Dr Esther Jones1, Dr Peter-Joon Lee1, Dr Colin McClintock1
1Dubbo Base Hospital, Dubbo, Australia
Biography:
Dr Esther Jones has completed Basic Physician Training and is commencing training in Obstetric Medicine. She has an interest in general and obstetric nephrology.
Pagett-Schroetter disease is a rarely described syndrome whereby repeated extrinsic compression of the subclavian vein through activity causes an upper limb deep venous thrombosis. We describe the first documented case of Pagett-Schroetter disease complicated by bilateral renal infarction due to a patent foramen ovale. Our patient initially presented with bilateral flank pain and nausea, and was found to have an acute kidney injury. Contrast enhanced computer tomography scan confirmed bilateral renal infarctions. A left subclavian vein thrombus was identified on doppler ultrasonography and an echocardiogram confirmed the presence of a patent foramen ovale with right-left shunt. Given his employment as a builder, it is likely that the thrombus was triggered by repeated upper limb use, with the thrombus translocating into the arterial system via the patent foramen ovale. A thrombophilia screen was negative. He was treated with systemic anticoagulation, resulting in complete resolution of his deep venous thrombosis and improvement in his renal function. The optimal treatment of Pagett-Schroetter disease may encompass surgery, thrombolysis or anticoagulation. Treatment of paradoxical embolism excluding cerebral in patients with patent foramen ovale is unclear, and the rarity of the condition has resulted in a lack of high quality prospective evidence. A decision was made to pursue closure of his foramen ovale in the hope of reducing the risk of recurrent paradoxical embolism.