engleski

Bilateral arterial thoracic outlet syndrome in 20- year-old woman.

Introduction/Objectives: Thoracic Outlet Syndrome (TOS) is a complex of symptoms which arise due to compression and/or irritation of the brachial plexus, subclavian artery or subclavian vein. This occurs at the site of their exit from the thorax between the clavicle and the first rib. According to Blanchard et al. (1992), TOS can be classified into following etiological types: neurogenic, arterial, venous, posttraumatic and scalenus anticus syndrome. Neurogenic TOS is the most frequent type that accounts for about 95% of TOS cases. Arterial type is proposed origin in 1% of all TOS patients. Venous type makes up for remaining 4%. Bilateral TOS is less common than unilateral TOS. We report here a case of unilateral arterial TOS with contralateral subclinical arterial TOS. Case report: A 20-year-old female patient presented to our outpatient clinic with history of intermittent intense right hand pain, along with edema, cyanosis and weakness of the hand. She also reported occurrences of severe headache and nausea. Physical exam findings included tense and painful muscles on the right side of the neck, limited range of right arm movements accompanied with pain and hyperesthesia of her whole right arm. Arterial pulsations were normal with hands relaxed and adducted. Roos test was positive on the right and marginally positive on the left. Adson's test revealed reduced arterial pulsations on both sides. Laboratory values, X-ray of the cervical spine and thorax, CT and MR of the brain, electromyoneurography and carotid ultrasound were normal. Color Doppler flow imaging of the right arm arteries was normal with arm adducted, but showed reduced amplitude and biphasic specter in abducted and elevated arm. The diagnosis of TOS was finally confirmed when DSA of both subclavian arteries was performed in adducted and abducted arm position. Finding was normal with arms adducted to the body. However, when arms were elevated and rotated inwards, a compression of subclavian artery was observed bilaterally at the site of their contact with upper edge of clavicle bones. Patient was referred to physical therapy and analgesics were prescribed. A surgical treatment is scheduled. Conclusions: Diagnosis of TOS is difficult due to absence of single gold standard test which would encompass all etiological types. Crucial diagnostic procedure for establishing the correct diagnosis in case of patient described here was digital subtraction angiography. Making the correct diagnosis is necessary for choosing the optimal therapeutic approach.

Thoracic outlet syndrome ; case report

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