Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Taylor R. Spencer, Richard E. Lagace, George Waterman
(Department of Emergency Medicine, Albany Medical Center, Albany, USA)
Am J Case Rep 2014; 15:333-336
Thrombotic events in otherwise healthy pediatric patients are rare. In patients presenting with limb swelling, thrombosis must be considered in the differential diagnosis. In pediatric patients with thrombosis, there has been wide variability in the rates of associated thrombophilia. Many pediatric patients may instead have other contributors such as venous catheters or physical activity.
Case Report: We present a case of bilateral upper extremity deep venous thrombi in a previously healthy 16-year-old male. The patient presented with swelling and pain in both arms after several days of weight-bearing exercise. Following emergency department evaluation with ultrasound and laboratory testing, the patient was diagnosed with effort thrombosis – also known as Paget-Schroetter syndrome – and rhabdomyolysis.
Conclusions: This case of Paget-Schroetter syndrome is distinguished by elevation in creatine kinase and transaminases. While these findings can be due to physical exertion and effort, effort thrombosis is not classically associated with laboratory abnormalities except an elevated D-dimer. The significance of these laboratory test result abnormalities remains unclear. Given the rarity of effort thrombosis, further epidemiological study is warranted to determine if these laboratory findings are seen in other cases, and, if so, what implications they may have for management and prognosis.
Keywords: Anticoagulants - administration & dosage, Adolescent, Diagnosis, Differential, Dose-Response Relationship, Drug, Fluid Therapy, Heparin - administration & dosage, Humans, Male, Rhabdomyolysis - diagnosis, Thrombolytic Therapy - methods, Ultrasonography, Doppler, Color, Upper Extremity Deep Vein Thrombosis - therapy