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Imaging Assessment of Thoracic Outlet Syndrome¹

¹ From the Departments of Musculoskeletal Radiology (X.D., P.H., N.B., A.C.) and Orthopedic Surgery B (C.C.), Hôpital Roger Salengro, Bd du Professeur Jules Leclercq, 59037 Lille Cedex, France; the Anatomy Laboratory, Faculté de Médecine Henri Warembourg, Lille, France (X.D.); and the Anatomy Laboratory, Faculté de Médecine, Université Libre de Bruxelles, Brussels, Belgium (S.V.S.J.). Recipient of a Certificate of Merit award for an education exhibit at the 2004 RSNA Annual Meeting. Received April 6, 2005; revision requested June 1 and received January 12, 2006; accepted February 6. All authors have no financial relationships to disclose. Address correspondence to X.D. (e-mail: xdemondion{at}chru-lille.fr).

The thoracic outlet includes three compartments (the interscalene triangle, costoclavicular space, and retropectoralis minor space), which extend from the cervical spine and mediastinum to the lower border of the pectoralis minor muscle. Dynamically induced compression of the neural, arterial, or venous structures crossing these compartments leads to thoracic outlet syndrome (TOS). The diagnosis is based on the results of clinical evaluation, particularly if symptoms can be reproduced when various dynamic maneuvers, including elevation of the arm, are undertaken. However, clinical diagnosis is often difficult; thus, the use of imaging is required to demonstrate neurovascular compression and to determine the nature and location of the structure undergoing compression and the structure producing the compression. Cervical plain radiography should be performed first to assess for bone abnormalities and to narrow the differential diagnosis. Computed tomographic (CT) angiography or magnetic resonance (MR) imaging performed in association with postural maneuvers is helpful in analyzing the dynamically induced compression. B-mode and color duplex ultrasonography (US) are good supplementary tools for assessment of vessel compression in association with postural maneuvers, especially in cases with positive clinical features of TOS but negative features of TOS at CT and MR imaging. US may also allow analysis of the brachial plexus. However, MR imaging remains the method of choice when searching for neurologic compression.

© RSNA, 2006

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