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[Deep venous thrombosis of the upper limb in a violin player: The "bow syndrome"].

Identifieur interne : 000B21 ( Main/Exploration ); précédent : 000B20; suivant : 000B22

[Deep venous thrombosis of the upper limb in a violin player: The "bow syndrome"].

Auteurs : H. Sanson [France] ; V. Gautier [France] ; A. Stansal [France] ; D. Sfeir [France] ; C. Franceschi [France] ; P. Priollet [France]

Source :

RBID : pubmed:27823916

Descripteurs français

English descriptors

Abstract

BACKGROUND

Exercise-induced thrombosis is a rare cause of deep venous thrombosis (DVT) of the upper limb and usually affects young subjects without comorbid conditions. The diagnosis may be challenging.

CASE REPORT

A 23-year-old female right-handed French teacher and amateur violin player presented with edema of the root of the right arm associated with erythrocyanosis of the extremity and collateral circulation of the shoulder. History taking revealed oral contraception and recent change in violin playing habits. D-dimers were negative. A second duplex-Doppler was required before visualization of a DVT in the right subclavian vein. The patient was given low-molecular-weight heparin alone, followed by rivaroxaban. The outcome was very favorable at 48h. The patient was seen at 4 months and had not had a recurrent episode.

DISCUSSION

The diagnosis of DVT of the upper limb is basically clinical. There is a clinical probability score for the introduction of anticoagulation even if the duplex-Doppler fails to visualize DVT, a situation that can occur due to the clavicular superposition in this region. Exercise-induced DVT should be suspected in patients with minimally intense but repeated exercise (hyper-abduction), e.g. as here playing the violin. Anticoagulation is the treatment of choice. The role for surgery and pharmacomechanical strategies remains to be defined.

CONCLUSION

Exercise-induced thrombosis (Paget-Schroetter syndrome) should be suspected in young patients free of any comorbidity who develop a thrombosis of the upper limb. Studies comparing different therapeutic options would be useful to achieve more homogeneous management practices despite the heterogeneous clinical presentations.


DOI: 10.1016/j.jmv.2016.10.004
PubMed: 27823916


Affiliations:

Links toward previous steps (curation, corpus...)

Le document en format XML

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<term>Jeune adulte (MeSH)</term>
<term>Musique (MeSH)</term>
<term>Thrombose veineuse (diagnostic)</term>
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<b>BACKGROUND</b>
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<p>Exercise-induced thrombosis is a rare cause of deep venous thrombosis (DVT) of the upper limb and usually affects young subjects without comorbid conditions. The diagnosis may be challenging.</p>
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<p>A 23-year-old female right-handed French teacher and amateur violin player presented with edema of the root of the right arm associated with erythrocyanosis of the extremity and collateral circulation of the shoulder. History taking revealed oral contraception and recent change in violin playing habits. D-dimers were negative. A second duplex-Doppler was required before visualization of a DVT in the right subclavian vein. The patient was given low-molecular-weight heparin alone, followed by rivaroxaban. The outcome was very favorable at 48h. The patient was seen at 4 months and had not had a recurrent episode.</p>
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<b>DISCUSSION</b>
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<p>The diagnosis of DVT of the upper limb is basically clinical. There is a clinical probability score for the introduction of anticoagulation even if the duplex-Doppler fails to visualize DVT, a situation that can occur due to the clavicular superposition in this region. Exercise-induced DVT should be suspected in patients with minimally intense but repeated exercise (hyper-abduction), e.g. as here playing the violin. Anticoagulation is the treatment of choice. The role for surgery and pharmacomechanical strategies remains to be defined.</p>
</div>
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<p>
<b>CONCLUSION</b>
</p>
<p>Exercise-induced thrombosis (Paget-Schroetter syndrome) should be suspected in young patients free of any comorbidity who develop a thrombosis of the upper limb. Studies comparing different therapeutic options would be useful to achieve more homogeneous management practices despite the heterogeneous clinical presentations.</p>
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<KeywordList Owner="NOTNLM">
<Keyword MajorTopicYN="N">Deep venous thrombosis</Keyword>
<Keyword MajorTopicYN="N">Exercise-induced venous thrombosis</Keyword>
<Keyword MajorTopicYN="N">Paget-Schroetter</Keyword>
<Keyword MajorTopicYN="N">Syndrome de Paget-Schroetter</Keyword>
<Keyword MajorTopicYN="N">Thrombose veineuse du membre supérieur</Keyword>
<Keyword MajorTopicYN="N">Thrombose veineuse d’effort</Keyword>
<Keyword MajorTopicYN="N">Upper limb</Keyword>
</KeywordList>
</MedlineCitation>
<PubmedData>
<History>
<PubMedPubDate PubStatus="received">
<Year>2016</Year>
<Month>07</Month>
<Day>01</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="accepted">
<Year>2016</Year>
<Month>09</Month>
<Day>26</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="pubmed">
<Year>2016</Year>
<Month>11</Month>
<Day>9</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="medline">
<Year>2017</Year>
<Month>6</Month>
<Day>15</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="entrez">
<Year>2016</Year>
<Month>11</Month>
<Day>9</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
</History>
<PublicationStatus>ppublish</PublicationStatus>
<ArticleIdList>
<ArticleId IdType="pubmed">27823916</ArticleId>
<ArticleId IdType="pii">S0398-0499(16)30104-4</ArticleId>
<ArticleId IdType="doi">10.1016/j.jmv.2016.10.004</ArticleId>
</ArticleIdList>
</PubmedData>
</pubmed>
<affiliations>
<list>
<country>
<li>France</li>
</country>
<region>
<li>Île-de-France</li>
</region>
<settlement>
<li>Paris</li>
</settlement>
</list>
<tree>
<country name="France">
<region name="Île-de-France">
<name sortKey="Sanson, H" sort="Sanson, H" uniqKey="Sanson H" first="H" last="Sanson">H. Sanson</name>
</region>
<name sortKey="Franceschi, C" sort="Franceschi, C" uniqKey="Franceschi C" first="C" last="Franceschi">C. Franceschi</name>
<name sortKey="Gautier, V" sort="Gautier, V" uniqKey="Gautier V" first="V" last="Gautier">V. Gautier</name>
<name sortKey="Priollet, P" sort="Priollet, P" uniqKey="Priollet P" first="P" last="Priollet">P. Priollet</name>
<name sortKey="Sfeir, D" sort="Sfeir, D" uniqKey="Sfeir D" first="D" last="Sfeir">D. Sfeir</name>
<name sortKey="Stansal, A" sort="Stansal, A" uniqKey="Stansal A" first="A" last="Stansal">A. Stansal</name>
</country>
</tree>
</affiliations>
</record>

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