AM Report Pearls: What is Paget-Schroetter Sd? What is the Sens/Spec of Imaging for Perf?

AM Report Pearls: What is Paget-Schroetter Syndrome?

  • Also known as “effort thrombosis” – refers to axillary-subclavian vein thrombosis associated with repetitive strenuous upper extremity activity
  • Pathophysiology: Anatomic abnormalities of thoracic outlet & repetitive trauma to the subclavian vein endothelium contribute to this
  • Risk factors: Risk factors include indwelling hardware (e.g. central lines, ports, pacemakers), malignancy, or other thrombophilic states
  • Genetic predisposition: The role of inherited thrombophilias is unclear but one study found increased incidence of Factor V Leiden!
  • Incidence: Accounts for 10-20% of all upper extremity DVTs!
  • Diagnosis: Doppler U/S is best first diagnostic test though MRV is increasingly used
  • Management: Simple, easy-to-understand diagram here:
  • Further reading: Check out this article for a great quick review! http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2967689/

AM Report Pearls: Sensitivity/Specificity of Abdominal Imaging for Perforation

  • Upright CXR to rule-out free air is usually initial screening test, but can’t detect free air <1mm and only 33% sensitive to detect 1-13 mm pockets
  • CT Abdomen can show site of perforation in 86% of cases!
  • U/S can also be good at detecting free air (sensitivity 92%, specificity of 53%), but CANNOT detect location of perforation
  • For mesenteric ischemia, angiography is the gold standard (93% sensitive, 99% specific)
    • CT with contrast has sensitivities reported as 93%, specificity 79% but another study showed lower sensitivity of only 14%!
  • This is a nice article which has a good review of sensitivities/specificities of different imaging modalities for different diagnoses: http://pubs.rsna.org/doi/full/10.1148/radiol.2531090302
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