Positional compression of the left axillary artery by the pectoralis minor muscle

Case contributed by Dr Chris O'Donnell

Presentation

Investigation of uneven upper limb blood pressure measurements, ? subclavian stenosis

Patient Data

Age: 80
Gender: Female
CT

Initial CT angio with the arms abducted, then repeated with the arms down (right brachial vein injection)

Extrinsic compression to the left axillary artery (and vein) by the pectoralis minor muscle with the arms abducted, corrected by adducting the arms. No residual arterial luminal narrowing or intrinsic stenosis.

Case Discussion

Arterial thoracic outlet syndrome (TOS) is a rare condition most frequently observed in relatively young, active, and otherwise healthy individuals. The most typical form involves compression of the subclavian artery within the scalene triangle at the level of the first rib. This usually occurs in conjunction with a congenital cervical rib or first rib anomaly. Similar clinical findings can develop from lesions in the distal axillary artery or its immediate branches, also caused by extrinsic compression, thereby representing a variant of arterial TOS. Compressive lesions of the axillary artery are rare but have been reported in overhead athletes such as baseball pitchers and volleyball players, and seems to be related to the pectoralis minor muscle as in this case.

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Case information

rID: 35383
Case created: 4th Apr 2015
Last edited: 15th Feb 2016
System: Vascular
Inclusion in quiz mode: Included

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