Thoracic outlet syndrome

Case contributed by Dr Amro Omar

Presentation

Upper limb ischemia , numbness on abduction

Patient Data

Age: 25
Gender: Female
CT

The study was performed with the arm down by the patient’s side and repeated with it raised above the patient’s head. There is a string-like narrowing of the right subclavian artery ( arrows ) due to the right cervical rib when arm is raised.

Compare the artery calibre with arm aside ( yellow arrow ) to it with arm raised (red arrow )

Case Discussion

Thoracic outlet syndrome is the term refers to compression of the neurovascular bundle at the thoracic inlet (the term ‘thoracic outlet syndrome’ is a misnomer). The syndrome can be classified into three subgroups: venous, arterial and nervous.

It is treated by resection of the cervical rib or fibrous band that is causing the problem. Thrombolysis could be considered in acute thrombosis.

Key points  :  Thoracic outlet syndrome occurs at one of three sites: (a) the interscalene space (just above the medial first anterior rib); (b) the costoclavicular triangle; (c) the subcoracoid space.

A Pancoast tumour can result in similar symptoms and should be excluded.

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Case information

rID: 26370
Case created: 17th Dec 2013
Last edited: 22nd Jun 2017
Inclusion in quiz mode: Included

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