Paget-Schroetter disease is commonly diagnosed with a history and physical examinations. However, imaging is usually utilized to confirm the diagnose. Duplex ultrasound is an accepted initial test and the gold standard imaging of Paget-Schroetter disease. Since this diagnostic tool is not fully appropriate to exclude the Paget-Schroetter disease, normal duplex ultrasound in a highly suspected patient requires further investigations.

• Duplex ultrasound is the gold standard method to diagnose Paget-Schroetter (effort thrombosis).^[1]
• Doppler ultrasonography is the best initial test to evaluate a patient with suspected Paget-Schroetter disease (also known as Effort thrombosis).^[2] There are some convenient features of this test that make it a proper initial imaging. These features include:
  • Low cost ^[3]
  • Availability
  • Portability
  • Specificity of 93%^[4]
  • Sensitivity of >80%^[5]
  • Non-invasive
• Based on some randomized trial duplex ultrasound has a sensitivity of 78-100% and specificity of 82-100%. ^[6]
• An experienced technician is able to distinguish between acute and chronic thrombus using duplex ultrasound.
• An acute thrombus which is echolucent leads to a non-compressible vein without any flow. In the contrary, a chronic thrombus will appear echogenic and fibrotic with notable collateral veins. ^[7]
• Some drawbacks of Duplex ultrasonography are:
  • Inadequate ability to picture the central parts of the subclavian and innominate veins ^[8]
  • Inadequate ability to distinguish central veins from an enlarged collateral vein^[9]
  • Highly technician dependent^[10]
  • Findings could be affected by superimposed clavicle and deepness of subclavian vein in the neck^[11]
  • False negative rate of 30% (which makes duplex ultrasonography an improper diagnostic tool to exclude the Paget-Schroetter disease)^[12]
• Ultrasound as a non-invasive imaging could be used postoperatively to evaluate venous flow and caliber.^[13]