Effort-Related Upper Extremity Deep Vein Thrombosis: A Case Series of Three Patients With Paget-Schröetter Syndrome Managed in Acute Care Settings.

Paget-Schröetter syndrome (PSS), also known as effort thrombosis, is a rare form of primary upper extremity deep vein thrombosis (UEDVT) caused by repetitive upper limb activity and/or venous thoracic outlet compression. Delayed recognition may result in pulmonary embolism, post-thrombotic syndrome, and chronic venous obstruction. We present three cases of effort-related UEDVT diagnosed in acute care settings with varying clinical presentations and management strategies. The first case involved a 78-year-old man who developed acute left upper limb swelling following prolonged gardening activity. The second case concerned a 45-year-old woman who presented with progressive left arm swelling after repetitive shoulder movements during Pilates. The third case involved a 27-year-old male athlete whose initial presentation mimicked a musculoskeletal injury before extensive subclavian and axillary vein thrombosis was identified. All patients underwent duplex ultrasonography confirming upper extremity venous thrombosis and received therapeutic anticoagulation. One patient was offered catheter-directed thrombectomy but elected conservative treatment. None demonstrated definitive thoracic outlet syndrome on subsequent investigations. Follow-up imaging demonstrated either re-canalization or complete resolution of thrombosis. These cases highlight the diverse presentations of effort-related UEDVT and emphasize the importance of maintaining a high index of suspicion, even in the absence of obvious swelling or traditional thrombotic risk factors. Early imaging and vascular specialist involvement are essential for optimal outcomes.