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