Computed Tomography Angiography to Evaluate Thoracic Outlet Neurovascular Compression

Abstract

The objective was to evaluate the efficacy of computed tomography angiography with upper extremity hyperabduction to diagnose thoracic outlet syndrome. Over 5 years, 21 patients were treated surgically for neurogenic symptoms of thoracic outlet syndrome. For patients whose diagnosis was unclear after history and physical examination, adjunctive tests (duplex, magnetic resonance angiography, or computed tomography angiography) were performed to help establish the diagnosis. Five of the 6 computed tomography angiograms were positive. The sixth computed tomography was deemed to be an incomplete study. With mean follow-up of 9.4 months, 95% (n = 19) of patients with a positive hyperabduction test on physical examination were free of symptoms postoperatively. All patients with a positive computed tomography angiogram, with their neurovascular compression localized to the thoracic outlet, had successful operative decompression. Computed tomography angiogram with abduction of the arm can be used as an adjunct to confirm the diagnosis of neurovascular compression and then predict successful operative decompression.

Keywords

thoracic outlet syndrome computed tomography angiography

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References

Roos DB Congenital anomalies associated with thoracic outlet syndrome: anatomy, symptoms, diagnosis, and treatment. Am J Surg. 1976;132:771-778.

Axelrod DA , Proctor MC , Geisser ME , Roth RS , Greenfield LJ Outcomes after surgery for thoracic outlet syndrome. J Vasc Surg. 2001;33:1220-1225.

Sanders RJ , Pearce WH The treatment of thoracic outlet syndrome: a comparison of different operations . J Vasc Surg. 1989;10:626-634.

Machleder HI Thoracic outlet disorders: thoracic outlet compression and axillary vein thrombosis . In: Hobson RW , Wilson SE , Veith FJ , eds. Vascular Surgery: Principles and Practice. 3rd ed, revised and expanded. New York, NY: Marcel Dekker; 2003 :889-902.

Bilbey JH , Muller NL , Connell DG , Luoma AA , Nelems B. Thoracic outlet syndrome: evaluation with CT. Radiology. 1989;171:381-384.

Panegyres PK , Moore N. , Gibson R. , Rushworth G. , Donaghy M. Thoracic outlet syndromes and magnetic resonance imaging. Brain. 1993;116:823-841.

Dymarkowski S. , Bosmans H. , Marchal G. , Bogaert J. Three-dimensional MR angiography in the evaluation of thoracic outlet syndrome. Am J Roentgenol. 1999;173: 1005-1008.

Yanaka K. , Asakawa H. , Matsumaru Y. , Kujiraoka Y. , Nose T. Diagnosis of vascular compression at the thoracic outlet using magnetic resonance angiography. Eur Neurol. 2004;51:122-123.

Brantigan CO , Johnston RJ , Roos DB Appendix: use of multidetector CT and three-dimensional reconstructions in thoracic outlet syndrome: a preliminary report. Hand Clin. 2004;20:123-126.

10.

Matsumura JS , Rilling WS , Pearce WH , Nemcek AA , Vogelzang RL , Yao Jst. Helical computed tomography of the normal thoracic outlet. J Vasc Surg. 1997;26: 776-783.