Computed tomography angiography in thoracic outlet syndrome

Abstract

Objectives: To evaluate the effectiveness of computed tomography (CT) angiography (CTA) in demonstrating subclavian artery stenosis and explaining symptoms in thoracic outlet syndrome (TOS). To investigate possible compression points of the neurovascular bundle along the cervicoaxillary canal and their changes with postural maneuver. Materials and Methods: The study group consisted of 50 patients referred from the physical therapy and rehabilitation clinic with TOS symptoms, while the control group consisted of 20 patients without symptoms of TOS who required contrast-enhanced thorax CT for other reasons. The thoracic outlet of the patients were scanned with a multidetector helical CT scanner during the postural maneuver and in the neutral position after the intravenous contrast medium was administered. The control group was scanned under the same conditions only during the postural maneuver. Axial, sagittal reformatted and volume rendering images were evaluated for bony anomalies, subclavian artery stenosis, costoclavicular distance and anterior scalene muscle thickness. Results: Six patients had cervical rib and eleven patients had hypertrophy of the C7 transverse process. Significant subclavian artery compression was found in 32 of the 100 shoulders in the study group during the postural maneuver, while no significant artery compression was recorded in the control group. The mean minimum costoclavicular distance after postural maneuver was significantly lower and anterior scalene muscle thickness was significantly higher in the patient group. Conclusion: CTA is a minimally invasive method that can guide the surgical planning, especially in patients with vascular TOS, as it objectively shows the arterial stenosis, its location and, possibly the cause of the compression.