Infraclavicular subpectoral lipoma causing thoracic outlet syndrome

Elia, Stefano; Cerioli, Alessandra; Fiaschetti, Valeria; Granai, Alessandra Vittoria

doi:10.1016/j.ijscr.2015.02.047

Cited by 12 publications

(10 citation statements)

References 13 publications

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“…For example, Zampieri et al have reported an unusual cause of compression on SCV by a cystic mass originated from thoracic duct, and resection of the mass completely decompressed the vein [19]. VTOS caused by the compression of subpectoral lipoma has also been documented, which was completely relieved by resection of the lipoma [4]. Therefore, excision of the anomaly compressing the vein is superior to the traditional procedure involving the first-rib resection in that it not only improves treatment outcome, but also reduces the surgical complications related with the traditional procedure, including pneumothorax, brachial plexus injury and vascular injury, etc.…”

Section: Discussionmentioning

confidence: 99%

Costoclavicular ligament as a novel cause of venous thoracic outlet syndrome: from anatomic study to clinical application

Liu

et al. 2020

Surg Radiol Anat

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Purpose Venous thoracic outlet syndrome (VTOS) is a compressive disorder of subclavian vein (SCV); we aimed to investigate the role of costoclavicular ligament (CCL) in the pathogenesis of VTOS. Methods A cadaver study was carried out to investigate the presence and morphology of CCL in thoracic outlet regions, as well as its relationship with the SCV. Six formalin-fixed adult cadavers were included, generating 12 dissections of costoclavicular regions (two sides per cadaver). Once CCL was identified, observation and measurement were made of its morphology and dimensions, and its relationship with SCV was studied. To take a step further, a clinical VTOS case was reported to prove the anatomical findings. Results Two out of twelve costoclavicular regions (2/12, 16.7%) were found to possess CCLs. Both ligaments were located in the left side of two male cadavers and were closely attached to the lateral aspect of sternoclavicular joint capsules. The lateral fibers of the ligament proceed in a superolateral-to-inferomedial manner, while the medial fibers proceed more vertically. Both ligaments were tightly adherent to the SCV, causing significant compression on the vein. In the clinical case, multiple bunches of CCLs were found to compress the SCV tightly intraoperatively. After removing the ligaments, the patient's symptom kept relief during a follow-up period of 2 years. Conclusion Our study demonstrated that CCL could be a novel cause of VTOS by severe compression of SCV. Patients diagnosed with this etiology could get less invasive surgical treatment by simply removing the ligament.

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Section: Discussionmentioning

confidence: 99%

Costoclavicular ligament as a novel cause of venous thoracic outlet syndrome: from anatomic study to clinical application

Liu

et al. 2020

Surg Radiol Anat

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“…It is caused by structural abnormalities such as clavicular deformity, cervical rib, anomalous fibromuscular band, or hypertrophic change of scalene musculature, or by occupational or repetitive strain injury 146). However, some cases of TOS have been reported to be caused by tumors around the thoracic outlet 235). TOS can be divided into neurogenic, arterial, and venous TOS depending on the structure entrapped, and can occur in combination.…”

Section: Discussionmentioning

confidence: 99%

“…This space is relatively wide and less structurally abnormal than other sites, and incidence of TOS is low 47). Most cases of TOS due to a mass have been reported in this space 235). Demondion et al1) reported that the costoclavicular space and pectoralis minor space were narrowed by a symptom provoking test, but not the scalene triangle.…”

Section: Discussionmentioning

confidence: 99%

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Thoracic Outlet Syndrome Induced by Huge Lipoma: A Case Report

Sul

Lim

Kang

et al. 2019

Korean J Neurotrauma

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Thoracic outlet syndrome is a relatively well known disease. Other than trauma, this disease is mostly caused by anatomical structures that cause vascular or neural compression. The cause of thoracic outlet syndrome is diverse; however, there are only few reports of thoracic outlet syndrome caused by lipoma in the pectoralis minor space. We report a case of compression of the lower trunk of brachial plexus in which a large lipoma that developed in the pectoral minor space grew into the subclavicular space, along with a review of literature.

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“…Those atypical lipomas can resemble non-neoplastic abnormal fat distribution conditions. Lipomas are usually asymptomatic, though local pain, tenderness, or nerve compression is reported when they become large [65]. Abnormal nonneoplastic fat distribution conditions usually show no such symptoms though mechanical obstruction or metabolic dysfunction may also be present.…”

Section: Adipose Tumors As Differential Diagnosesmentioning

confidence: 99%

Imaging spectrum of abnormal subcutaneous and visceral fat distribution

et al. 2020

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Adipose tissue plays multiple and complex roles not only in mechanical cushioning and energy storage but also as an important secretory organ that regulates energy balance and homeostasis multilaterally. Fat tissue is categorized into subcutaneous fat tissue (SCAT) or visceral fat tissue (VSA) depending on its distribution, with the two having different metabolic functions. Near-total lack of fat in congenital/acquired generalized lipodystrophy, cachexia, or any other severe malnutrition condition induces severe multi-organ dysfunction due to lack of production of leptin and other adipokines. Increased visceral fat tissue secondary to obesity, hypercortisolism, or multiple symmetric lipomatosis raises the risk of insulin resistance, cardiac complications, and airway or spinal canal stenosis, although the fat distribution pattern differs in each condition. Partial abnormal fat distribution conditions such as HIV/HAART therapy-associated lipodystrophy, familial partial lipodystrophies, and acquired partial lipodystrophy frequently show a mixture of lipoatrophy and lipohypertrophy with metabolic dysfunction. Characteristic imaging features in conditions with local abnormal fat distribution can provide information about a patient's co-existent/unrecognized disease(s), past medical history, or lifestyle. Knowledge of characteristic abnormal fat distribution patterns can contribute to proper and timely therapeutic decision-making and patient education.

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Infraclavicular subpectoral lipoma causing thoracic outlet syndrome

Cited by 12 publications

References 13 publications

Costoclavicular ligament as a novel cause of venous thoracic outlet syndrome: from anatomic study to clinical application

Costoclavicular ligament as a novel cause of venous thoracic outlet syndrome: from anatomic study to clinical application

Thoracic Outlet Syndrome Induced by Huge Lipoma: A Case Report

Imaging spectrum of abnormal subcutaneous and visceral fat distribution

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