Paget-Schroetter syndrome as a result of 1st rib stress fracture due to gym activity presenting with Urschel’s sign – A case report and review of literature

BACKGROUND: Paget-Schrotter Syndrome (PSS) also known as "effort thrombosis" is a form of primary thrombosis in the subclavian vein at the costoclavicular junction is usually seen in younger patients after repeated strenuous activity of the shoulders and arms. When occurring in younger patients, PSS presents itself with predisposing factors such as unilateral dull, aching pain in the shoulder or axilla and swelling of the arm and hand. CASE PRESENTATION: We report a rare case of unusual left axillo-subclavian vein thrombosis following narrowing of thoracic outlet due to stress injury of rib fracture likely during gym activity in absence of other clear risk factors and a negative hypercoagulable workup in a 27-year-old man who was admitted as left deltoid rupture 5 days after his usual gym. Subsequently he was transferred under vascular surgery for thrombectomy. CONCLUSION: In addition to the unusual location in the left upper extremity in our case, the absence of common etiologic factors makes our case of Paget-Schroetter Syndrome a very unique one. This case report aims to discuss the common causes of PSS in order to raise a high index of suspicion in certain groups of patients. This will allow early identification and avoidance of catastrophic outcomes such as pulmonary embolism and stroke.