Paget–Schroetter Syndrome in a Case of Ovarian Germ Cell Tumour

Paget–Schroetter syndrome also known as effort thrombosis is a rare condition of primary upper extremity deep vein thrombosis. A 20-year-old unmarried, nulligravida with torticollis was presented with breathlessness, abdominal distension, and pain in abdomen. On examination, patient had tachypnea, with reduced air entry in both inframammary areas on chest auscultation. Per abdominal examination revealed a fixed hard pelvic mass extending up to umbilical region. On further investigation, her chest X-ray was suggestive of right-sided moderate pleural effusion and elevated tumour markers—lactate dehydrogenase, and alpha fetoprotein. Ultrasound of pelvis and abdomen revealed a right ovarian mass with moderated ascitis. Therapeutic and diagnostic pleural tapping was performed which was negative for malignant cells. A staging laparotomy was performed. On second postoperative day, there was oedema on left upper limb with erythema on overlying skin and tenderness. Ultrasonographic Doppler studies revealed a complete thrombus in the left subclavian vein and partial thrombus in the left axillary and brachial vein of the left upper limb. Subsequently, patient developed acute onset breathlessness with chest pain and fall in oxygen saturation and CT scan of thorax and pulmonary angiography was suggestive of pulmonary embolism. Heparinisation was immediately instituted and patient recovered. The reason for the development of thrombosis of upper limb deep veins can be attributed to the “effort” brought upon the cardio thoracic region by the pleural effusion and the role of torticollis of the neck can also have precipitated the onset of thrombosis by potential compression and or friction of the subclavian vein against the sternocleidomastoid muscle and first rib.