A Case of Paget-Schroetter Syndrome Successfully Treated With Endovascular Treatment

A 16-year-old male presented with a five-day history of numbness in the left upper limb. Physical examination revealed asymmetry in upper arm circumference: the circumference of the right upper arm was 25.5 cm, whereas that of the left was 28.5 cm. Contrast-enhanced computed tomography (CECT) revealed thrombotic occlusion of the left brachial vein, extending proximally to just before its confluence with the internal jugular vein. Evaluation of the thrombus at the elbow level was inconclusive due to poor contrast opacification. A diagnosis of Paget-Schroetter syndrome was made, and the patient was initiated on oral rivaroxaban 30 mg/day. Four days later, venous ultrasonography revealed no improvement, and the patient was admitted for further management. Endovascular therapy, including thrombus aspiration and balloon angioplasty, was performed, and an infusion catheter was placed for continuous administration of urokinase at 240,000 units/day. On day eight of hospitalization, venography confirmed satisfactory venous flow. No recurrence has been observed since then. Although the treatment strategies for Paget-Schroetter syndrome are diverse, this case demonstrates successful management with a combination of endovascular therapy and anticoagulation.