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Surgery to Relieve Thoracic Outlet Syndrome Complaints Should Have Preoperative Imaging:MRI/MRA/MRV
Author(s) -
Collins James Douglas,
Saxton Ernestina Howell,
Gelabert Hugh Anthony,
Carnes Alfred
Publication year - 2016
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.30.1_supplement.780.4
Subject(s) - medicine , thoracic outlet syndrome , brachial plexus , magnetic resonance imaging , radiology , thoracic outlet , subclavian artery , neurovascular bundle , subclavian vein , pectoralis major muscle , anatomy , catheter
Thoracic Outlet Syndrome (TOS) patients are normally managed conservatively with physical therapy (PT) and may undergo scalenectomy and first rib resection without imaging. Bilateral multiplanar magnetic resonance imaging and 2D time of flight magnetic resonance angiography and venography (MRA/MRV) of the brachial plexus display costoclavicular compression of the draining veins within the neck, supraclavicular fossae, and neurovascular bundles as the diagnostic cause of thoracic outlet syndrome. METHODS Bilateral MRI/MRA/MRV displays sites of obstruction of the draining veins of the neck and the subclavian and axillary arteries with binding nerve roots. Monitored multiplanar images are acquired on a 1.5 Tesla GE Signa LX unit, 44 cm field of view, 512 × 256 matrix with saline water bags to enhance signal to noise ratio. SUMMARY The case selected for this presentation was diagnosed with left TOS and left pectoralis minor syndrome. Her surgeon convinced her that there was no need for imaging. However, she developed postoperative complaints and sought evaluation by a neurologist. Thereafter, bilateral imaging of the brachial plexus was requested displaying the surgical alteration of landmark anatomy, costoclavicular compression of binding nerves to the subclavian and axillary arteries, obstruction to venous drainage, scarring and fibrosis from the resected lymphatics marginating veins within the pectoralis minor muscle adhering the pectoralis major muscle to the anterior chest wall. CONCLUSION Nerves, arteries, veins and lymphatics are within the fascial planes marginating muscles. Health professionals should be aware that resection of the pectoralis minor muscle tendon (tenotomy) at the coracoid process disrupts lymph drainage precipitating fibrosis and scarring of those structures within. Baseline plain radiographs and MRI of the brachial plexus should be obtained prior to all surgical intervention.