Thoracic Outlet Syndrome

Findings:
3D TOF MRA of the aortic arch great vessels shows abrupt termination of flow signal in the bilateral subclavian arteries with arm abduction.

Discussion:
Thoracic outlet syndrome is caused by rib anomalies or musculofibrous bands between the clavicle, cervical spine, and first rib. Alternatively, this may be an acquired condition due to malunited clavicle fracture or body habitus (thin or muscular). An anomalous anterior scalene muscle is the most common cause. Any condition which narrows the costoclavicular space may cause the symptom complex. These patients experience ischemic symptoms in the arms with abduction, associated with loss of the radial pulse and possibly a subclavian bruit. Complications include poststenotic aneurysm, subclavian artery thrombosis, mural thrombus with distal embolization, or venous thrombosis. Surgery can be curative.

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