Patients with PvSS are often considered for rib resection, especially when symptoms persist despite thrombolysis and anticoagulation when balloon angioplasty may improve flow pending surgical decompression. 7 However, not all patients require surgery. 8 Following decompression, if the vein remains narrowed, balloon angioplasty and stent placement have been shown to have good long-term results. 9 Paget-von Schroetter syndrome usually occurs in young, healthy individuals. Prompt recognition and

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... ferral for urgent imaging enables treatment to re-canalise the vein and may prevent venous thrombosis if identified at the 'herald symptom' stage. Surgical assessment enables consideration for rib resection if necessary. References 1 Hughes ESR. Venous obstruction in the upper extremity. (Paget-von Schrotter's syndrome): a review of 320 cases.