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Role of the Noninvasive Vascular Laboratory in Thoracic Outlet Syndrome

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Noninvasive Vascular Diagnosis

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Abstract

The thoracic outlet extends from above the first rib to the clavicle and allows for passage of the subclavian artery, vein, and brachial plexus from the neck and chest into the upper extremity. Thoracic outlet syndrome (TOS) is a constellation of symptoms caused by abnormalities anywhere along this pathway resulting in impinged blood flow, impaired neurologic transmission, or combination of both. Depending on which structure is compressed, TOS is separated into two categories: neurogenic or vascular. Vascular TOS is further subdivided into venous or arterial. In the non-acute stage, the majority of vascular TOS patients present clinically with the same vague symptoms as the neurogenic TOS group, making diagnosis and subsequent treatment challenging. With improvements in ultrasound equipment, there is considerable emphasis placed on the utility of duplex imaging in the upper extremity. A TOS duplex ultrasound protocol and diagnostic interpretation, with a focus on the anatomic relationship of the upper extremity vessels, normal and abnormal color filling, and velocities with and without provocative maneuvers, is described within this chapter. The role of the noninvasive vascular examination in the diagnosis, treatment, and follow-up of the TOS patient can aid in providing a diagnosis for this complex disease process.

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Author information

Authors and Affiliations

  1. UC Davis Medical Center, Vascular Surgery, 4860 Y St., Ste 3400, Sacramento, CA, 95817, USA

    Blake A. Hamby MD, Edward L. Ronningen BS, RVT & Misty Dawn Humphries MD

  2. Human Health Sciences, UC Davis, 4610 X Street Suite 3101, Sacramento, CA, 95817, USA

    Julie Ann Freischlag MD

  3. School of Medicine, UC Davis, 4610 X Street Suite 3101, Sacramento, CA, 95817, USA

    Julie Ann Freischlag MD

Authors
  1. Blake A. Hamby MD
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  2. Edward L. Ronningen BS, RVT
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  3. Misty Dawn Humphries MD
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  4. Julie Ann Freischlag MD
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Corresponding author

Correspondence to Julie Ann Freischlag MD .

Editor information

Editors and Affiliations

  1. Charleston, West Virginia, USA

    Ali F. AbuRahma

Review Questions

Review Questions

  1. 1.

    Compression of structures at the thoracic outlet may be caused by each of the following, except:

    1. a.

      Presence of a cervical rib

    2. b.

      Presence of abnormal fibrous bands

    3. c.

      Hypertrophy of the scalene muscle

    4. d.

      Hypertrophy of the pectoralis minor muscle

  2. 2.

    Compression of structures at the thoracic outlet may cause each of the following, except:

    1. a.

      Subclavian vein thrombosis

    2. b.

      Subclavian artery aneurysm

    3. c.

      Subclavian artery thrombosis

    4. d.

      Elevated hemidiaphragm (phrenic nerve compression)

  3. 3.

    Venous TOS may present with each of the following, except:

    1. a.

      Claudication

    2. b.

      Pain

    3. c.

      Cyanosis

    4. d.

      Swelling

  4. 4.

    True or false: A complete duplex evaluation for venous TOS should include views with the arm in neutral position as well as abduction to 90° and 180°.

    1. a.

      True

    2. b.

      False

  5. 5.

    True or false: Decreased amplitudes in finger photoplethysmography (PPG) waveforms with provocative maneuvers may be a normal variant.

    1. a.

      True

    2. b.

      False

Answer Key

  1. 1.

    d

  2. 2.

    d

  3. 3.

    a

  4. 4.

    a

  5. 5.

    a

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Hamby, B.A., Ronningen, E.L., Humphries, M.D., Freischlag, J.A. (2017). Role of the Noninvasive Vascular Laboratory in Thoracic Outlet Syndrome. In: AbuRahma, A. (eds) Noninvasive Vascular Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-319-54760-2_43

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  • DOI: https://doi.org/10.1007/978-3-319-54760-2_43

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-54758-9

  • Online ISBN: 978-3-319-54760-2

  • eBook Packages: MedicineMedicine (R0)

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