No abstract

Thoracic outlet syndrome (TOS) occurs due to compression of the neurovascular bundle exiting the thoracic outlet, through which the brachial plexus and subclavian vessels pass. Here, we report a case of venous TOS combined with brachial neuritis, which was caused by axillary lymphadenopathy after the first dose of the BNT162b2 vaccine against coronavirus disease 2019 (COVID-19). A 17-year-old female patient presented with left upper extremity swelling and pain after inoculation with the BNT162b2 vaccine in the left deltoid muscle. Contrast-enhanced brachial plexus magnetic resonance imaging revealed severe swelling of the left axillary and subclavian lymph nodes, which lie immediately above the subclavian vein. An electrodiagnostic study revealed left brachial plexopathy, mainly involving the lower trunk with mixed demyelinating and axonal injury. The patient received intravenous steroid pulse therapy and oral steroid therapy. A follow-up examination showed complete recovery of muscle strength and function, pain, and swelling in the left upper extremity within 3 months after vaccination against COVID-19.

ObjectivesAcquired lymphedema of upper extremity is a chronic pathologic status that frequently occurs after breast cancer treatment. Reliable and quantitative evaluation of lymphedema is crucial for successful management of patients. Although lymphoscintigraphy is the primary investigation for the confirmation and evaluation of lymphedema, the specific protocol of stress intervention is not well established. This study aims to introduce intermittent pneumatic compression (IPC) as a part of stress lymphoscintigraphy and compare the effectiveness of conventional stress lymphoscintigraphy (CSL) and pneumatic compression–assisted lymphoscintigraphy (PCAL).MethodsOur study was designed as a retrospective analysis of 85 breast cancer patients with lymphedema who underwent lymphoscintigraphy utilizing either IPC device or conventional stress maneuver and received complex decongestive therapy. The flow extent of the lymphatic fluid (FE) was evaluated using a 0- to 4-point scale based on lymphoscintigraphic images. The visualization of lymph nodes was also assessed. The clinical outcomes were evaluated by changes in side-to-side circumferential and volume differences of upper extremities and compared between groups.ResultsOf 85 patients, 47 underwent CSL, and 38 underwent PCAL. Participants with relatively preserved flow extent of the lymphatic fluid (FE 3) showed a significant difference in percentage reduction of volume (PRV) between CSL and PCAL groups (P = 0.036). In the other groups, CSL and PCAL demonstrated comparable differences in PRV without statistical significance.ConclusionOur study suggests that participants in the PCAL group with relatively preserved lymphatic flow extent (FE 3) had better PRV compared with those in the CSL group. The use of IPC devices in lymphoscintigraphy with the novel stress maneuver can help in the quantitative description of lymphedema status and the selection of an appropriate treatment method.