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1
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Rizzo S, Talei Franzesi C, Cara A, Cassina EM, Libretti L, Pirondini E, Raveglia F, Tuoro A, Vaquer S, Degiovanni S, Cavalli EM, Marchesi A, Froio A, Petrella F. Diagnostic and Therapeutic Approach to Thoracic Outlet Syndrome. Tomography 2024; 10:1365-1378. [PMID: 39330749 PMCID: PMC11436167 DOI: 10.3390/tomography10090103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 08/26/2024] [Accepted: 08/30/2024] [Indexed: 09/28/2024] Open
Abstract
Thoracic outlet syndrome (TOS) is a group of symptoms caused by the compression of neurovascular structures of the superior thoracic outlet. The knowledge of its clinical presentation with specific symptoms, as well as proper imaging examinations, ranging from plain radiographs to ultrasound, computed tomography and magnetic resonance imaging, may help achieve a precise diagnosis. Once TOS is recognized, proper treatment may comprise a conservative or a surgical approach.
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Affiliation(s)
- Stefania Rizzo
- Imaging Institute of Italian Switzerland (IIMSI), Ente Ospedaliero Cantonale, via Tesserete 46, 6900 Lugano, Switzerland
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana, via G.Buffi 13, 6900 Lugano, Switzerland
| | | | - Andrea Cara
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Enrico Mario Cassina
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Lidia Libretti
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Emanuele Pirondini
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Federico Raveglia
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Antonio Tuoro
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Sara Vaquer
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Sara Degiovanni
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Erica Michela Cavalli
- Division of Plastic and Reconstructive Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Andrea Marchesi
- Division of Plastic and Reconstructive Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Alberto Froio
- Division of Vascular Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Francesco Petrella
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
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2
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Young VA, Obi C, Oladini LK, Josephs SC, Hofmann LV. Venous Compressive Disorders. Tech Vasc Interv Radiol 2024; 27:100964. [PMID: 39168547 DOI: 10.1016/j.tvir.2024.100964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Venous compressive disorders are a heterogenous group of vascular syndromes characterized by extrinsic venous compression that can lead to complications of venous hypertension or venous thrombosis. Endovascular damage secondary to deep venous thrombosis (DVT) can result in post-thrombotic syndrome (PTS), a potentially debilitating condition that can be associated with significant morbidity in the pediatric population. Here we discuss 4 venous compressive disorders: iliac vein compression (May-Thurner syndrome [MTS]); subclavian vein compression at the venous thoracic inlet (Paget-Schroetter syndrome); left renal vein compression (nutcracker syndrome); and popliteal vein compression (popliteal entrapment syndrome) with a focus on clinical evaluation and diagnostic methods. Where endovascular therapy is appropriate, specific procedural considerations including procedure indications, equipment, procedural steps, technical challenges, complications, clinical follow-up and expected outcomes are discussed.
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Affiliation(s)
- Victoria A Young
- Department of Radiology, Division of Pediatric Radiology, Stanford University School of Medicine, Palo Alto, CA.
| | - Chrystal Obi
- Department of Radiology, Division of Pediatric Radiology, Stanford University School of Medicine, Palo Alto, CA
| | - Lola K Oladini
- Department of Radiology, Division of Pediatric Radiology, Stanford University School of Medicine, Palo Alto, CA
| | - Shellie C Josephs
- Department of Radiology, Division of Pediatric Radiology, Stanford University School of Medicine, Palo Alto, CA
| | - Lawrence V Hofmann
- Department of Radiology, Division of Pediatric Radiology, Stanford University School of Medicine, Palo Alto, CA
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Ogawa T, Onishi S, Mamizuka N, Yoshii Y, Ikeda K, Mammoto T, Yamazaki M. Clinical Significance of Maximum Intensity Projection Method for Diagnostic Imaging of Thoracic Outlet Syndrome. Diagnostics (Basel) 2023; 13:diagnostics13020319. [PMID: 36673129 PMCID: PMC9858151 DOI: 10.3390/diagnostics13020319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/04/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
The aim of this study was to use the magnetic resonance imaging maximum-intensity projection (MRI-MIP) method for diagnostic imaging of thoracic outlet syndrome (TOS) and to investigate the stricture ratios of the subclavian artery (SCA), subclavian vein (SCV), and brachial plexus bundle (BP). A total of 113 patients with clinically suspected TOS were evaluated. MRI was performed in a position similar to the Wright test. The stricture was classified into four grades. Then, the stricture ratios of the SCA, SCV, and BP in the sagittal view were calculated by dividing the minimum diameter by the maximum diameter of each structure. Patients were divided into two groups: surgical (n = 22) and conservative (n = 91). Statistical analysis was performed using the Mann-Whitney U test. The stricture level and ratio in the SCV were significantly higher in the surgical group, while the stricture level and the ratio of SCA to BP did not show significant differences between the two groups. The MRI-MIP method may be helpful for both subsidiary and severe diagnoses of TOS.
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Affiliation(s)
- Takeshi Ogawa
- Department of Orthopedic Surgery, National Hospital Organization Mito Medical Center, 280 Sakuranosato, Ibarakimachi 311-3193, Japan
- Department of Orthopedic Surgery and Sports Medicine, Mito Clinical Education and Training Center, University of Tsukuba Hospital, Mito Kyodo General Hospital, 3-2-7 Miya-Machi, Mito 310-0015, Japan
| | - Shinzo Onishi
- Department of Orthopedic Surgery and Sports Medicine, Mito Clinical Education and Training Center, University of Tsukuba Hospital, Mito Kyodo General Hospital, 3-2-7 Miya-Machi, Mito 310-0015, Japan
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Naotaka Mamizuka
- Baseball and Sports Clinic, 2-228-1 Kosugi, Park City Musashikosugi the Garden Towers West 1st Floor W4, Nakahara-Ward, Kawasaki 211-0063, Japan
| | - Yuichi Yoshii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan
- Correspondence: ; Tel.: +81-298871161
| | - Kazuhiro Ikeda
- Department of Orthopedic Surgery, Kikkoman General Hospital, Noda 278-0005, Japan
| | - Takeo Mammoto
- Department of Orthopedic Surgery and Sports Medicine, Mito Clinical Education and Training Center, University of Tsukuba Hospital, Mito Kyodo General Hospital, 3-2-7 Miya-Machi, Mito 310-0015, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan
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4
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Satake H, Honma R, Nito T, Naganuma Y, Shibuya J, Maruyama M, Uno T, Takagi M. Midterm results of endoscopically assisted first rib resection in the zero position for thoracic outlet syndrome. Interact Cardiovasc Thorac Surg 2022; 35:6696242. [PMID: 36094365 PMCID: PMC9536291 DOI: 10.1093/icvts/ivac239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/05/2022] [Accepted: 09/09/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Hiroshi Satake
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
| | - Ryusuke Honma
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
| | - Toshiya Nito
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
| | - Yasushi Naganuma
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
| | - Junichiro Shibuya
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
| | - Masahiro Maruyama
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
| | - Tomohiro Uno
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine , Yamagata, Japan
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5
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Nacif MS. Qualidade em angiotomografia: começamos com o que pode ser considerado normal. Radiol Bras 2022. [DOI: 10.1590/0100-3984.2022.55.4e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Stowell JT, McComb BL, Mendoza DP, Cahalane AM, Chaturvedi A. Axillary Anatomy and Pathology: Pearls and "Pitfalls" for Thoracic Imagers. J Thorac Imaging 2022; 37:W28-W40. [PMID: 35142752 DOI: 10.1097/rti.0000000000000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The axilla contains several important structures which exist in a relatively confined anatomic space between the neck, chest wall, and upper extremity. While neoplastic lymphadenopathy may be among the most common axillary conditions, many other processes may be encountered. For example, expanded use of axillary vessels for access routes for endovascular procedures will increase the need for radiologists to access vessel anatomy, patency, and complications that may arise. Knowledge of axillary anatomy and pathology will allow the imager to systematically evaluate the axillae using various imaging modalities.
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Affiliation(s)
| | | | - Dexter P Mendoza
- Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai Health System, New York
| | | | - Abhishek Chaturvedi
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
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7
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Chang MC, Kim DH. Essentials of thoracic outlet syndrome: A narrative review. World J Clin Cases 2021; 9:5804-5811. [PMID: 34368299 PMCID: PMC8316950 DOI: 10.12998/wjcc.v9.i21.5804] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/06/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Thoracic outlet syndrome (TOS) is a group of diverse disorders involving compression of the nerves and/or blood vessels in the thoracic outlet region. TOS results in pain, numbness, paresthesia, and motor weakness in the affected upper limb. We reviewed the pathophysiology, clinical evaluation, differential diagnoses, and treatment of TOS. TOS is usually classified into three types, neurogenic, venous, and arterial, according to the primarily affected structure. Both true neurogenic and disputed TOS are considered neurogenic TOS. Since identifying the causative lesions is complex, detailed history taking and thorough clinical investigation are needed. Electrodiagnostic and imaging studies are helpful for excluding other possible disorders and confirming the diagnosis of true neurogenic TOS. The existence of a disputed TOS remains controversial. Neuromuscular physicians tend to be skeptical about the existence of disputed TOS, but thoracic surgeons argue that disputed TOS is under-diagnosed. Clinicians who encounter patients with TOS need to understand its key features to avoid misdiagnosis and provide appropriate treatment.
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Affiliation(s)
- Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu 42415, South Korea
| | - Du Hwan Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, South Korea
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Yuen HLA, Tran H, Chunilal S. Upper Extremity Deep Vein Thrombosis: Current Knowledge and Future Directions. Semin Thromb Hemost 2021; 47:677-691. [PMID: 33971684 DOI: 10.1055/s-0041-1725116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Upper extremity deep vein thrombosis (UEDVT) has been increasing in incidence due to the escalating use of central venous catheters such as peripherally inserted central catheters. UEDVT can be primary idiopathic or secondary to pacemaker leads, intravascular catheters or cancer. In comparison to conventional venous thromboembolism such as lower limb deep vein thrombosis or pulmonary embolism the risk factors, investigations, and management are not well defined. We review current evidence in primary and secondary UEDVT, highlighting areas in need of further research. We also explore the entity of venous thoracic outlet syndrome, which is said to be a risk factor for recurrent primary UEDVT and is the rationale behind surgical interventions.
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Affiliation(s)
- Hiu Lam Agnes Yuen
- Monash Haematology, Monash Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Huyen Tran
- Department of Medicine, Monash University, Melbourne, Australia
| | - Sanjeev Chunilal
- Monash Haematology, Monash Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
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9
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Abstract
Arterial thoracic outlet syndrome is rare and may be associated with a bony anomaly. Patient presentation can range from mild arm discoloration and claudication to severe limb-threatening ischemia. For patients with subclavian artery dilation without secondary complications, thoracic outlet decompression and arterial surveillance is sufficient. Patients with subclavian artery aneurysms or distal embolization require decompression with reconstruction or thromboembolectomy and distal bypass respectively.
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Affiliation(s)
- Louis L Nguyen
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Andrew J Soo Hoo
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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10
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Abstract
Imaging studies play a significant role in assessment of thoracic outlet syndrome. In this article, we discuss the etiology and definition of thoracic outlet syndrome and review the spectrum of imaging findings seen in patients with thoracic outlet syndrome. We then discuss an optimized technique for computed tomography and MRI of patients with thoracic outlet syndrome, based on the experience at our institution and present some representative examples. Based on our experience, a combination of computed tomography angiography and MRI (with postural maneuvers) effectively demonstrate thoracic outlet syndrome abnormalities.
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Affiliation(s)
- Omid Khalilzadeh
- Department of Radiology, Division of Musculoskeletal Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - McKinley Glover
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital and Harvard Medical School, Room: GRB-273A, 55 Fruit Street, Boston, MA 02114, USA
| | - Martin Torriani
- Department of Radiology, Division of Musculoskeletal Radiology, Massachusetts General Hospital and Harvard Medical School, Room: YAW-6-6048, 32 Fruit Street, Boston, MA 02114, USA
| | - Rajiv Gupta
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital and Harvard Medical School, Room: GRB-273A, 55 Fruit Street, Boston, MA 02114, USA.
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11
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Thevenon A, de la Barge de Certeau AC, Wieczorek V, Allart E, Tiffreau V. Efficacy of intensive, hospital-based rehabilitation in cases of thoracic outlet syndrome that failed to respond to private-practice physiotherapy. J Back Musculoskelet Rehabil 2020; 33:545-552. [PMID: 32444532 DOI: 10.3233/bmr-170906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rehabilitation is currently the preferred first-line treatment for thoracic outlet syndrome (TOS). When physiotherapy fails, the next treatment option is usually surgery - a complex procedure with potential complications. OBJECTIVE We sought to establish whether an intensive, multidisciplinary, day-hospital-based rehabilitation programme could reduce the symptoms of TOS after the failure of private-practice physiotherapy and before surgery was considered. METHODS We performed a retrospective, single-centre study of 63 TOS patients admitted to our day hospital for 3 weeks (15 therapy sessions) between 2003 and 2014. The data were extracted from hospital records or gathered in a phone interview. RESULTS Immediately after discharge, the observed improvements in hand function were related to lifting a load, reaching a high shelf, sweeping the floor, cleaning windows, and combing hair. Three months after the end of the intensive rehabilitation program, 80% of the patients reported a reduction in their symptoms. Forty-one of the 63 patients were subsequently contacted by phone. The mean time interval between the end of the rehabilitation programme and the phone interview was 4.5 years (median: 3.5 years; range: 1-12 years). Twenty-seven patients (66%) reported a worsening in hand function, and 25% had undergone surgery. Twenty-three patients had kept the same job, 7 had changed jobs after retraining, 4 had stopped working before the programme but were able to return to work afterwards (including one patient in a part-time job), 4 had not returned to work, and 3 received disability benefits. CONCLUSION An intensive, multidisciplinary, hospital-based rehabilitation programme was associated with improvements in the great majority of patients with TOS - even after private-practice physiotherapy had failed.
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Affiliation(s)
- A Thevenon
- Pôle RRSS, Hôpital Swynghedauw, CHU, F-59000 Lille, France.,URePSS, Université de Lille, F-59000 Lille, France
| | | | - V Wieczorek
- Pôle RRSS, Hôpital Swynghedauw, CHU, F-59000 Lille, France
| | - E Allart
- Pôle RRSS, Hôpital Swynghedauw, CHU, F-59000 Lille, France
| | - V Tiffreau
- Pôle RRSS, Hôpital Swynghedauw, CHU, F-59000 Lille, France.,URePSS, Université de Lille, F-59000 Lille, France
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12
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Zurkiya O, Ganguli S, Kalva SP, Chung JH, Shah LM, Majdalany BS, Bykowski J, Carter BW, Chandra A, Collins JD, Gunn AJ, Kendi AT, Khaja MS, Liebeskind DS, Maldonado F, Obara P, Sutphin PD, Tong BC, Vijay K, Corey AS, Kanne JP, Dill KE. ACR Appropriateness Criteria® Thoracic Outlet Syndrome. J Am Coll Radiol 2020; 17:S323-S334. [PMID: 32370976 DOI: 10.1016/j.jacr.2020.01.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 10/24/2022]
Abstract
Thoracic outlet syndrome (TOS) is the clinical entity that occurs with compression of the brachial plexus, subclavian artery, and/or subclavian vein at the superior thoracic outlet. Compression of each of these structures results in characteristic symptoms divided into three variants: neurogenic TOS, venous TOS, and arterial TOS, each arising from the specific structure that is compressed. The constellation of symptoms in each patient may vary, and patients may have more than one symptom simultaneously. Understanding the various anatomic spaces, causes of narrowing, and resulting neurovascular changes is important in choosing and interpreting radiological imaging performed to help diagnose TOS and plan for intervention. This publication has separated imaging appropriateness based on neurogenic, venous, or arterial symptoms, acknowledging that some patients may present with combined symptoms that may require more than one study to fully resolve. Additionally, in the postoperative setting, new symptoms may arise altering the need for specific imaging as compared to preoperative evaluation. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Omar Zurkiya
- Research Author, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | | | - Sanjeeva P Kalva
- Panel Chair, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Lubdha M Shah
- Panel Chair, University of Utah, Salt Lake City, Utah
| | | | | | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ankur Chandra
- Scripps Green Hospital, La Jolla, California; Society for Vascular Surgery
| | | | - Andrew J Gunn
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - David S Liebeskind
- University of California Los Angeles, Los Angeles, California; American Academy of Neurology
| | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | - Piotr Obara
- Loyola University Medical Center, Maywood, Illinois
| | | | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | | | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Karin E Dill
- Specialty Chair, UMass Memorial Medical Center, Worcester, Massachusetts
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13
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Baz AA. An overview of the findings of dynamic upper limbs’ arterial and venous duplex in cases of vascular thoracic outlet syndrome. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0100-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractBackgroundTo describe the findings of the dynamic upper limb arterial and venous duplex in the assessment of vascular compression in cases of VTOS. This study was conducted on 58 patients with VTOS; they were evaluated by dynamic duplex examination.ResultsVascular compression was subdivided into a venous compression that was detected in (84.4%,n = 49), arterial compression that was seen in (1.7%,n = 1), and combined arterial and venous compression that was present in (13.7%,n = 8); bilateral compression was existing in (94.4%,n = 55), compression at the scalene triangle was seen in (1.7%,n = 1), at the costo-clavicular space was seen in (91.3%,n = 53), and at the retro-pectoral space was depicted in (8.6%,n = 5).Complicated arterial compression was detected in (1.7%,n = 1), whereas venous complications were seen in (6.8%,n = 4).ConclusionDynamic duplex ultrasound offered a simple, noninvasive, and quick technique that can help in the evaluation of the vascular thoracic outlet syndrome without exposure to ionizing radiation or contrast media administration like that in CT; nevertheless, it is done with the patient in the upright position, thus avoiding the high false-negative results associated with the supine position that is used in the CT and MRI studies.
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14
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Kim SW, Jeong JS, Kim BJ, Choe YH, Yoon YC, Sung DH. Clinical, electrodiagnostic and imaging features of true neurogenic thoracic outlet syndrome: Experience at a tertiary referral center. J Neurol Sci 2019; 404:115-123. [PMID: 31374409 DOI: 10.1016/j.jns.2019.07.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE True neurogenic thoracic outlet syndrome (TN-TOS) is an extremely rare neuromuscular disease. We report clinical, electrodiagnostic and radiologic features of patients with TN-TOS. METHODS Retrospective chart review of patients satisfying criteria was done. Nerve conduction study (NCS) and needle electromyography (EMG) of upper extremity were reviewed. Brachial plexus MRI and computed tomography angiography (CTA) were also reviewed. RESULTS Thirteen TN-TOS patients were identified. The most common neurologic signs were hypesthesia in the medial forearm or ulnar digits and weakness of the abductor pollicis brevis (APB) muscle. In NCS, medial antebrachial cutaneous (MABC) sensory nerve action potential amplitude was decreased in all tested patients. The APB muscle was most commonly involved in EMG. Among radiologic criteria, focal stenosis of subclavian artery in CTA was the most common finding. CONCLUSION We confirmed that TN-TOS is T1 predominant lower roots/trunk brachial plexopathy with clinical and electrodiagnostic features. Radiologic studies may be used to detect structural abnormalities. SIGNIFICANCE As MABC NCS showed abnormal results in all tested patients, it should be added to electrodiagnostic study as screening method. If present, structural abnormalities might be confirmed with radiologic studies.
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Affiliation(s)
- Sun Woong Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Seon Jeong
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Duk Hyun Sung
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Nicholson JA, Stirling PHC, Strelzow J, Robinson CM. Dynamic Compression of the Subclavian Artery Secondary to Clavicle Nonunion: A Report of 2 Cases. JBJS Case Connect 2019; 9:e4. [PMID: 30628922 DOI: 10.2106/jbjs.cc.18.00200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe 2 patients with nonunion of the clavicle and dynamic compression of the subclavian artery. In both patients, no structural abnormality of the subclavian vessels was evident at rest; however, with the arm in hyperabduction, arterial occlusion occurred because of the mobility of the fracture and a prominent callus. CONCLUSION This small case series demonstrates an important and, to our knowledge, unreported clinical complication of clavicle fracture nonunion. We believe that this complication is worth considering as a rare but important cause of pain in patients with delayed union or nonunion of the clavicle.
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16
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Henry BM, Vikse J, Sanna B, Taterra D, Gomulska M, Pękala PA, Tubbs RS, Tomaszewski KA. Cervical Rib Prevalence and its Association with Thoracic Outlet Syndrome: A Meta-Analysis of 141 Studies with Surgical Considerations. World Neurosurg 2017; 110:e965-e978. [PMID: 29203316 DOI: 10.1016/j.wneu.2017.11.148] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/23/2017] [Accepted: 11/25/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cervical ribs (CR) are supernumerary ribs that arise from the seventh cervical vertebra. In the presence of CR, the boundaries of the interscalene triangle can be further constricted and result in neurovascular compression and thoracic outlet syndrome (TOS). The aim of our study was to provide a comprehensive evidence-based assessment of CR prevalence and their association with TOS as well as surgical approach to excision of CR and surgical patients' characteristics. METHODS A thorough search of major electronic databases was conducted to identify any relevant studies. Data on the prevalence, laterality, and side of CR were extracted from the eligible studies for both healthy individuals and patients with TOS. Data on the type of TOS and surgical approach to excision of CR were extracted as well. RESULTS A total of 141 studies (n = 77,924 participants) were included into the meta-analysis. CR was significantly more prevalent in patients with TOS than in healthy individuals, with pooled prevalence estimates of 29.5% and 1.1%, respectively. More than half of the patients had unilateral CR in both the healthy and the TOS group. The analysis showed that 51.3% of the symptomatic patients with CR had vascular TOS, and 48.7% had neurogenic TOS. Most CR were surgically excised in women using a supraclavicular approach. CONCLUSIONS CR ribs are frequent findings in patients with TOS. We recommended counseling asymptomatic patients with incidentally discovered CR on the symptoms of TOS, so that if symptoms develop, the patients can undergo prompt and appropriate workup and treatment.
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Affiliation(s)
- Brandon Michael Henry
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland.
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Beatrice Sanna
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Faculty of Medicine and Surgery, University of Cagliari, Monserrato, Italy
| | - Dominik Taterra
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Martyna Gomulska
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław A Pękala
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA
| | - Krzysztof A Tomaszewski
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
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Gillet R, Teixeira P, Meyer JB, Rauch A, Raymond A, Dap F, Blum A. Dynamic CT angiography for the diagnosis of patients with thoracic outlet syndrome: Correlation with patient symptoms. J Cardiovasc Comput Tomogr 2017; 12:158-165. [PMID: 29233633 DOI: 10.1016/j.jcct.2017.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Vasculo-nervous structures serving the upper limbs may be compressed as they pass through three areas: the inter-scalene triangle (IST), the costo-clavicular space (CCS) and the retropectoralis minor space (RMS). The diagnosis of thoracic outlet syndrome (TOS) is essentially clinical, but requires imaging to specify the site of compression, its grade and the existence of predisposing anatomical factors, in order to guide the treatment and eliminate the main differential diagnoses. MATERIAL AND METHODS Images from 141 patients who underwent dynamic CT angiography of the thoracic outlets from June 2008 to January 2015 were analyzed retrospectively. Patients had unilateral or bilateral vascular, neurological, mixed or atypical symptoms. We studied the degree of stenosis of the subclavian artery with the following grading system: 1 (0-<25%), 2 (25-<50%), 3 (50-<75%), 4 (75-100%). The site of stenosis and the presence of underlying anatomical predisposing factors were also taken in account. RESULTS A total of 221 thoracic outlets were analyzed. Symptoms were neurological, mixed, vascular and atypical in 30%, 28%, 13% and 12%, respectively. Among patients with bilateral acquisitions, 38 outlets were asymptomatic; 40% of symptomatic outlets and only 5% of asymptomatic ones had grade 3 or 4 stenosis. 63% of the stenosis were in the CCS and 37% in the IST; 21% had a predisposing anatomical factor most often a costo-clavicular anomaly, associated with significant stenosis in 50% of cases. CONCLUSION Vascular stenosis of more than 50% on dynamic CT angiography is strongly associated with TOS. Predisposing factors were present in 21% of cases, causing significant vascular stenosis in half, underscoring the need for functional evaluation.
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Affiliation(s)
- Romain Gillet
- service d'imagerie GUILLOZ, Hôpital Central, CHU de Nancy, 54000 Nancy, France.
| | - Pedro Teixeira
- service d'imagerie GUILLOZ, Hôpital Central, CHU de Nancy, 54000 Nancy, France
| | - Jean-Baptiste Meyer
- service d'imagerie GUILLOZ, Hôpital Central, CHU de Nancy, 54000 Nancy, France
| | - Aymeric Rauch
- service d'imagerie GUILLOZ, Hôpital Central, CHU de Nancy, 54000 Nancy, France
| | - Ariane Raymond
- service d'imagerie GUILLOZ, Hôpital Central, CHU de Nancy, 54000 Nancy, France
| | - François Dap
- service de chirurgie orthopédique, Centre Chirurgical Emile Gallé, CHU de Nancy, France
| | - Alain Blum
- service d'imagerie GUILLOZ, Hôpital Central, CHU de Nancy, 54000 Nancy, France
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MRI of thoracic outlet syndrome in children. Pediatr Radiol 2017; 47:1222-1234. [PMID: 28493011 DOI: 10.1007/s00247-017-3854-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 03/04/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
Thoracic outlet syndrome is caused by compression of the neurovascular bundle as it passes from the upper thorax to the axilla. The neurovascular bundle can be compressed by bony structures such as the first rib, cervical ribs or bone tubercles, or from soft-tissue abnormalities like a fibrous band, muscle hypertrophy or space-occupying lesion. Thoracic outlet syndrome commonly affects young adults but can be seen in the pediatric age group, especially in older children. Diagnosis is based on a holistic approach encompassing clinical features, physical examination findings including those triggered by various maneuvers, electromyography, nerve conduction studies and imaging. Imaging is performed to confirm the diagnosis, exclude mimics and classify thoracic outlet syndrome into neurogenic, arterial, venous or mixed causes. MRI and MR angiography are useful in this process. A complete MRI examination for suspected thoracic outlet syndrome should include the assessment of anatomy and any abnormalities using routine sequences, vessel assessment with the arms in adduction by MR angiography and assessment of dynamic compression of vessels with abduction of the arms. The purpose of this paper is to describe the anatomy of the thoracic outlet, causes of thoracic outlet syndrome, the MR imaging techniques used in its diagnosis and the principles of image interpretation.
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Kuwayama DP, Lund JR, Brantigan CO, Glebova NO. Choosing Surgery for Neurogenic TOS: The Roles of Physical Exam, Physical Therapy, and Imaging. Diagnostics (Basel) 2017. [PMID: 28644402 PMCID: PMC5489957 DOI: 10.3390/diagnostics7020037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Neurogenic thoracic outlet syndrome (nTOS) is characterized by arm and hand pain, paresthesias, and sometimes weakness resulting from compression of the brachial plexus within the thoracic outlet. While it is the most common subtype of TOS, nTOS can be difficult to diagnose. Furthermore, patient selection for surgical treatment can be challenging as symptoms may be vague and ambiguous, and diagnostic studies may be equivocal. Herein, we describe some approaches to aid in identifying patients who would be expected to benefit from surgical intervention for nTOS. We describe the role of physical examination, physical therapy, and imaging in the evaluation and diagnosis of nTOS.
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Affiliation(s)
- David P Kuwayama
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado Denver, Denver, CO 80045 USA.
| | - Jason R Lund
- Ashbaugh Center for Physical Therapy, Denver, CO 80222, USA.
| | - Charles O Brantigan
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado Denver, Denver, CO 80045 USA.
| | - Natalia O Glebova
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado Denver, Denver, CO 80045 USA.
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado Anschutz Medical Campus, 12631 East 17th Ave, Room 5409, Mail Stop C 312, Aurora, CO 80045, USA.
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Otoshi K, Kikuchi S, Kato K, Sato R, Igari T, Kaga T, Shishido H, Konno S, Koga R, Furushima K, Itoh Y. The Prevalence and Characteristics of Thoracic Outlet Syndrome in High School Baseball Players. Health (London) 2017. [DOI: 10.4236/health.2017.98088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ahmed S, Lewis J, Abidia A, Partridge W, Hamady M, Aldin Z. Thoracic outlet syndrome arising from an extrapleural lipoma. J Vasc Surg Cases Innov Tech 2016. [DOI: 10.1016/j.jvsc.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Raptis CA, Sridhar S, Thompson RW, Fowler KJ, Bhalla S. Imaging of the Patient with Thoracic Outlet Syndrome. Radiographics 2016; 36:984-1000. [PMID: 27257767 DOI: 10.1148/rg.2016150221] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Patients with symptoms from compression of the neurovascular bundle in the thoracic outlet are described as having thoracic outlet syndrome (TOS), which is best thought of as three conditions classified according to which structures are involved. The purpose of this article is to review the role of imaging in evaluation of patients with TOS, beginning with diagnosis and extending through postoperative management. While diagnosis of TOS still rests on the patient's presenting history and physical examination, imaging examinations are helpful in supporting the diagnosis, delineating abnormal anatomy, determining which structures are compressed, identifying the site of compression, and excluding other diagnoses. Magnetic resonance imaging is the noninvasive imaging modality of choice in evaluating patients with suspected TOS, but computed tomography also plays an important role, particularly in delineating bone anatomy. Evidence of vascular damage is required to make the diagnosis of TOS at imaging. Dynamic compression of the axillosubclavian vessels at the thoracic outlet can be a finding supportive of the diagnosis of TOS but is not a stand-alone diagnostic criterion, as it can be seen in patients without TOS. As diagnosis and treatment of TOS increase, radiologists will increasingly encounter the TOS patient after decompression surgery. Recognition of the expected postoperative appearance of these patients is critical, as is an understanding of the imaging findings of potential short- and long-term complications. (©)RSNA, 2016.
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Affiliation(s)
- Constantine A Raptis
- From the Mallinckrodt Institute of Radiology (C.A.R., S.S., K.J.F., S.B.) and Division of Surgery, Vascular Surgery Section (R.W.T.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Sreevathsan Sridhar
- From the Mallinckrodt Institute of Radiology (C.A.R., S.S., K.J.F., S.B.) and Division of Surgery, Vascular Surgery Section (R.W.T.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Robert W Thompson
- From the Mallinckrodt Institute of Radiology (C.A.R., S.S., K.J.F., S.B.) and Division of Surgery, Vascular Surgery Section (R.W.T.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Kathryn J Fowler
- From the Mallinckrodt Institute of Radiology (C.A.R., S.S., K.J.F., S.B.) and Division of Surgery, Vascular Surgery Section (R.W.T.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology (C.A.R., S.S., K.J.F., S.B.) and Division of Surgery, Vascular Surgery Section (R.W.T.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
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23
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24
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Cervical rib mimicking supraclavicular mass. Joint Bone Spine 2015; 82:464. [DOI: 10.1016/j.jbspin.2015.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 02/11/2015] [Indexed: 11/19/2022]
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Moriarty JM, Bandyk DF, Broderick DF, Cornelius RS, Dill KE, Francois CJ, Gerhard-Herman MD, Ginsburg ME, Hanley M, Kalva SP, Kanne JP, Ketai LH, Majdalany BS, Ravenel JG, Roth CJ, Saleh AG, Schenker MP, Mohammed TLH, Rybicki FJ. ACR Appropriateness Criteria Imaging in the Diagnosis of Thoracic Outlet Syndrome. J Am Coll Radiol 2015; 12:438-43. [DOI: 10.1016/j.jacr.2015.01.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
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Kim JJ, Park HJ, Park JK, Cho DG, Moon SW. A study about the costoclavicular space in patients with pectus excavatum. J Cardiothorac Surg 2014; 9:189. [PMID: 25480443 PMCID: PMC4266879 DOI: 10.1186/s13019-014-0189-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/20/2014] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the present study is to investigate the costoclavicular space in patients with pectus excavatum. Materials and methods Between April and November 2011, consecutive 50 patients with pectus excavatum and consecutive 50 patients without pectus excavatum were included into the present study. The costoclavicular measurements (the shortest distance, the crossing angle) were measured for the costoclavicular investigation. Results Firstly, there were no significant differences of the costoclavicular measurements in each and between symmetric and asymmetric subgroup, and in the overall, bilaterally. The shortest distance had a significant positive correlation with BMI (right p = 0.001, left p = 0.032) and a significant negative correlation with the crossing angle (right p = 0.013, left p = 0.001). Secondly, in the control group, the shortest distance had significant positive correlations with body weight and BMI (Body weight right p = 0.001, left p < 0.001; BMI right p = 0.001, left p < 0.001), and significant negative correlations with the crossing angles (right p = 0.002, left p < 0.001) and the sternal angle (right p = 0.032, left p = 0.017). Thirdly, the control group had the significant longer shortest distance than the pectus excavatum group (right p <0.001, left p <0.001). Fourthly, a decrease of the shortest distance (right p <0.001, left p <0.001), an increase of the crossing angle (right p < 0.001, left p < 0.001) and the sternal angle (p <0.001), and also a decrease of the Haller index (p <0.001) was found postoperatively. Conclusion Patients with pectus excavatum originally have narrower costoclavicular spaces than the normal control group, and the postoperative costoclavicular space are much narrower also. Electronic supplementary material The online version of this article (doi:10.1186/s13019-014-0189-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jae-Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
| | - Hyung Joo Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, 222, Banpo-Daero, Seocho-gu, Seoul, 137-701, Korea.
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, 222, Banpo-Daero, Seocho-gu, Seoul, 137-701, Korea.
| | - Deog Gon Cho
- Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, St. Paul's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
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Daniels B, Michaud L, Sease F, Cassas KJ, Gray BH. Arterial thoracic outlet syndrome. Curr Sports Med Rep 2014; 13:75-80. [PMID: 24614419 DOI: 10.1249/jsr.0000000000000034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Arterial thoracic outlet syndrome is a rare cause of shoulder pain due to compression of the subclavian or axillary artery within the thoracic outlet. It is the least common form of thoracic outlet syndrome but is potentially dangerous as it can result in significant morbidity. An athlete initially may present with exertional pain, early fatigability, a dull ache, or discomfort in the affected arm. History and physical examination are paramount in diagnosis, and imaging confirms the anatomy. Surgical repair or resection alleviates the compression of the affected structure and allows for a safe return to participation. Familiarity with this condition aids in the prompt diagnosis and treatment of this disorder.
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Affiliation(s)
- Brian Daniels
- 1Steadman Hawkins Clinic of the Carolinas, Greenville Health Systems, Greenville, SC; 2Drisko, Fee, and Parkins, Independence, MO; 3University of South Carolina School of Medicine, Greenville, SC; and 4Vascular Health Alliance, Greenville Health Systems, Greenville, SC
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Zajac JM, Angeline ME, Bohon TM, Loftus M, Potter HG, Weiland AJ, Thompson RW, Coleman SH, Altchek DW. Axillary artery thrombosis in a major league baseball pitcher: a case report and rehabilitation guide. Sports Health 2014; 5:402-6. [PMID: 24427409 PMCID: PMC3752194 DOI: 10.1177/1941738113495647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This case study describes a Major League Baseball player who was diagnosed with an axillary artery thrombosis due to arterial compression from throwing. The purpose of this article is to create awareness as to the signs and symptoms associated with arterial positional compression and the rehabilitative implications to surgical intervention.
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Case report: Thoracic outlet syndrome in an elite archer in full-draw position. Clin Orthop Relat Res 2013; 471:3056-60. [PMID: 23430722 PMCID: PMC3734406 DOI: 10.1007/s11999-013-2865-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 02/08/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND One possible pathomechanism of thoracic outlet syndrome (TOS) is shoulder abduction and extension inducing backward motion of the clavicle which causes compression on the brachial plexus. This position occurs during the full-draw stage of archery, by drawing and holding the bowstring. CASE DESCRIPTION A 28-year-old elite archer presented with a feeling of weakness and dull shoulder pain, and experienced decreased grip power and hypoesthesia in the ulnar nerve dermatome in the full-draw position. On CT angiography, the cross-sectional area of the subclavian artery in the costoclavicular space decreased to 40% compared with that of the subclavian artery in a noncompressed state. This patient had first rib resection through the supraclavicular approach with a clavicle osteotomy. At 3.5 years postoperatively, the patient maintained his job as a professional coach and did not have any specific complaints when teaching and demonstrating archery skills. LITERATURE REVIEW A literature review revealed numerous causes of TOS, ranging from congenital abnormalities to repetitive postures related to sports activities. The abduction and external rotation (ABER) position (shoulder at 90° abduction and external rotation) has been suggested for detecting TOS and is a documented cause of compression of the brachial plexus and subclavian vessels. We present the case of an archer with TOS association with repeated use of the ABER position. PURPOSE AND CLINICAL RELEVANCE TOS should be suspected when athletes repeatedly use shoulder extension and abduction for their sports if other pathologic conditions can be ruled out.
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Butros SR, Liu R, Oliveira GR, Ganguli S, Kalva S. Venous compression syndromes: clinical features, imaging findings and management. Br J Radiol 2013; 86:20130284. [PMID: 23908347 DOI: 10.1259/bjr.20130284] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Extrinsic venous compression is caused by compression of the veins in tight anatomic spaces by adjacent structures, and is seen in a number of locations. Venous compression syndromes, including Paget-Schroetter syndrome, Nutcracker syndrome, May-Thurner syndrome and popliteal venous compression will be discussed. These syndromes are usually seen in young, otherwise healthy individuals, and can lead to significant overall morbidity. Aside from clinical findings and physical examination, diagnosis can be made with ultrasound, CT, or MR conventional venography. Symptoms and haemodynamic significance of the compression determine the ideal treatment method.
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Affiliation(s)
- S R Butros
- Department of Radiology, Division of Vascular Imaging and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Aljabri B, Al-Omran M. Surgical management of vascular thoracic outlet syndrome: a teaching hospital experience. Ann Vasc Dis 2013; 6:74-9. [PMID: 23641288 DOI: 10.3400/avd.oa.12.00081] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 01/17/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Thoracic outlet syndrome (TOS) consists of a group of distinct disorders that are caused by compression of the brachial plexus and/or subclavian artery and vein. The aim of this study was to highlight the different modalities of diagnosing and treating vascular TOS and evaluate outcomes. METHODS We conducted a retrospective cohort study between 1999 and 2011 using the medical records database from a teaching hospital. RESULTS During the study period, 54 cases with vascular TOS were identified in 38 patients. Bilateral TOS was in 16 patients. The median age of the patients was 33 years (range 12-49), and the majority (79%) were female. Arterial TOS represented forty-nine cases (90.7%). Preoperative information derived from plain x-ray, duplex scanning and in selected cases computed tomography (CT) and/or angiography. Decompression of the TOS was performed through a supraclavicular approach in all cases with scalenectomy coupled with either cervical rib excision (70%), 1st rib excision alone (15%) and excision of both cervical and 1st ribs (15%). Adjunctive vascular reconstructive procedures were done in 11 cases (20.3%); 9 arterial cases and 2 venous cases. There was no mortality; however, postoperative complications occurred in 7 cases (13%). CONCLUSION The use of advanced radiological imaging and careful surgical planning for Vascular TOS in a high volume center resulted in good outcomes.
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Affiliation(s)
- Badr Aljabri
- Peripheral Vascular Disease Research Chair and Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Aralasmak A, Cevikol C, Karaali K, Senol U, Sharifov R, Kilicarslan R, Alkan A. MRI findings in thoracic outlet syndrome. Skeletal Radiol 2012; 41:1365-74. [PMID: 22782291 DOI: 10.1007/s00256-012-1485-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 06/14/2012] [Accepted: 06/21/2012] [Indexed: 02/02/2023]
Abstract
We discuss MRI findings in patients with thoracic outlet syndrome (TOS). A total of 100 neurovascular bundles were evaluated in the interscalene triangle (IS), costoclavicular (CC), and retropectoralis minor (RPM) spaces. To exclude neurogenic abnormality, MRIs of the cervical spine and brachial plexus (BPL) were obtained in neutral. To exclude compression on neurovascular bundles, sagittal T1W images were obtained vertical to the longitudinal axis of BPL from spinal cord to the medial part of the humerus, in abduction and neutral. To exclude vascular TOS, MR angiography (MRA) and venography (MRV) of the subclavian artery (SA) and vein (SV) in abduction were obtained. If there is compression on the vessels, MRA and MRV of the subclavian vessels were repeated in neutral. Seventy-one neurovascular bundles were found to be abnormal: 16 arterial-venous-neurogenic, 20 neurogenic, 1 arterial, 15 venous, 8 arterial-venous, 3 arterial-neurogenic, and 8 venous-neurogenic TOS. Overall, neurogenic TOS was noted in 69%, venous TOS in 66%, and arterial TOS in 39%. The neurovascular bundle was most commonly compressed in the CC, mostly secondary to position, and very rarely compressed in the RPM. The cause of TOS was congenital bone variations in 36%, congenital fibromuscular anomalies in 11%, and position in 53%. In 5%, there was unilateral brachial plexitis in addition to compression of the neurovascular bundle. Severe cervical spondylosis was noted in 14%, contributing to TOS symptoms. For evaluation of patients with TOS, visualization of the brachial plexus and cervical spine and dynamic evaluation of neurovascular bundles in the cervicothoracobrachial region are mandatory.
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Affiliation(s)
- Ayse Aralasmak
- Department of Radiology, Bezmialem Vakif University, Fatih/Istanbul, Turkey.
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Dahlstrom KA, Olinger AB. Descriptive Anatomy of the Interscalene Triangle and the Costoclavicular Space and Their Relationship to Thoracic Outlet Syndrome: A Study of 60 Cadavers. J Manipulative Physiol Ther 2012; 35:396-401. [DOI: 10.1016/j.jmpt.2012.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 01/31/2012] [Accepted: 03/01/2012] [Indexed: 11/28/2022]
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Eliahou R, Sosna J, Bloom AI. Between a rock and a hard place: clinical and imaging features of vascular compression syndromes. Radiographics 2012; 32:E33-49. [PMID: 22236908 DOI: 10.1148/rg.321115011] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vascular compression syndromes are caused by the entrapment of vessels between rigid or semirigid surfaces in a confined anatomic space. Chronic entrapment may lead to arterial ischemia and embolism, venous stasis and thrombosis, and hematuria. These syndromes are usually seen in otherwise healthy young patients, among whom underdiagnosis is common. Most occurrences of vascular compression are associated with an underlying anatomic abnormality. In a small percentage of cases, other contributing factors, including repetitive microtrauma, may cause pathologic changes leading to the onset of pain and other symptoms of vascular and neural compression. Hence, the diagnosis must be based on both clinical and radiologic findings. Because some cases of vascular entrapment become symptomatic only when specific physical maneuvers are performed, dynamic diagnostic imaging methods are especially useful. Digital subtraction angiography has been the mainstay of imaging-based diagnosis for most vascular compression syndromes, but other methods (eg, color Doppler ultrasonography, computed tomographic angiography, and magnetic resonance angiography) are used with increasing frequency for initial diagnostic evaluation. Because vascular compression syndromes are caused by the external compression of vessels, endoluminal treatment alone is rarely adequate and surgical decompression is likely to be required for optimal and durable clinical benefit. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.321115011/-/DC1.
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Affiliation(s)
- Ruth Eliahou
- Department of Radiology, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel
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Vascular Thoracic Outlet Syndrome: Protocol Design and Diagnostic Value of Contrast-Enhanced 3D MR Angiography and Equilibrium Phase Imaging on 1.5- and 3-T MRI Scanners. AJR Am J Roentgenol 2012; 198:1180-7. [DOI: 10.2214/ajr.11.6417] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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A possible relationship between reliability of thoracic outlet syndrome diagnostic testing and the position of the axillary artery. Surg Radiol Anat 2012; 34:499-507. [DOI: 10.1007/s00276-012-0948-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 02/16/2012] [Indexed: 10/28/2022]
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Clavicle-induced narrowing of the thoracic outlet during shoulder abduction as imaged by computed tomographic angiography and enhanced by three-dimensional reformation. Am J Phys Med Rehabil 2011; 90:572-8. [PMID: 21552107 DOI: 10.1097/phm.0b013e31821a70ff] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to confirm the location and degree of compromise of the subclavian vessels within the thoracic outlet during ipsilateral arm abduction in patients with clinical evidence of thoracic outlet syndrome and to identify both the physical and physiologic source of neurovascular compromise that induces the symptoms of thoracic outlet syndrome. DESIGN After a neuromuscular and vascular examination, all of the subjects underwent a two-part high-resolution computed tomographic angiography with three-dimensional reformation. The initial study was performed with the arm held at the side in an anatomical neutral position. Subsequently, the arm was abducted to 90 degrees with external rotation (ABER). In each position, 60 ml of iodinated nonionic contrast medium was injected in the opposite arm at 4 ml/sec. Three-dimensional volume-rendered images were obtained. Each image was subsequently reviewed by a musculoskeletal radiologist (S. Yadavalli). Patients were initially evaluated in the physiatrist's private office (M.M. LaBan). The computed tomographic scans were obtained from the participants as outpatients in an academic community-based medical center (William Beaumont Hospital). Seventeen outpatients with clinical signs and symptoms of thoracic outlet syndrome were evaluated, including seven men and ten women. This group has an average age of 48 yrs (range, 17-73 yrs). RESULTS The level of vessel occlusion varied in the costoclavicular space as well as in demonstrating the alterations in the diameter of both the subclavian artery and vein both in the neutral and ABER positions. The possible levels of occlusions included the costoclavicular space, the interscalene triangle, and the retropectoralis minor space. The narrowing of the subclavian vessel was considered significant if the percentage change of the vessel's diameter between the neutral and the ABER positions was 30% or greater for the subclavian artery and 50% or greater for the subclavian vein. CONCLUSIONS The average change in the costoclavicular space between the neutral and ABER positions was 18.2 mm or 55.6%. The degree of subclavian artery occlusion was significant in 8 (47%) of the 17 patients. The average change in artery diameter was 28% (5.5 to 7.5 mm). Significant subclavian vein occlusion was present in 12 (75%) of 16 patients. The average change in venous diameter was 54.1% (5.7 to 12.6 mm). In two cases, venous occlusion occurred in the retropectoralis minor space, one of which was significant at 79%. The vast majority of patients, that is, 13 (76.5%) of 17, demonstrated a compression of either the subclavian vein or artery, whereas 6 (35.3%) of 17 demonstrated a compression in both. In each of these cases, the asymptomatic side failed to demonstrate a significant change in either the venous and/or arterial caliber.
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Marina R. Swimmer's CT Angiography of Thoracic Outlet Syndrome. Neuroradiol J 2008; 21:244-7. [DOI: 10.1177/197140090802100215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Accepted: 09/01/2007] [Indexed: 11/15/2022] Open
Abstract
A pictorial essay is presented where the so-called swimmer's position is employed as a postural provocative maneuver to enhance the anatomic characteristics of the thoracic outlet in a symptomatic patient. Helical CT angiography showed severe axillary artery compression due to significant narrowing of the costoclavicular space.
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Affiliation(s)
- R. Marina
- U.O. Neuroradiologia. Ospedale S. Gerardo, Università Milano Bicocca; Monza, Italy
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Thoracic Outlet Syndrome: Part II. Management and Outcomes of 133 Operative Neurogenic Thoracic Outlet Syndrome Cases. ACTA ACUST UNITED AC 2007. [DOI: 10.1097/wnq.0b013e31803201a1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gómez E, Bastida R, Oleaga L, Gorriño M, Grande D. [Diagnosis of thoracic outlet syndrome by angio-MRI]. RADIOLOGIA 2006; 48:295-300. [PMID: 17168238 DOI: 10.1016/s0033-8338(06)75138-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the sequences and maneuvers recommended for the study of the thoracic outlet syndrome (TOS) and the usefulness of magnetic resonance imaging (MRI) in demonstrating its etiology. MATERIAL AND METHODS We present a study of eight patients with clinical presentation suggestive of TOS. All underwent MRI, gadolinium-enhanced angio-MRI with the arms extended along the body and with postural maneuvers of abduction and elevation of the arms, plain-film chest x-rays, and digital angiography. The anatomic characteristics of the superior aperture of the thorax were analyzed on both sides before and during postural maneuvering. Likewise, the permeability of the vessels and integrity of the brachial plexus was studied. RESULTS In two cases, angio-MRI demonstrated thrombosis, of the subclavian artery in one case and of the subclavian vein in the other, caused by a cervical rib, which was confirmed at plain-film chest x-ray. In one case, angio-MRI demonstrated stenosis of the subclavian artery on abduction, secondary to hypertrophy of the anterior scalene muscle, and digital angiography showed the same findings. In two cases, angio-MRI showed vascular thrombosis, arterial in one case and venous in the other, without evidence of anatomic anomalies; these findings were confirmed at digital angiography. In two cases, no pathological findings were observed at MRI, angio-MRI, or digital angiography. In one case, MRI showed the presence of a cervical rib without vascular repercussions. CONCLUSION Gadolinium-enhanced angio-MRI is useful in the evaluation of TOS. It is important to examine patients at rest and during different postural maneuvers. In many cases it is possible to determine the cause of vascular compression.
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Affiliation(s)
- E Gómez
- Servicio de Radiodiagnóstico, Hospital de Basurto, Bilbao, España.
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Demondion X, Herbinet P, Van Sint Jan S, Boutry N, Chantelot C, Cotten A. Imaging assessment of thoracic outlet syndrome. Radiographics 2006; 26:1735-50. [PMID: 17102047 DOI: 10.1148/rg.266055079] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The thoracic outlet includes three compartments (the interscalene triangle, costoclavicular space, and retropectoralis minor space), which extend from the cervical spine and mediastinum to the lower border of the pectoralis minor muscle. Dynamically induced compression of the neural, arterial, or venous structures crossing these compartments leads to thoracic outlet syndrome (TOS). The diagnosis is based on the results of clinical evaluation, particularly if symptoms can be reproduced when various dynamic maneuvers, including elevation of the arm, are undertaken. However, clinical diagnosis is often difficult; thus, the use of imaging is required to demonstrate neurovascular compression and to determine the nature and location of the structure undergoing compression and the structure producing the compression. Cervical plain radiography should be performed first to assess for bone abnormalities and to narrow the differential diagnosis. Computed tomographic (CT) angiography or magnetic resonance (MR) imaging performed in association with postural maneuvers is helpful in analyzing the dynamically induced compression. B-mode and color duplex ultrasonography (US) are good supplementary tools for assessment of vessel compression in association with postural maneuvers, especially in cases with positive clinical features of TOS but negative features of TOS at CT and MR imaging. US may also allow analysis of the brachial plexus. However, MR imaging remains the method of choice when searching for neurologic compression.
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Affiliation(s)
- Xavier Demondion
- Department of Musculoskeletal Radiology, Hôpital Roger Salengro, Bd du Professeur Jules Leclercq, 59037 Lille Cedex, France.
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Brandão LR, Williams S, Kahr WHA, Ryan C, Temple M, Chan AKC. Exercise-induced deep vein thrombosis of the upper extremity. 1. Literature review. Acta Haematol 2006; 115:214-20. [PMID: 16549899 DOI: 10.1159/000090938] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Paget-Schroetter syndrome or effort-related upper extremity deep vein thrombosis is a rare condition that usually afflicts young healthy individuals, most commonly males. The cause is multifactorial but almost always involves extrinsic compression of the subclavian vein at the thoracic inlet, causing venous stenosis from repetitive trauma. The diagnosis of this condition may be difficult, and its delay may contribute to potential complications including thrombosis progression, pulmonary embolism, thrombosis recurrence, and post-thrombotic syndrome. Similarly, the best therapeutic option has not been established and in the lack of evidence-based guidelines, treatment may be extremely challenging especially in children, in whom long-term complications can be particularly disabling.
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Affiliation(s)
- Leonardo R Brandão
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ont., Canada.
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Demondion X, Vidal C, Herbinet P, Gautier C, Duquesnoy B, Cotten A. Ultrasonographic assessment of arterial cross-sectional area in the thoracic outlet on postural maneuvers measured with power Doppler ultrasonography in both asymptomatic and symptomatic populations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:217-24. [PMID: 16439785 DOI: 10.7863/jum.2006.25.2.217] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the feasibility and potential usefulness of power Doppler ultrasonography (PDU) in the assessment of changes in arterial cross-sectional area in the thoracic outlet during upper limb elevation. METHODS Forty-four volunteers and 28 patients with a clinical diagnosis of arterial thoracic outlet syndrome were evaluated by B-mode imaging and PDU. Arterial cross-sectional area was assessed in the 3 compartments of the thoracic outlet with the arm alongside the body and at 90 degrees, 130 degrees, and 170 degrees of abduction. The percentage of arterial stenosis was calculated for each of these arm positions. Nineteen of the 28 patients were also assessed by magnetic resonance (MR) imaging. RESULTS No significant arterial stenosis was shown in the interscalene triangle and in the retropectoralis minor space of the volunteers and patients. A significant difference (P < .01) in stenosis between volunteers and patients was seen for all degrees of abduction in the costoclavicular space. The 130 degrees hyperabduction maneuver appeared to be the most discriminating postural maneuver. Seven patients assessed with MR imaging did not have any arterial stenosis on MR images, whereas an appreciable degree of arterial stenosis was shown with ultrasonography. CONCLUSIONS Arterial compression inside the thoracic outlet can be detected and quantified with B-mode imaging in association with PDU.
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Affiliation(s)
- Xavier Demondion
- Service de Radiologie Ostéo-Articulaire, Hôpital Roger Salengro, Lille, France.
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Drapé JL, Cotten A, Chevrot A. Intérêt de l’IRM dans les syndromes canalaires du membre supérieur. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.main.2004.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Loewe C, Schillinger M, Haumer M, Loewe-Grgurin M, Lammer J, Thurnher S, Fuchsjäger M, Cejna M. MRA versus DSA in the assessment of occlusive disease in the aortic arch vessels: accuracy in detecting the severity, number, and length of stenoses. J Endovasc Ther 2004; 11:152-60. [PMID: 15056027 DOI: 10.1583/03-1087.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the diagnostic accuracy of contrast-enhanced magnetic resonance angiography (MRA) to that of digital subtraction angiography (DSA) in the detection, grading, and measurement of atherosclerotic stenoses involving the aortic arch arteries. METHODS The MRA and DSA studies from 28 patients (16 women; mean age 61.6 years, range 24-83) being evaluated for possible aortic arch vessel disease were examined. The aortic arch vasculature was divided into 9 segments; within each segment, the presence and severity of stenotic or occlusive disease was determined based on a 5-point scale. In addition, stenosis length and distance to the branch were measured in 5-mm increments. Image quality was assessed using a 5-point scale. The accuracy, sensitivity, and specificity values, as well as the positive and negative predictive values in MRA's identification of lesions, were evaluated in comparison to DSA. RESULTS In 28 patients, 189 segments were assessed by both methods. Of these, 173 were correctly rated by MRA, resulting in an accuracy of 91.5%. The accuracy dropped slightly to 86.5% when 11 "not assessable" lesions were included. Sensitivity and specificity for severity measurement were 88.5% and 95.6%, respectively. In 39 of 45 lesions, stenosis length measurements were identical by both methods, but there was a difference of 0.5 cm each in 6 lesions. CONCLUSIONS MRA as compared to DSA shows high accuracy in the detection and grading of lesions involving the aortic arch vessels. The noninvasive nature of this method recommends its use for screening, treatment planning, and follow-up in known or suspected arterial disease in aortic arch arteries.
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Affiliation(s)
- Christian Loewe
- Department of Radiology, Division of Angiography and Interventional Radiology, Vienna Medical School, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Charon JPM, Milne W, Sheppard DG, Houston JG. Evaluation of MR angiographic technique in the assessment of thoracic outlet syndrome. Clin Radiol 2004; 59:588-95. [PMID: 15208064 DOI: 10.1016/j.crad.2003.11.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2003] [Revised: 11/19/2003] [Accepted: 11/24/2003] [Indexed: 11/29/2022]
Abstract
AIM To evaluate two-dimensional time of flight (2D TOF) and three-dimensional contrast-enhanced magnetic resonance angiographic (3DCE MRA) techniques in the assessment of patients with suspected thoracic outlet syndrome (TOS) of vascular origin. MATERIALS AND METHODS Fifty-five consecutive examinations, in 51 patients with suspected TOS of vascular origin, were examined using either a 1T or 1.5T Siemens magnetic resonance imaging (MRI) unit, using either 2D TOF (n=13) or 3DCE MRA (n=42). Examinations were performed with the arms abducted (n=27) or both abducted and adducted (n=28). The source images and MIPs were reviewed retrospectively and assessed for image quality and the presence of significant persistent stenosis or impingement (a >60% reduction in the diameter of the subclavian vessels at the thoracic outlet or evidence of post-stenotic dilatation). When significant impingement was identified, the images were reformatted with multiplanar reconstruction to determine the cause. RESULTS Images were sub-optimal in 53% 2D TOF and 10% 3DCE MRA examinations. 3DCE MRA offered vessel coverage from the aortic arch to the distal axilliary arteries, whereas, 2D TOF sequences gave more limited coverage. Eight patients were found to have significant impingement (n=7) or stenosis (n=1) of the subclavian artery attributable to TOS. 3DCE MRA also demonstrated other relevant significant stenoses not attributable to TOS (n=5). All cases of impingement were either seen only, or more prominently, on sequences with the arms abducted. Reformatting the 3DCE MRA studies demonstrated the cause of impingement. CONCLUSIONS Both 2D TOF and 3DCE MRA may demonstrate TOS with significant arterial impingement. In comparison with 2D TOF sequences, 3DCE MRA offers extensive vessel coverage, is less prone to artefact and frequently demonstrates the underlying cause of TOS when studies are reformatted. Evidence of impingement should be sought from sequences performed with the arms abducted and venous phase sequences may show corroborative venous impingement.
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Affiliation(s)
- J-P M Charon
- Tayside Institute for Cardiovascular Research, Ninewells Hospital and Medical School, Dundee, UK.
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Abstract
Although axial images are sufficient for diagnosis in most instances, knowledge of multiplanar imaging techniques is essential to apply them in appropriate circumstances. In particular, appropriately applied multiplanar imaging adds confidence to interpretations and assists surgeons and bronchoscopists in planning procedures. The need for multiplanar imaging must be assessed before performing any study so that the image acquisition parameters allow for suitable reformations.
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Affiliation(s)
- James G Ravenel
- Department of Radiology, Medical University of South Carolina, Box 250322, 169 Ashley Avenue, Charleston, SC 29425, USA.
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Ravenel JG, McAdams HP, Remy-Jardin M, Remy J. Multidimensional imaging of the thorax: practical applications. J Thorac Imaging 2001; 16:269-81. [PMID: 11685092 DOI: 10.1097/00005382-200110000-00008] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Over the past decade, faster CT scan times, thinner collimation, and the development of multirow detectors, coupled with the increasing capability of computers to process large amounts of data in short periods of time, have lead to an expansion in the ability to create diagnostically useful two-dimensional (2D) and three-dimensional (3D) images within the thorax. Applications within the thorax include, but are not limited to, evaluation of pulmonary and systemic vasculature, evaluation of the tracheobronchial tree, and delineation of diffuse lung disease. Pulmonary nodule volume and growth can be more accurately predicted, and represents an improvement in the evaluation of the solitary pulmonary nodule. Multiplanar images increase our understanding of thoracic anatomy and can help to guide bronchoscopic procedures. Because there are strengths and weaknesses to all the reconstruction algorithms, the utility of any given technique is dependent on the clinical question to be answered. For instance, although maximum intensity projection imaging (MIP) is helpful in the evaluation of micronodular lung disease, it is of little value in the diagnosis of aortic dissection. As the ability to generate faster and more precise multidimensional images grow, the demand for such imaging is likely to increase. In this review, the authors discuss the various reconstruction techniques available, followed by a discussion of the clinical applications.
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Affiliation(s)
- J G Ravenel
- Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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