Imaging of the Patient with Thoracic Outlet Syndrome

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.

Advanced imaging in acute and chronic deep vein thrombosis

“…Like CT, imaging is performed with the arm in adducted and abducted (external rotation). Catheter angiography still is useful in initial management in patients with acute symptoms or known thrombosis and also in postoperative patients to evaluate for residual/recurrent thrombosis (91). The advantages and disadvantages of the various modalities used for imaging DVT have been summarized (Table 1).…”

Arterial Thoracic Outlet Syndrome – A Rare Entity

“…Neurogenic type of TOS is commonest (more than 90%) while arterial type is rarest (1-3%) with former presenting with pain, paresthesia & numbness of upper limb [2]. Venous type is commonly associated with thrombosis of subclavian vein presenting with pain & swelling of upper limb while arterial type is characterised by signs of ischemia like coolness, pallor, claudication, paresthesia and reduced upper limb pulses.…”

“…Imaging in adducted & abducted position of arm (latter above the level of head) using CDI, CT, magnetic resonance imaging (MRI) or angiography can be variably useful depending upon the clinical setting [1][2][3][4][5]. CDI is primarily useful in venous & arterial type of TOS and has the advantage of being dynamic, less time-consuming, noninvasive & radiation-free.…”

Thoracic outlet syndrome: clinical and diagnostic features

“…В России рутинная МР-визуализация нервных стволов в целях диагности-ки и дифференциальной диагностики по-прежнему используется недостаточно. Однако правильная поста-новка задачи и методически адекватно проведенное МР-исследование могут значительно помочь клини-цисту, особенно при отсутствии электрофизиологиче-ских изменений [23,46,47]. Информативность МРТ в диагностике TOS возрастает при ее выполнении с позиционными пробами и провокационными теста-ми [47][48][49].…”

“…Сегодня активно обсужда-ется диагностическая значимость метода в исследова-нии нервных стволов, в том числе при нейрогенном TOS [22,46,47,51,52]. УЗИ плечевого сплетения с провокационными маневрами, которое показало свою эффективность в подтверждении нейрогенного TOS, подробно описано в работе S. M. Fried и соавт.…”