Effort thrombosis in a young triathlete: an unusual presentation of painless neck swelling secondary to right brachiocephalic vein thrombosis

Allana AMB, Teo LLS, Chuah BYS, Liu TC, Cheah WK
Correspondence: Dr Lynette Teo, lynette_ls_teo@nuhs.edu.sg

ABSTRACT
Effort thrombosis of the upper extremity is secondary to thrombosis of the axillary and/or subclavian veins that develop from heavy arm exertion. This case illustrates venous thrombosis of the right brachiocephalic vein in a 32-year-old man who presented with a cyst-like swelling in the right neck with no associated pain or trauma. Our patient, a trained athlete, was preparing for a triathlon at the time of presentation. He was treated by first-line therapy of subcutaneous and oral anti-coagulation medication. In this study, we highlight the importance of early investigation and treatment of symptomatic athletes so that long-term disability can be prevented. This study also shows the timely use of computed tomography imaging, which can help to identify the syndrome in previously undiagnosed patients.

Keywords: anti-coagulation, effort thrombosis, heavy arm exertion, neck swelling
Singapore Med J 2011; 52(3): e37-e39