Effort Thrombosis Presenting as Pulmonary Embolism in a Professional Baseball Pitcher

Abstract

Context:Effort thrombosis, or Paget-Schroetter’s syndrome, is a rare subset of thoracic outlet syndrome in which deep venous thrombosis of the upper extremity occurs as the result of repetitive overhead motion. It is occasionally associated with pulmonary embolism. This case of effort thrombosis and pulmonary embolus was in a 25-year-old major league professional baseball pitcher, in which the only presenting complaints involved dizziness and shortness of breath without complaints involving the upper extremity—usually, a hallmark of most cases of this condition. The patient successfully returned to play for 5 subsequent seasons at the major league level after multimodal treatment that included surgery for thoracic outlet syndrome.Objective:Though rare, effort thrombosis should be included in the differential diagnosis of throwing athletes with traditional extremity-focused symptoms and in cases involving pulmonary or thoracic complaints. Rapid diagnosis is a critical component of successful treatment.

Paget-Schroetter syndrome: treatment of venous thrombosis and outcomes

“…PSS can also present with or be complicated by pulmonary embolism (PE). Studies report rates of PE and PSS ranging from 20-30% (17)(18)(19). Among upper extremity deep vein thromboses (DVT), PE occurs more often with secondary upper extremity DVT.…”

Nerve Injuries About the Elbow in the Athlete

“…Sternal origin of first rib, under the clavicle, to base of coracoid Also associated with aberrant insertion of middle scalene onto dorsal aspect second rib Hyperabduction 33 Pectoralis minor compression Compression of brachial plexus and/or subclavian vessels on pectoralis minor tendon or coracoid due to shoulder hyperabduction SPHERE 34 Pancoast tumor (lung cancer) Superior vena cava syndrome, Pancoast tumor (due to superior lung cancer), Horner syndrome, endocrinopathy, recurrent laryngeal neuropathy, effusions (pleural, pericardial) "Dynamic" 35 Unknown Speculative etiology: active vigorous breathing in amateur marathon runner causing bilateral anterior and middle scalene hypertrophy, first rib elevation due to lung expansion, and gravitational pull on arms due to fatigue Dynamic 36 Axillary artery thrombosis MLB pitcher with axillary artery thrombosis (third part-proximal to posterior circumflex humeral artery) Dynamic 37 Innominate artery thrombosis MLB pitcher with innominate, subclavian, and carotid occlusion, with ischemic embolic stroke Dynamic 38 Subclavian vein thrombosis MLB pitcher with effort thrombosis, subclavian DVT, bilateral pulmonary emboli DVT indicates deep vein thrombosis; MLB, major league baseball.…”

Upper Extremity Deep Vein Thromboses: The Bowler and the Barista

“…Other studies support the recognition of effort thrombosis to prevent catastrophic injury such as the case of a 25-year-old major league pitcher who presented with dizziness and shortness of breath without upper extremity symptoms. He was diagnosed with effort thrombosis and secondary pulmonary embolus and treated successfully with mechanical thrombectomy and catheter-directed venolysis—a lifesaving intervention [ 1 ].…”

“…Effort thrombosis of the upper extremity refers to a deep venous thrombosis of the upper extremity resulting from repetitive activity of the upper limb [ 1 ]. While most cases of effort thrombosis occur in young elite athletes with strenuous upper extremity activity, any repetitive activity capable of damaging vascular endothelium can cause it.…”