Thoracic Outlet Syndrome: Diagnostic Accuracy of MRI

Hardy, Alexandre; Pougès, Cécile; Wavreille, G.; Behal, Hélène; Demondion, Xavier; Lefebvre, G.

doi:10.1016/j.otsr.2019.09.020

Cited by 40 publications

(26 citation statements)

References 11 publications

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“…[7][8][9][10] While this typical electrodiagnostic pattern has been very helpful for detecting patients with a certain anatomic abnormality, recent studies showed that nerve imaging (MRI and ultrasound [US]) may be an important complementary tool that can identify the actual site and cause of compression. 9,[11][12][13] Whereas earlier reports on electrodiagnostic testing in NTOS mainly described the most frequent findings, data on variability of these results is scarce. Therefore, we performed a retrospective study on a cohort of patients with NTOS, and systematically compared the distribution of electrodiagnostic abnormalities with findings at imaging and surgery.…”

Section: Introductionmentioning

confidence: 99%

Variability in electrodiagnostic findings associated with neurogenic thoracic outlet syndrome

et al. 2021

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Introduction/Aims Neurogenic thoracic outlet syndrome (NTOS) is a heterogeneous and often disputed entity. An electrodiagnostic pattern of T1 > C8 axon involvement is considered characteristic for the diagnosis of NTOS. However, since the advent of high‐resolution nerve ultrasound (US) imaging, we have encountered several patients with a proven entrapment of the lower brachial plexus who showed a different, variable electrodiagnostic pattern. Methods In this retrospective case series, 14 patients with an NTOS diagnosis with a verified source of compression of the lower brachial plexus and abnormal findings on their electrodiagnostic testing were included. Their medical records were reviewed to obtain clinical, imaging, and electrodiagnostic data. Results Seven patients showed results consistent with the “classic” T1 axon > C8 pattern of involvement. Less typical findings included equally severe involvement of T1 and C8 axons, more severe C8 involvement, pure motor abnormalities, neurogenic changes on needle electromyography in the flexor carpi radialis and biceps brachii muscles, and one patient with an abnormal sensory nerve action potential (SNAP) amplitude for the median sensory response recorded from the third digit. Patients with atypical findings on electrodiagnostic testing underwent nerve imaging more often compared to patients with classic findings (seven of seven patients vs. five of seven respectively), especially nerve ultrasound. Discussion When there is a clinical suspicion of NTOS, an electrodiagnostic finding other than the classic T1 > C8 pattern of involvement does not rule out the diagnosis. High resolution nerve imaging is valuable to diagnose additional patients with this treatable condition.

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Section: Introductionmentioning

confidence: 99%

Variability in electrodiagnostic findings associated with neurogenic thoracic outlet syndrome

et al. 2021

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“…Magnetic resonance imaging is superior in visualizing neurovascular and muscle tissue. However, this modality is limited in visualizing fibrotic muscle [22], [23]. Therefore, due to the limitation of the above examination, clinical findings remain the primary diagnostic tool in scalenus syndrome.…”

Section: Discussionmentioning

confidence: 99%

Novel Use of Ali Shahab Score as a Diagnostic Tool and Decision of Surgical Management in Scalenus Syndrome: A Case Series

Shahab

Mahadewa

Sadewo

et al. 2022

Open Access Maced J Med Sci

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BACKGROUND: Scalenus syndrome is a collection of symptoms as the consequences of nerve and vascular compression within the scalene triangle. However, the entity has long been forgotten in publications and is difficult to recognize. The diagnosis of scalenus syndrome is mainly based on clinical findings. The Ali Shahab score is a new scoring system, generated based on clinical symptoms of scalenus syndrome. AIM: In this study, we presented a case series of scalenus syndrome patients who were diagnosed and decide to be managed surgically based on Ali Shahab score. We also reported post-operative outcomes following scalenectomy in our series. METHODS: This was a case series including patients with scalenus syndrome in Gatot Soebroto Army Hospital, Indonesia, and Siloam Asri Hospital, Indonesia, between 2016 and 2021. The diagnosis of scalenus syndrome was made based on Ali Shahab score with a value of more than 7. All patients were performed scalenectomy to decompress the stenotic subclavian artery and brachial plexus from surrounding fibrotic tissue. Eligible subjects were assessed for sex, side of symptoms, pre-operative and post-operative Ali Shahab score, and post-operative outcome. RESULTS: We included 96 patients with scalenus syndrome in this case series. Most of the included patients were male (59.4%) and experienced scalenus syndrome on the right side (76%). The average pre-operative Ali Shahab score in our series was 7.12 ± 0.48 and the post-operative score was 0.11 ± 0. Regarding post-operative outcomes, more than half of the patients experienced symptoms reduction with 38.5% of patients experiencing complete resolution of symptoms following scalenectomy. CONCLUSION: The application of the Ali Shahab score may be used as a diagnostic tool and decision of surgical management for scalenus syndrome patients. Decompression of the subclavian artery and releasing brachial plexus from surrounding fibrotic tissue can improve clinical symptoms in scalenus syndrome patients.

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“…Furthermore, the poor diagnostic accuracy of clinical tests for TOS [ 38 ], and its broad localization and features of symptoms, both vascular and neurogenic are very similar to other musculoskeletal, neurological and visceral disorders [ 12 , 39 ]. In some cases, MRI with dynamic maneuvers can detect anatomical abnormalities potentially responsible for compression; indeed, specificity is sufficiently high to provide guidance especially for planning the surgical procedures; however, sensitivity is too low for MRI to be useful as a single screening test [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

A Thoracic Outlet Syndrome That Concealed a Glioblastoma. Findings from a Case Report

Storari¹,

Signorini

Barbari³

et al. 2021

Medicina

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Background: Glioblastoma is the most frequent and aggressive malignant brain tumor among adults. Unfortunately, its symptoms can vary considerably depending on the size, location and the anatomic structures of the involved brain. Case report: A 58-year-old male amateur cyclist who suffered from sharp arm pain was examined for a thoracic outlet syndrome due to a previous clavicle fracture. Because of ambiguous results of the neck and nerve plexus imaging, he was referred to a neurosurgeon who properly suspected a brain tumor. The neuroimaging of the brain shown a 3 cm disploriferative mass with a blood enhancement within the left parietal lobe. The mass was urgently removed, and its histologic analysis stated a grade 4 glioblastoma. Conclusion: This case report highlights the differential diagnosis process and the teamwork approach needed to diagnose a rare presentation of a brain glioblastoma, which started its symptoms mimicking a thoracic outlet syndrome caused by a previous bone fracture.

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Thoracic Outlet Syndrome: Diagnostic Accuracy of MRI

Cited by 40 publications

References 11 publications

Variability in electrodiagnostic findings associated with neurogenic thoracic outlet syndrome

Variability in electrodiagnostic findings associated with neurogenic thoracic outlet syndrome

Novel Use of Ali Shahab Score as a Diagnostic Tool and Decision of Surgical Management in Scalenus Syndrome: A Case Series

A Thoracic Outlet Syndrome That Concealed a Glioblastoma. Findings from a Case Report

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