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Radiation fibrosis triggers complaints of thoracic outlet syndrome (TOS): MRI/MRA/MRV
Author(s) -
Collins James D.,
Saxton Ernestina H,
Jones Jennifer,
Miller Theodore Q,
Ahn Samuel S.,
Carnes Alfred
Publication year - 2006
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.20.4.a450-b
Subject(s) - medicine , radiology , fibrosis , magnetic resonance imaging , radiography , pathology
Fibrosis and scarring are displayed as intermediate gray signal intensity on MRI obscuring details of landmark anatomy of the chest wall and thorax. Radiation with as little as 1000 rads causes radiation pneumonitis in one week, which progresses to fibrosis and scarring in the area of the radiation port. Patients with a history of radiation for breast cancer and lymphoma display linear fibrosis on chest radiographs. The T1‐weighted images on MRI display hazy gray signal intensities obscuring landmark anatomy. The 2D MRA/MRV displays the disruption of the fascial planes and the vascular supply, including the nutrient blood vessels, and confirmed at surgery. These patients present with pain and paresthesias of the upper extremity; headache with or without visual changes; tinnitus; facial, back and leg pain; muscle spasms, and tremors; intrinsic hand muscle weakness, and syncope. Abduction external rotation of the upper extremity enhances the costoclavicular compression of the draining veins of the neck, supraclavicular fossae, lymphatics and neurovascular bundles and triggers these complaints, which correlate with the chest radiographs and the MRI. Bilateral MRI, MRA and MRV display neurovascular compression in these TOS patients without the use of contrast material. Bilateral multiplanar imaging was conducted on a 1.5 Tesla GE Signa LX ( Clin. Anat. 1995; 8 :–16), with the field of view modified to include the dural sinuses. Patients for this presentation were selected from over 40 patients with radiation fibrosis. Edema occurs early and metasplastic changes of the tissue ensue. Fibrosis and scarring are the result.