J Surg Case Rep 2017 Aug 21;2017(8):rjx158. Epub 2017 Aug 21.

Department of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA.

Thoracic outlet syndrome (TOS) was first introduced in literature by Peet et al. in 1956. Since then is has been studied extensively and subcategorized into at least four closely related syndrome. Read More

Ann Vasc Surg 2017 Sep 5. Epub 2017 Sep 5.

First Department of Surgery, Vascular Unit, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.

Background: Aneurysms of the subclavian artery are usually the result of trauma, atherosclerosis or thoracic outlet syndrome. Until the 90s, open surgical repair was considered the only therapeutic choice, exhibiting high complication rates. Since the first report of endovascular repair of subclavian aneurysms in 1991, promising results have been published. Read More

Intern Med 2017 Sep 6. Epub 2017 Sep 6.

Division of Cardiology, Toho University Ohashi Medical Center, Japan.

A 29-year-old woman who worked as a KAATSU (a type of body exercise that involves blood flow restriction) instructor visited our emergency room with a chief complaint of swelling and left upper limb pain. Chest computed tomography (CT) showed non-uniform contrast images corresponding to the site from the left axillary vein to the left subclavian vein; vascular ultrasonography of the upper limb revealed a thrombotic obstruction at the same site, leading to a diagnosis of Paget-Schroetter syndrome (PSS). We herein report our experience with a case of PSS derived from thoracic outlet syndrome (TOS), in a patient who was a KAATSU instructor. Read More

Case Rep Pulmonol 2017 6;2017:9350735. Epub 2017 Aug 6.

Thoracic Surgery Department, University College London Hospitals (UCLH), NHS Foundation Trust, London, UK.

Thoracic outlet syndrome (TOS) is a constellation of signs and symptoms caused by compression of the neurovascular structures in the thoracic outlet. TOS may be classified as either neurogenic TOS (NTOS) or vascular TOS: venous TOS (VTOS) or arterial TOS (ATOS), depending on the specific structure being affected. The basis for the surgical treatment of TOS is resection of the first rib, and it may be combined with scalenectomy or cervical rib resection. Read More

J Thorac Dis 2017 Jul;9(7):2022-2028

Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea.

Background: First rib resection is a surgical treatment for decompressing the neurovascular structures in thoracic outlet syndrome (TOS). Historically, extrathoracic approaches have used a posterior, supraclavicular, or transaxillary incision to remove the first rib. In this report, we demonstrate video-assisted thoracoscopic surgery for intrathoracic first rib resection (VATS-IFRR). Read More

Diagnostics (Basel) 2017 Jul 28;7(3). Epub 2017 Jul 28.

The Department of Surgery, University of Colorado Health Science Center, Aurora, Colorado and Presbyterian-St. Lukes Hospital, Denver, CO 80202, USA.

The diagnosis of brachial plexus compression-either neurogenic thoracic outlet syndrome (NTOS) or neurogenic pectoralis minor syndrome (NPMS)-is based on old fashioned history and physical examination. Tests, such as scalene muscle and pectoralis minor muscle blocks are employed to confirm a diagnosis suspected on clinical findings. Electrodiagnostic studies can confirm a diagnosis of nerve compression, but cannot establish it. Read More

Undersea Hyperb Med 2016 Nov-Dec;43(7):835-840

Division of Hyperbaric Medicine, Intermountain Medical Center, Murray, Utah and Intermountain LDS Hospital, Salt Lake City, Utah U.S.

Although Raynaud's phenomenon is a well-known consequence of exposure to cold, neither its incidence in recreational divers nor case reports in that population have been reported in the medical literature. We present a case report of the initial manifestation of primary Raynaud's phenomenon during a warm-water scuba dive. A healthy 18-year-old Caucasian male made four open-circuit compressed air scuba dives over two days in the Florida Keys to a maximum depth of 90 feet. Read More

Case Rep Vasc Med 2017 10;2017:8764903. Epub 2017 Jul 10.

Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA.

Paget-Schroetter syndrome is thrombosis of the axillary-subclavian vein that is associated with strenuous and repetitive activity of the upper extremities. Overuse of the arm coupled with external compression results in microtrauma in the intima of the subclavian vein, resulting in the activation of the coagulation cascade. Diagnosis is usually made by Doppler ultrasound and the treatment involves thrombolysis, while routine surgical decompression of the thoracic outlet is controversial. Read More

BMJ Case Rep 2017 Aug 2;2017. Epub 2017 Aug 2.

Vascular Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, Dumfries and Galloway, UK.

A young man presented with the severe right upper limb swelling following a heavy weight lifting that was thought to be caused by a biceps tendon rupture. However, subsequent investigations confirmed the diagnosis of Paget-Schroetter syndrome that was associated with an incidental pulmonary embolism. The patient underwent a successful thrombolysis followed by a surgical thoracic outlet decompression. Read More

J Vasc Surg 2017 Aug;66(2):533-544.e2

Department of Surgery, Center for Thoracic Outlet Syndrome and the Section of Vascular Surgery, Washington University School of Medicine in St. Louis, St. Louis, Mo. Electronic address:

Objective: Neurogenic thoracic outlet syndrome (NTOS) is caused by dynamic compression of the brachial plexus at the level of the supraclavicular scalene triangle or the subcoracoid (pectoralis minor) space, or both. The purpose of this study was to characterize relationships between 14 clinical diagnostic criteria (CDC) and seven pretreatment patient-reported outcomes measures (PROMs) in a prospective cohort of patients with NTOS.

Methods: There were 183 new patient referrals between July 1 and December 31, 2015, with 150 (82%) meeting an established set of predefined CDC for NTOS. Read More

Int Heart J 2017 Aug 13;58(4):637-640. Epub 2017 Jul 13.

Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences.

Paget-Schroetter syndrome (PSS) is thrombosis of the deep veins draining the upper extremity due to anatomic abnormalities of the thoracic outlet that cause subclavian compression and subsequent thrombosis, leading to thrombus formation in the subclavian vein. Vigorous arm activity in sports is a known risk factor. Here, we report a case of Paget-Schroetter syndrome in a 31-year-old male non-professional baseball pitcher. Read More

Diagnostics (Basel) 2017 Jul 4;7(3). Epub 2017 Jul 4.

Department of Anatomy, Midwestern University, Glendale, AZ 85308, USA.

Structural variations of the thoracic outlet create a unique risk for neurogenic thoracic outlet syndrome (nTOS) that is difficult to diagnose clinically. Common anatomical variations in brachial plexus (BP) branching were recently discovered in which portions of the proximal plexus pierce the anterior scalene. This results in possible impingement of BP nerves within the muscle belly and, therefore, predisposition for nTOS. Read More

J Plast Reconstr Aesthet Surg 2017 Oct 3;70(10):1433-1439. Epub 2017 Jun 3.

Department of Plastic and Reconstructive Surgery, Medical/Graduate School of Kagawa University, Kagawa, Japan.

Objective: The present study aims to elucidate the frequency of thoracic outlet syndrome after the Nuss procedure for pectus excavatum and the conditions in which thoracic outlet syndrome is likely to develop.

Methods: A retrospective study including 85 pectus excavatum patients (58 males and 27 females) was conducted. Thoracic outlet syndrome was defined as a condition in which the patient has numbness, lassitude, or pain of the upper limbs at rest or during motion of the upper limbs. Read More

Diagnostics (Basel) 2017 06 23;7(2). Epub 2017 Jun 23.

Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado Denver, Denver, CO 80045 USA.

Neurogenic thoracic outlet syndrome (nTOS) is characterized by arm and hand pain, paresthesias, and sometimes weakness resulting from compression of the brachial plexus within the thoracic outlet. While it is the most common subtype of TOS, nTOS can be difficult to diagnose. Furthermore, patient selection for surgical treatment can be challenging as symptoms may be vague and ambiguous, and diagnostic studies may be equivocal. Read More

Diagnostics (Basel) 2017 Jun 17;7(2). Epub 2017 Jun 17.

Division of Vascular and Endovascular Surgery, University of California Davis Health, 4860 Y Street, Suite 3400, Sacramento, CA 95817, USA.

The creation of any patient database requires substantial planning. In the case of thoracic outlet syndrome, which is a rare disease, the Society for Vascular Surgery has defined reporting standards to serve as an outline for the creation of a patient registry. Prior to undertaking this task, it is critical that designers understand the basics of registry planning and a priori establish plans for data collection and analysis. Read More

Eur Spine J 2017 Jun 17. Epub 2017 Jun 17.

, 11754 County Rd. 29, Roseneath, ON, K0K 2X0, Canada.

Purpose: Metal implants have been used to treat adolescent idiopathic scoliosis since the 1960s. Only recently, however, it has the issue of metal-bone breakdown secondary to metal corrosion in situ come to light, raising concerns of possible long-term complications from the resulting metallosis and inflammation of spinal tissues. We present a case of a patient with neurological deficit, pain, and disability with Harrington rod in place for over 30 years, to bring attention to the issue of bio-corrosion of metal implants and its effect on human tissue. Read More

J Surg Case Rep 2017 Jun 7;2017(6):rjx100. Epub 2017 Jun 7.

Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.

Neurogenic thoracic outlet syndrome (nTOS) resulting from an isolated first rib fracture is extremely infrequent. We report a case of performance limiting nTOS in a college athlete who was initially evaluated and treated for upper extremity ligamentous injury with only transient improvement. Subsequent noninvasive studies were consistent with TOS physiology and MRA showed a large hypertrophic callus on the first rib adjacent to the brachial plexus. Read More

Tech Hand Up Extrem Surg 2017 Sep;21(3):91-100

*Center for Orthopaedic Surgery, State Hospitals Aarau and Baden, Baden †School of Life Sciences, Institute for Medical and Analytical Technologies, University of Applied Sciences Northwestern Switzerland, Muttenz, Switzerland.

Midshaft clavicular fractures are often treated nonoperatively with good reported clinical outcome in a majority of patients. However, malunion with shortening of the affected clavicle is not uncommon. Shortening of the clavicle has been shown to affect shoulder strength and kinematics with alteration of scapular position. Read More

Diagnostics (Basel) 2017 Jun 10;7(2). Epub 2017 Jun 10.

Division of Vascular Surgery, Department of Surgery, Ronald Reagan Medical Center at the University of California, Los Angeles, CA 90095, USA.

Thoracic Outlet Syndrome (TOS) describes a set of disorders that arise from compression of the neurovascular structures that exit the thorax and enter the upper extremity. This can present as one of three subtypes: neurogenic, venous, or arterial. The objective of this section is to outline our current practice at a single, high-volume institution for venous and arterial TOS. Read More

Instr Course Lect 2017 Feb;66:103-113

Fellow, The Philadelphia Hand Center, Thomas Jefferson University, Philadelphia, Pennsylvania.

Thoracic outlet syndrome is a disorder caused by thoracic outlet compression of the brachial plexus and/or the subclavian vessels. The characteristics of thoracic outlet syndrome are highly variable. Objective tests, such as electrodiagnostic studies, are often unreliable in characterizing thoracic outlet syndrome. Read More

J Vasc Surg 2017 Sep 31;66(3):858-865. Epub 2017 May 31.

Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc. Electronic address:

Background: Thoracic outlet syndrome (TOS) and its management are relatively controversial topics. Most of the literature reporting the outcomes of surgical decompression for TOS derives from single-center experiences. The objective of our study was to describe the current state of TOS surgery among hospitals that participate in the American College of Surgeons National Surgical Quality Improvement Program database. Read More

Ann Vasc Surg 2017 Oct 30;44:423.e3-423.e5. Epub 2017 May 30.

Department of Vascular Surgery, Black Country Vascular Network, Dudley, UK. Electronic address:

Thoracic outlet syndrome (TOS) poses a difficult diagnostic entity with varied etiology and clinical presentation. We present a 35-year-old gentleman with unilateral long thoracic nerve palsy and contralateral subscapular paralysis caused by aberrant scalenus medius anatomy. TOS ought to be considered in patients presenting with isolated nerve palsies. Read More

Diagnostics (Basel) 2017 May 27;7(2). Epub 2017 May 27.

Department of Surgery, Johns Hopkins Heart and Vascular Institute, Johns Hopkins Medical Centers, Baltimore, MD 21287, USA.

Neurogenic thoracic outlet syndrome is a widely recognized, yet controversial, syndrome. The lack of specific objective diagnostic modalities makes diagnosis difficult. This is compounded by a lack of agreed upon definitive criteria to confirm diagnosis. Read More

Angiology 2017 Jul 14;68(6):502-507. Epub 2016 Nov 14.

1 Department of Vascular and Endovascular Surgery, Johns Hopkins Medical Institutes, Baltimore, MD, USA.

We evaluated the occurrence of thoracic outlet syndrome (TOS) and 30-day postoperative outcomes. Patients undergoing cervical/first rib resection surgery were identified in the American College of Surgeons National Surgical Quality Improvement Program database (2005-2013). Thoracic outlet syndrome types were then examined. Read More

Ann Thorac Surg 2017 Sep 17;104(3):907-916. Epub 2017 May 17.

Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California.

Background: Major aortopulmonary collateral arteries (MAPCAs) are frequently found in association with pulmonary atresia with ventricular septal defect (PA/VSD). However, some patients with MAPCAs do not have PA/VSD but have a variety of other "atypical" anatomic diagnoses.

Methods: This was a retrospective review of patients with MAPCAs and atypical anatomy. Read More

J Vet Med Sci 2017 Jun 18;79(6):1120-1124. Epub 2017 May 18.

Veterinary Teaching Hospital, School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione, 93/95, 62024 Matelica, MC, Italy.

A 4-year-old intact female, mixed breed dog was presented with a complaint of dyspnea. Clinical examination revealed symptoms related to disease of the upper airways. Radiographic findings were consistent with tracheal collapse associated with anomalies involving the seventh cervical vertebra and the first ribs bilaterally. Read More

Pediatr Radiol 2017 May 10. Epub 2017 May 10.

Division of Plastic Surgery, Department of Pediatric Surgery, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.

Thoracic outlet syndrome is caused by compression of the neurovascular bundle as it passes from the upper thorax to the axilla. The neurovascular bundle can be compressed by bony structures such as the first rib, cervical ribs or bone tubercles, or from soft-tissue abnormalities like a fibrous band, muscle hypertrophy or space-occupying lesion. Thoracic outlet syndrome commonly affects young adults but can be seen in the pediatric age group, especially in older children. Read More

Ann Vasc Surg 2017 Oct 4;44:241-244. Epub 2017 May 4.

Division of Vascular and Cardiothoracic Surgery, College of Medicine, University of South Florida, Tampa, FL.

Background: Thoracic outlet decompression (TOD) is associated with significant postoperative pain often leading to hospital length of stay out of proportion to the risk profile of the operation. We seek to describe the improvement in hospital length of stay and patient pain control with an improved multiagent pain management regimen.

Methods: We retrospectively reviewed the hospital length of stay, medication regimen/usage, operative details, and operative indications for all patients undergoing TOD from January 2012 through June 2015. Read More

R I Med J (2013) 2017 May 1;100(5):33-36. Epub 2017 May 1.

Department of Medicine, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI.

Upper extremity deep venous thrombosis (UEDVT) involves thrombosis of the deep veins of the arm as they enter the thorax. They are increasing in frequency, largely due to the rising use of central venous catheters and implantable cardiac devices, and represent more than 10% of all DVT cases, Upper extremity deep venous thrombosis has been historically misunderstood when compared to lower extremity deep vein thrombosis (LEDVT). Their associated disease states may carry devastating complications, with mortality rates often higher than that of LEDVT. Read More

Arthroscopy 2017 Aug 17;33(8):1449-1457. Epub 2017 Apr 17.

Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France.

Purpose: To describe an all-endoscopic technique for infra- and supraclavicular brachial plexus (BP) neurolysis and to assess its functional outcomes for patients suffering from nonspecific neurogenic thoracic outlet syndrome (NTOS).

Methods: Between January 2010 and January 2013, 36 patients presenting an idiopathic nonspecific NTOS benefited from an endoscopic decompression in our institution. The inclusion criteria were a typical clinical NTOS and failure of a 6-month well-conducted nonsurgical treatment. Read More

J Magn Reson Imaging 2017 Jun 19;45(6):1559-1572. Epub 2017 Apr 19.

Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

Over the past two decades there have been significant advances in the use of magnetic resonance imaging (MRI) to assess the vascular system. New imaging sequences and improvements in magnet design have enabled the creation of higher spatial resolution images. MRI is now a viable alternative imaging modality when compared to both invasive angiography and computed tomographic angiography. Read More

Zentralbl Chir 2017 Feb 16;142(1):104-112. Epub 2017 Mar 16.

Klinik für Thorax-, Gefäß- und endovaskuläre Chirurgie, Klinikum Chemnitz gGmbH, Deutschland.

Introduction Thoracic outlet syndrome (TOS) is one of the most extensively discussed diagnoses. There is neither a clear and homogenous clinical presentation nor an accepted definition. The term describes a complex of symptoms and complaints caused by the compression of nerves and vascular structures at one of the three defined constrictions of the upper thoracic aperture. Read More

Ann Vasc Surg 2017 Jul 1;42:306.e1-306.e4. Epub 2017 Mar 1.

Division of Vascular Surgery, Mayo Clinic Rochester, Rochester, MN.

Venous thoracic outlet syndrome (vTOS) usually results from compression of the subclavian vein classically as a result of narrowing of the costoclavicular space. We report 2 rare cases of soft tissue neoplasms resulting in apparent vTOS. The first case is a 46-year-old female with a 2-year history of intermittent unilateral shoulder pain, who was initially diagnosed with intervertebral disk herniation. Read More

CMAJ 2017 Feb;189(8):E323

Neurologist, University of Alberta, Edmonton, Alta.

Neurosurg Focus 2017 Mar;42(3):E7

Department of Neurosurgery, Louisiana State University, New Orleans, Louisiana.

The traditional posterior subscapular approach offers excellent exposure of the lower brachial plexus and has been successfully used in patients with recurrent thoracic outlet syndrome after an anterior operation, brachial plexus tumors involving the proximal roots, and postirradiation brachial plexopathy, among others. However, this approach also carries some morbidity, mostly related to the extensive muscle dissection of the trapezius, rhomboids, and levator scapulae. In this article, the authors present the surgical technique and video illustration of a modified, less invasive posterior subscapular approach, using a small, self-retaining retractor and only a partial trapezius and rhomboid minor muscle dissection. Read More

J Thorac Dis 2017 Jan;9(1):19-21

Department of Thoracic Surgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.

J Vasc Surg 2017 May 8;65(5):1429-1439. Epub 2017 Feb 8.

Center for Thoracic Outlet Syndrome and the Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Mo. Electronic address:

Objective: Arterial thoracic outlet syndrome (TOS) is a rare condition characterized by subclavian artery pathology associated with a bony abnormality. This study assessed contemporary clinical management of arterial TOS at a high-volume referral center.

Methods: A prospectively maintained database was used to conduct a retrospective review of patients undergoing primary or reoperative treatment for arterial TOS during an 8-year period (2008 to 2016). Read More

Ann Plast Surg 2017 May;78(5):533-536

From the Department of Hand Surgery, The First Hospital of Ji Lin University, Chang Chun, 130021, China.

Objective: There are significant differences in the results on disputed thoracic outlet syndrome (TOS) surgery, which reflect that not all patients with disputed TOS are amenable to surgery. It is necessary to find out appropriate indicators for screening of patients who are suitable for surgery. Pain and paresthesia are 2 prominent symptoms of disputed TOS. Read More

Korean J Thorac Cardiovasc Surg 2017 Feb 5;50(1):36-40. Epub 2017 Feb 5.

Department of General Surgery, Emam Hosein Hospital, Shahid Beheshti University of Medical Sciences.

Background: Surgical treatment of thoracic outlet syndrome (TOS) is necessary when non-surgical treatments fail. Complications of surgical procedures vary from short-term post-surgical pain to permanent disability. The outcome of TOS surgery is affected by the visibility during the operation. Read More

J Thorac Dis 2016 Dec;8(12):E1739-E1740

Department of Orthopaedic Surgery, Guy's & St Thomas' Hospital, London, UK.

Int Med Case Rep J 2017 13;10:19-23. Epub 2017 Jan 13.

Center for Life Nano Science, CLNS@Sapienza, Istituto Italiano di Tecnologia, Rome, Italy.

This study deals with an osteopathic approach used for a patient with left-ventricular assist device (L-VAD) affected by left brachialgia. Clinical examination revealed the presence of thoracic outlet syndrome and pectoralis minor syndrome, with compression of the left proximal ulnar nerve, related to the surgical sternotomy performed. The osteopathic techniques used can be classified as indirect and direct, addressed to the pectoralis minor and the first left rib, respectively. Read More

Int J Surg Case Rep 2017 17;31:139-141. Epub 2017 Jan 17.

Dept. of General Surgery, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pondicherry, India. Electronic address:

Introduction: Neurogenic thoracic outlet syndrome (nTOS) is the most common manifestation of thoracic outlet syndrome (TOS), accounting for more than 95% of cases. It is usually caused by cervical ribs, anomalies in the scalene muscle anatomy or post-traumatic inflammatory changes causing compression of the brachial plexus.

Case Presentation: We present an unusual case of nTOS caused by a cystic lymphangioma at the thoracic outlet, with only one case reported previously in the literature. Read More

Cardiovasc Diagn Ther 2016 Dec;6(6):519-532

Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.

Venous compression syndromes are a unique group of disorders characterized by anatomical extrinsic venous compression, typically in young and otherwise healthy individuals. While uncommon, they may cause serious complications including pain, swelling, deep venous thrombosis (DVT), pulmonary embolism, and post-thrombotic syndrome. The major disease entities are May-Thurner syndrome (MTS), variant iliac vein compression syndrome (IVCS), venous thoracic outlet syndrome (VTOS)/Paget-Schroetter syndrome, nutcracker syndrome (NCS), and popliteal venous compression (PVC). Read More

J Pain Res 2017 4;10:79-88. Epub 2017 Jan 4.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

Delineation of architecture of peripheral nerves can be successfully achieved by high-resolution ultrasound (US), which is essential for US-guided pain management. There are numerous musculoskeletal pain syndromes involving the trunk nerves necessitating US for evaluation and guided interventions. The most common peripheral nerve disorders at the trunk region include thoracic outlet syndrome (brachial plexus), scapular winging (long thoracic nerve), interscapular pain (dorsal scapular nerve), and lumbar facet joint syndrome (medial branches of spinal nerves). Read More

J Brachial Plex Peripher Nerve Inj 2016 10;11(1):e21-e28. Epub 2016 May 10.

Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania, United States.

Rationale Knowledge of the relationship of the dorsal scapular artery (DSA) with the brachial plexus is limited. Objective We report a case of a variant DSA path, and revisit DSA origins and under-investigated relationship with the plexus in cadavers. Methods The DSA was examined in a male patient and 106 cadavers. Read More

J Thorac Dis 2016 Nov;8(11):3046-3048

Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.

BMJ Case Rep 2016 Oct 8;2016. Epub 2016 Oct 8.

Department of Radiology, Eastbourne District General Hospital, Eastbourne, UK.

An interesting and rare case where a longstanding multinodular goitre causes sudden onset symptoms of superior vena cava obstruction. The symptoms were caused by bilateral brachiocephalic vein compression against the first rib. The patient's symptoms included upper limb and facial swelling, whereas her lower limbs were not oedematous (figure 1). Read More

Thorac Cardiovasc Surg Rep 2016 Dec 16;5(1):74-76. Epub 2015 Dec 16.

Department of Cardiothoracic Surgery, New York Presbyterian Hospital, New York, New York, United States.

Aneurysmal bone cyst is a rare benign cystic bone lesion with an incidence of only 0.14 per 100,000 individuals and most commonly affects the metaphyses of long bones, spine, and pelvis. We present a very rare case of a 17-year-old boy with a rapidly expanding aneurysmal bone cyst arising from the first rib, resulting in neurogenic thoracic outlet syndrome secondary to its compression of the brachial plexus. Read More

Muscle Nerve 2017 Oct 21;56(4):663-673. Epub 2017 Mar 21.

Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

The thoracic outlet syndromes (TOSs) are a group of etiologically and clinically distinct disorders with 1 feature in common: compression of 1 or more neurovascular elements as they traverse the thoracic outlet. The medical literature reflects 5 TOSs: arterial; venous; traumatic neurovascular; true neurogenic; and disputed. Of these, the first 4 demonstrate all of the features expected of a syndrome, whereas disputed TOS does not, causing many experts to doubt its existence altogether. Read More

Muscle Nerve 2017 Jun 21;55(6):782-793. Epub 2017 Mar 21.

Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

The thoracic outlet syndromes (TOSs) are a group of etiologically and clinically distinct disorders with 1 feature in common: compression of 1 or more neurovascular elements as they traverse the thoracic outlet. The medical literature reflects 5 TOSs: arterial; venous; traumatic neurovascular; true neurogenic; and disputed. Of these, the first 4 demonstrate all of the features expected of a syndrome, whereas disputed TOS does not, causing many experts to doubt its existence altogether. Read More