Life-threatening acute and chronic thromboembolic pulmonary hypertension and subclavian vein thrombosis

Abstract

Severe thromboembolic pulmonary hypertension is an infrequent but potentially fatal complication of effort thrombosis (Paget-Schroetter syndrome) of the upper extremity. It has been sporadically reported in the literature, but in most cases has affected young, otherwise healthy athletes. Because this syndrome has been rarely described, it is likely underdiagnosed, and optimal evaluation and treatment has not been established. We describe three young athletic persons who developed thrombosis of the subclavian vein after repetitive motion of the upper extremity, and in whom life-threatening pulmonary hypertension resulted from acute and chronic pulmonary emboli. We then review the mechanism, clinical presentation, diagnosis, and available therapeutic modalities.