ترومبوز وريد آگزيلار متعاقب كار با وزنه در يك ورزشكار ميانسال

Axillary vein thrombosis in a middle aged sportsman following resistance training

سابقه و هدف: ترومبوز وريد آگزيلار متعاقب فعاليت يا سندرم Paget–Von Scrotter، بيماري نادر با عوارض خطرناكي است كه در ورزشكاران سالم و فاقد هرگونه بيماري زمينه‌اي سيستميك، متعاقب فعاليت بدني شديد در اندام فوقاني رخ مي‌دهد. معرفي بيمار: آقاي ورزشكار 50 ساله‌اي ‌با تورم حاد بازوي راست متعاقب كار با وزنه مراجعه كرده و در ابتدا با تشخيص سلوليت، درمان آنتي‌بيوتيكي خوراكي دريافت نمود. به دنبال عدم بهبودي و انجام سونوگرافي داپلر اندام فوقاني، با تشخيص ترومبوز وريد آگزيلار، تحت درمان ضد انعقادي وريدي و شش ماهه‌ي خوراكي قرار گرفت. بيمار كاملاً بهبود يافته و تا 4 سال، بدون ترومبوز باقي مانده بود. نتيجه‌گيري: اطلاع پزشك از اين بيماري جهت تشخيص صحيح آن حايز اهميت است تا بيمار دچار عوارض خطرناك احتمالي بيماري، نظير آمبولي ريه نشود.

Background and Aim: Axillary vein thrombosis after physical activities of upper limbs or Paget-Von Schroetter syndrome is a rare disease with potentially lethal complications, which occurs mainly in athletes without any systemic predisposing factors after repetitive, vigorous activities of upper limbs. Axillary vein can be compressed at various places along its route, most importantly in the costoclavicular space (space between clavicle and the first rib). Compression usually occurs when the patient hyperextends the neck and hyperabducts the arm concurrently (as in bench press), or when the patient takes a military brace posture with a backward movement of the shoulders. Most patients with effort-related upper extremity deep vein thrombosis have an underlying venous thoracic outlet syndrome. Presentation: A 50?year?old male presented with acute onset of right arm swelling, heaviness and range of motion impairment after weight training. The arm was cyanotic. The pulses were intact. He initially diagnosed with cellulitis and received oral antibiotics, which were ineffective. Doppler sonography examination confirmed the diagnosis of axillary vein thrombosis. He was started on intravenous and then six-month oral anticoagulation therapy. His symptoms resolved and he was without thrombosis at four-year follow?up. He did not have any systemic predisposing factors for thrombosis such as thrombophilia or malignancy. Conclusion: The potentially life threatening complications (such as pulmonary emboli) and unusual presentations of the disease, makes its correct diagnosis more important.