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Thoracic Outlet Syndrome
Kevin R. Moore, MD; Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Thoracic outlet syndrome (TOS)
              • Definitions

                • Neural, venous, &/or arterial compressive syndrome at thoracic outlet (TO)
                • Diagnosis made by 1 of 3 methods (by event, affected structure, or compression cause)

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Ultrasonographic Findings

                        • Angiographic Findings

                          • Imaging Recommendations

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              • Image Interpretation Pearls

                                                Selected References

                                                1. Jones MR et al: Thoracic outlet syndrome: a comprehensive review of pathophysiology, diagnosis, and treatment. Pain Ther. 8(1):5-18, 2019
                                                2. Chavhan GB et al: MRI of thoracic outlet syndrome in children. Pediatr Radiol. 47(10):1222-34, 2017
                                                3. Ferrante MA et al: The thoracic outlet syndromes: Part 1. Overview of the thoracic outlet syndromes and review of true neurogenic thoracic outlet syndrome. Muscle Nerve. 55(6):782-93, 2017
                                                4. Peek J et al: Outcome of surgical treatment for thoracic outlet syndrome: systematic review and meta-analysis. Ann Vasc Surg. 40:303-26, 2017
                                                5. Hussain MA et al: Vascular thoracic outlet syndrome. Semin Thorac Cardiovasc Surg. 28(1):151-7, 2016
                                                6. Baumer P et al: Thoracic outlet syndrome in 3T MR neurography-fibrous bands causing discernible lesions of the lower brachial plexus. Eur Radiol. 24(3):756-61, 2014
                                                7. Daniels B et al: Arterial thoracic outlet syndrome. Curr Sports Med Rep. 13(2):75-80, 2014
                                                8. Gelabert HA et al: Regrown first rib in patients with recurrent thoracic outlet syndrome. Ann Vasc Surg. 28(4):933-8, 2014
                                                9. Klaassen Z et al: Thoracic outlet syndrome: a neurological and vascular disorder. Clin Anat. 27(5):724-32, 2014
                                                10. Likes K et al: Coexistence of arterial compression in patients with neurogenic thoracic outlet syndrome. JAMA Surg. 149(12):1240-3, 2014
                                                11. Poretti D et al: Simultaneous bilateral magnetic resonance angiography to evaluate thoracic outlet syndrome. Radiol Med. 120(5):407-12, 2014
                                                12. Reidler JS et al: Thoracic outlet syndrome caused by synostosis of the first and second thoracic ribs: 2 case reports and review of the literature. J Hand Surg Am. 39(12):2444-7, 2014
                                                13. Singh VK et al: Diagnostic value of magnetic resonance imaging in thoracic outlet syndrome. J Orthop Surg (Hong Kong). 22(2):228-31, 2014
                                                14. Smayra T et al: The subclavius posticus muscle: an unusual cause of thoracic outlet syndrome. Surg Radiol Anat. 36(7):725-8, 2014
                                                15. Socolovsky M et al: [Thoracic Outlet Syndrome: is it always a surgical condition? Analysis of a series of 31 cases operated by the supraclavicular route.] Surg Neurol Int. 5(Suppl 5):S247-55, 2014
                                                16. Vu AT et al: Thoracic outlet syndrome in the pediatric population: case series. J Hand Surg Am. 39(3):484-7.e2, 2014
                                                17. Weber AE et al: Relevance of bone anomalies in patients with thoracic outlet syndrome. Ann Vasc Surg. 28(4):924-32, 2014
                                                18. Yildizgören MT et al: Magnetic resonance imaging of a fibrous band causing true neurogenic thoracic outlet syndrome. Am J Phys Med Rehabil. 93(8):732-3, 2014
                                                19. Aljabri B et al: Surgical management of vascular thoracic outlet syndrome: a teaching hospital experience. Ann Vasc Dis. 6(1):74-9, 2013
                                                20. Marine L et al: Arterial thoracic outlet syndrome: a 32-year experience. Ann Vasc Surg. 27(8):1007-13, 2013
                                                21. Matur Z et al: Teaching neuroimages: swollen T1 nerve root in neurogenic thoracic outlet syndrome. Neurology. 80(23):e247, 2013
                                                22. Simon NG et al: Sonographic diagnosis of true neurogenic thoracic outlet syndrome. Neurology. 81(22):1965, 2013
                                                23. Twaij H et al: Thoracic outlet syndromes in sport: a practical review in the face of limited evidence--unusual pain presentation in an athlete. Br J Sports Med. 47(17):1080-4, 2013
                                                24. Walden MJ et al: Cervical ribs: identification on MRI and clinical relevance. Clin Imaging. 37(5):938-41, 2013
                                                25. Aralasmak A et al: MRI findings in thoracic outlet syndrome. Skeletal Radiol. 41(11):1365-74, 2012
                                                26. Dahlstrom KA et al: Descriptive anatomy of the interscalene triangle and the costoclavicular space and their relationship to thoracic outlet syndrome: a study of 60 cadavers. J Manipulative Physiol Ther. 35(5):396-401, 2012
                                                27. Ersoy H et al: Vascular thoracic outlet syndrome: protocol design and diagnostic value of contrast-enhanced 3D MR angiography and equilibrium phase imaging on 1.5- and 3-T MRI scanners. AJR Am J Roentgenol. 198(5):1180-7, 2012
                                                28. Luigetti M et al: Teaching neuroimages: neurogenic thoracic outlet syndrome. Neurology. 79(2):e11, 2012
                                                29. Ciampi P et al: Surgical treatment of thoracic outlet syndrome in young adults: single centre experience with minimum three-year follow-up. Int Orthop. 35(8):1179-86, 2011
                                                30. Lee PP et al: Magnetic resonance neurography-surgical correlation of neurologic thoracic outlet syndrome. Microsurgery. 31(8):662-5, 2011
                                                31. Spears J et al: Anatomical relationship of Roos' type 3 band and the T1 nerve root. Plast Reconstr Surg. 128(6):1257-62, 2011
                                                32. Braun RM: Thoracic outlet syndrome: a primer on objective methods of diagnosis. J Hand Surg Am. 35(9):1539-41; quiz 1541, 2010
                                                33. van Es HW et al: MRI of the brachial plexus: a pictorial review. Eur J Radiol. 74(2):391-402, 2010
                                                34. Ambrad-Chalela E et al: Recurrent neurogenic thoracic outlet syndrome. Am J Surg. 187(4):505-10, 2004
                                                35. Charon JP et al: Evaluation of MR angiographic technique in the assessment of thoracic outlet syndrome. Clin Radiol. 59(7):588-95, 2004
                                                36. Konstantinou DT et al: Klippel-Feil syndrome presenting with bilateral thoracic outlet syndrome. Spine. 29(9):E189-92, 2004
                                                37. Samarasam I et al: Surgical management of thoracic outlet syndrome: a 10-year experience. ANZ J Surg. 74(6):450-4, 2004
                                                38. Yanaka K et al: Diagnosis of vascular compression at the thoracic outlet using magnetic resonance angiography. Eur Neurol. 51(2):122-3, 2004
                                                39. Demondion X et al: Thoracic outlet: assessment with MR imaging in asymptomatic and symptomatic populations. Radiology. 227(2):461-8, 2003
                                                40. Reid JR et al: Thoracic outlet syndrome with subclavian aneurysm in a very young child: the complementary value of MRA and 3D-CT in diagnosis. Pediatr Radiol. 32(1):22-4, 2002
                                                41. Athanassiadi K et al: Treatment of thoracic outlet syndrome: long-term results. World J Surg. 25(5):553-7, 2001
                                                42. Demondion X et al: Thoracic outlet: anatomic correlation with MR imaging. AJR Am J Roentgenol. 175(2):417-22, 2000
                                                43. Hagspiel KD et al: Diagnosis of vascular compression at the thoracic outlet using gadolinium-enhanced high-resolution ultrafast MR angiography in abduction and adduction. Cardiovasc Intervent Radiol. 23(2):152-4, 2000
                                                44. Dymarkowski S et al: Three-dimensional MR angiography in the evaluation of thoracic outlet syndrome. AJR Am J Roentgenol. 173(4):1005-8, 1999
                                                45. Esposito MD et al: Thoracic outlet syndrome in a throwing athlete diagnosed with MRI and MRA. J Magn Reson Imaging. 7(3):598-9, 1997
                                                46. Matsumura JS et al: Helical computed tomography of the normal thoracic outlet. J Vasc Surg. 26(5):776-83, 1997
                                                47. Remy-Jardin M et al: Functional anatomy of the thoracic outlet: evaluation with spiral CT. Radiology. 205(3):843-51, 1997
                                                48. Juvonen T et al: Anomalies at the thoracic outlet are frequent in the general population. Am J Surg. 170(1):33-7, 1995
                                                49. Liu JE et al: Shoulder-arm pain from cervical bands and scalene muscle anomalies. J Neurol Sci. 128(2):175-80, 1995
                                                50. Longley DG et al: Thoracic outlet syndrome: evaluation of the subclavian vessels by color duplex sonography. AJR Am J Roentgenol. 158(3):623-30, 1992
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          • Diagnostic Checklist

                                                            TERMINOLOGY

                                                            • Abbreviations

                                                              • Thoracic outlet syndrome (TOS)
                                                            • Definitions

                                                              • Neural, venous, &/or arterial compressive syndrome at thoracic outlet (TO)
                                                              • Diagnosis made by 1 of 3 methods (by event, affected structure, or compression cause)

                                                            IMAGING

                                                            • General Features

                                                              • Radiographic Findings

                                                                • CT Findings

                                                                  • MR Findings

                                                                    • Ultrasonographic Findings

                                                                      • Angiographic Findings

                                                                        • Imaging Recommendations

                                                                          DIFFERENTIAL DIAGNOSIS

                                                                            PATHOLOGY

                                                                            • General Features

                                                                              • Gross Pathologic & Surgical Features

                                                                                • Microscopic Features

                                                                                  CLINICAL ISSUES

                                                                                  • Presentation

                                                                                    • Demographics

                                                                                      • Natural History & Prognosis

                                                                                        • Treatment

                                                                                          DIAGNOSTIC CHECKLIST

                                                                                          • Consider

                                                                                            • Image Interpretation Pearls

                                                                                              Selected References

                                                                                              1. Jones MR et al: Thoracic outlet syndrome: a comprehensive review of pathophysiology, diagnosis, and treatment. Pain Ther. 8(1):5-18, 2019
                                                                                              2. Chavhan GB et al: MRI of thoracic outlet syndrome in children. Pediatr Radiol. 47(10):1222-34, 2017
                                                                                              3. Ferrante MA et al: The thoracic outlet syndromes: Part 1. Overview of the thoracic outlet syndromes and review of true neurogenic thoracic outlet syndrome. Muscle Nerve. 55(6):782-93, 2017
                                                                                              4. Peek J et al: Outcome of surgical treatment for thoracic outlet syndrome: systematic review and meta-analysis. Ann Vasc Surg. 40:303-26, 2017
                                                                                              5. Hussain MA et al: Vascular thoracic outlet syndrome. Semin Thorac Cardiovasc Surg. 28(1):151-7, 2016
                                                                                              6. Baumer P et al: Thoracic outlet syndrome in 3T MR neurography-fibrous bands causing discernible lesions of the lower brachial plexus. Eur Radiol. 24(3):756-61, 2014
                                                                                              7. Daniels B et al: Arterial thoracic outlet syndrome. Curr Sports Med Rep. 13(2):75-80, 2014
                                                                                              8. Gelabert HA et al: Regrown first rib in patients with recurrent thoracic outlet syndrome. Ann Vasc Surg. 28(4):933-8, 2014
                                                                                              9. Klaassen Z et al: Thoracic outlet syndrome: a neurological and vascular disorder. Clin Anat. 27(5):724-32, 2014
                                                                                              10. Likes K et al: Coexistence of arterial compression in patients with neurogenic thoracic outlet syndrome. JAMA Surg. 149(12):1240-3, 2014
                                                                                              11. Poretti D et al: Simultaneous bilateral magnetic resonance angiography to evaluate thoracic outlet syndrome. Radiol Med. 120(5):407-12, 2014
                                                                                              12. Reidler JS et al: Thoracic outlet syndrome caused by synostosis of the first and second thoracic ribs: 2 case reports and review of the literature. J Hand Surg Am. 39(12):2444-7, 2014
                                                                                              13. Singh VK et al: Diagnostic value of magnetic resonance imaging in thoracic outlet syndrome. J Orthop Surg (Hong Kong). 22(2):228-31, 2014
                                                                                              14. Smayra T et al: The subclavius posticus muscle: an unusual cause of thoracic outlet syndrome. Surg Radiol Anat. 36(7):725-8, 2014
                                                                                              15. Socolovsky M et al: [Thoracic Outlet Syndrome: is it always a surgical condition? Analysis of a series of 31 cases operated by the supraclavicular route.] Surg Neurol Int. 5(Suppl 5):S247-55, 2014
                                                                                              16. Vu AT et al: Thoracic outlet syndrome in the pediatric population: case series. J Hand Surg Am. 39(3):484-7.e2, 2014
                                                                                              17. Weber AE et al: Relevance of bone anomalies in patients with thoracic outlet syndrome. Ann Vasc Surg. 28(4):924-32, 2014
                                                                                              18. Yildizgören MT et al: Magnetic resonance imaging of a fibrous band causing true neurogenic thoracic outlet syndrome. Am J Phys Med Rehabil. 93(8):732-3, 2014
                                                                                              19. Aljabri B et al: Surgical management of vascular thoracic outlet syndrome: a teaching hospital experience. Ann Vasc Dis. 6(1):74-9, 2013
                                                                                              20. Marine L et al: Arterial thoracic outlet syndrome: a 32-year experience. Ann Vasc Surg. 27(8):1007-13, 2013
                                                                                              21. Matur Z et al: Teaching neuroimages: swollen T1 nerve root in neurogenic thoracic outlet syndrome. Neurology. 80(23):e247, 2013
                                                                                              22. Simon NG et al: Sonographic diagnosis of true neurogenic thoracic outlet syndrome. Neurology. 81(22):1965, 2013
                                                                                              23. Twaij H et al: Thoracic outlet syndromes in sport: a practical review in the face of limited evidence--unusual pain presentation in an athlete. Br J Sports Med. 47(17):1080-4, 2013
                                                                                              24. Walden MJ et al: Cervical ribs: identification on MRI and clinical relevance. Clin Imaging. 37(5):938-41, 2013
                                                                                              25. Aralasmak A et al: MRI findings in thoracic outlet syndrome. Skeletal Radiol. 41(11):1365-74, 2012
                                                                                              26. Dahlstrom KA et al: Descriptive anatomy of the interscalene triangle and the costoclavicular space and their relationship to thoracic outlet syndrome: a study of 60 cadavers. J Manipulative Physiol Ther. 35(5):396-401, 2012
                                                                                              27. Ersoy H et al: Vascular thoracic outlet syndrome: protocol design and diagnostic value of contrast-enhanced 3D MR angiography and equilibrium phase imaging on 1.5- and 3-T MRI scanners. AJR Am J Roentgenol. 198(5):1180-7, 2012
                                                                                              28. Luigetti M et al: Teaching neuroimages: neurogenic thoracic outlet syndrome. Neurology. 79(2):e11, 2012
                                                                                              29. Ciampi P et al: Surgical treatment of thoracic outlet syndrome in young adults: single centre experience with minimum three-year follow-up. Int Orthop. 35(8):1179-86, 2011
                                                                                              30. Lee PP et al: Magnetic resonance neurography-surgical correlation of neurologic thoracic outlet syndrome. Microsurgery. 31(8):662-5, 2011
                                                                                              31. Spears J et al: Anatomical relationship of Roos' type 3 band and the T1 nerve root. Plast Reconstr Surg. 128(6):1257-62, 2011
                                                                                              32. Braun RM: Thoracic outlet syndrome: a primer on objective methods of diagnosis. J Hand Surg Am. 35(9):1539-41; quiz 1541, 2010
                                                                                              33. van Es HW et al: MRI of the brachial plexus: a pictorial review. Eur J Radiol. 74(2):391-402, 2010
                                                                                              34. Ambrad-Chalela E et al: Recurrent neurogenic thoracic outlet syndrome. Am J Surg. 187(4):505-10, 2004
                                                                                              35. Charon JP et al: Evaluation of MR angiographic technique in the assessment of thoracic outlet syndrome. Clin Radiol. 59(7):588-95, 2004
                                                                                              36. Konstantinou DT et al: Klippel-Feil syndrome presenting with bilateral thoracic outlet syndrome. Spine. 29(9):E189-92, 2004
                                                                                              37. Samarasam I et al: Surgical management of thoracic outlet syndrome: a 10-year experience. ANZ J Surg. 74(6):450-4, 2004
                                                                                              38. Yanaka K et al: Diagnosis of vascular compression at the thoracic outlet using magnetic resonance angiography. Eur Neurol. 51(2):122-3, 2004
                                                                                              39. Demondion X et al: Thoracic outlet: assessment with MR imaging in asymptomatic and symptomatic populations. Radiology. 227(2):461-8, 2003
                                                                                              40. Reid JR et al: Thoracic outlet syndrome with subclavian aneurysm in a very young child: the complementary value of MRA and 3D-CT in diagnosis. Pediatr Radiol. 32(1):22-4, 2002
                                                                                              41. Athanassiadi K et al: Treatment of thoracic outlet syndrome: long-term results. World J Surg. 25(5):553-7, 2001
                                                                                              42. Demondion X et al: Thoracic outlet: anatomic correlation with MR imaging. AJR Am J Roentgenol. 175(2):417-22, 2000
                                                                                              43. Hagspiel KD et al: Diagnosis of vascular compression at the thoracic outlet using gadolinium-enhanced high-resolution ultrafast MR angiography in abduction and adduction. Cardiovasc Intervent Radiol. 23(2):152-4, 2000
                                                                                              44. Dymarkowski S et al: Three-dimensional MR angiography in the evaluation of thoracic outlet syndrome. AJR Am J Roentgenol. 173(4):1005-8, 1999
                                                                                              45. Esposito MD et al: Thoracic outlet syndrome in a throwing athlete diagnosed with MRI and MRA. J Magn Reson Imaging. 7(3):598-9, 1997
                                                                                              46. Matsumura JS et al: Helical computed tomography of the normal thoracic outlet. J Vasc Surg. 26(5):776-83, 1997
                                                                                              47. Remy-Jardin M et al: Functional anatomy of the thoracic outlet: evaluation with spiral CT. Radiology. 205(3):843-51, 1997
                                                                                              48. Juvonen T et al: Anomalies at the thoracic outlet are frequent in the general population. Am J Surg. 170(1):33-7, 1995
                                                                                              49. Liu JE et al: Shoulder-arm pain from cervical bands and scalene muscle anomalies. J Neurol Sci. 128(2):175-80, 1995
                                                                                              50. Longley DG et al: Thoracic outlet syndrome: evaluation of the subclavian vessels by color duplex sonography. AJR Am J Roentgenol. 158(3):623-30, 1992