism (VTE) is an under-recognized issue in the pediatric population, with an increasing incidence. Paget-Schroetter syndrome (PSS), a rare form of primary upper extremity deep vein thrombosis, is particularly uncommon in this age group. A 14-year-old healthy female presented with acute pain, swelling, and discoloration in the right upper limb after repetitive overhead activities in volleyball and dance. Diagnostic workup, including Doppler ultrasound, confirmed a deep vein thrombosis in the right axillary and subclavian veins, consistent with PSS. Thrombophilia screening was normal. The patient was treated with enoxaparin for three months, resulting in significant clinical improvement. Follow-up imaging showed an organized thrombus and identified intermittent positional obstruction, confirming venous thoracic outlet syndrome. The patient is currently asymptomatic with no post-thrombotic syndrome or recurrent VTE. This case highlights the importance of recognizing PSS in pediatric patients and highlights the need for a precise diagnostic approach and tailored management. Continued research is necessary to improve treatment protocols and outcomes for pediatric PSS.