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A Man in His 50s With an Unusual Network of Small Veins in the Left Infraclavicular Region—Paget-Schroetter Syndrome

To identify the key insights or developments described in this article
1 Credit CME

A man in his 50s with dilated nonischemic cardiomyopathy and reduced ejection fraction was referred for implantation of an implantable cardioverter defibrillator. After preparation of the left cephalic vein and failure to place the lead, a puncture of the left subclavian vein was attempted but was unsuccessful. Implantation was discontinued, and venography of the left subclavian vein was performed the next day. The venography showed thrombosis of the left subclavian vein, with a network of small veins (Figure, Video). Further history revealed that the patient was a manual worker who engaged in repetitive arm motion. The diagnosis of primary effort thrombosis subclavian vein, or Paget-Schroetter syndrome, was confirmed. Paget-Schroetter syndrome is a rare condition and refers to primary thrombosis of the subclavian vein at the costoclavicular junction.1 This rare finding serves as reminder that there are patients with Paget-Schroetter syndrome who have no symptoms as a result of developing fine networks of venous collaterals.

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Article Information

Published Online: February 8, 2023. doi:10.1001/jamacardio.2022.5455

Corresponding Author: Elnur Tahirović, MD, PhD, Department for Cardiovascular Surgery, Clinical Center University of Sarajevo, Bolnička 25, Sarajevo 71000, Bosnia and Herzegovina (elnur.tahirovic@gmail.com).

Conflict of Interest Disclosures: None reported.

Reference
1.
Illig  KA , Doyle  AJ .  A comprehensive review of Paget-Schroetter syndrome.   J Vasc Surg. 2010;51(6):1538-1547. doi:10.1016/j.jvs.2009.12.022PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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