Pediatric Thoracic Outlet Syndrome

  • Etiology: Compression of brachial plexus or subclavian vessels as they pass through superior thoracic aperture
  • Imaging: Performed with arms in raised (abducted) and neutral (adducted) positions
  • Imaging Neurogenic thoracic outlet syndrome:
    — Bone and soft tissue abnormalities
    — Loss of fat around brachial plexus with abduction
    — Edema in brachial plexus
  • Imaging Venous thoracic outlet syndrome:
    — Bone and soft tissue abnormalities
    — Axillosubclavian vein narrowing with abduction
    — Enlarged collaterals
    — Axillosubclavian vein thrombosis
  • Imaging Arterial thoracic outlet syndrome:
    — Bone and soft tissue abnormalities
    — Axillosubclavian artery narrowing with abduction
    — Enlarged collaterals
    — Axillosubclavian artery aneurysm or pseudoaneurysm
    — Axillosubclavian artery thrombosis
  • DDX:
  • Complications: Thrombosis of subclavian artery and vein
  • Treatment: Surgical
  • Clinical:
    — Neurogenic thoracic outlet syndrome: Presents with pain, paresthesia, numbness of upper extremity due to brachial plexus compression
    — Venous thoracic outlet syndrome: Upper limb swelling and pain due to subclavian vein compression
    — Arterial thoracic outlet syndrome: Upper limb ischemia with coolness, pallor, paresthesias, decreased pulses due to subclavian artery compression

Radiology Cases of Thoracic Outlet Syndrome

Radiology Cases of Thoracic Outlet Syndrome Due to Cervical Rib

CXR of cervical rib
CXR AP shows a large right cervical rib at C7.

Radiology Cases of Arterial Thoracic Outlet Syndrome

MRA of arterial thoracic outlet syndrome
MRA with contrast of the chest performed via a right forearm injection with the arms in a neutral (adducted) position (above) shows a normal appearance to the subclavian arteries. MRA was then performed with the arms in a raised (abducted) position (below) which shows development of a moderate stenosis in the proximal left subclavian artery.