Costoclavicular Compression- Radiology and Treatment

Abstract

Thoracic outlet syndrome is described as the compression of one or several neurovascular structures that cross the thoracic outlet. The syndrome often appears overlooked and misdiagnosed because objective findings are scarce leading to persistent pain, impaired function and emotional distress. The aim of this study was to identify normal and abnormal anatomy of thoracic outlet using computed tomography scan in symptomatic costoclavicular compression syndrome and to plan them for surgery there after. This was a prospective hospital based study. All the symptomatic cases of costoclavicular compression syndrome admitted in the department of Cardiovascular and thoracic surgery, SKIMS, Srinagar from May 2011 to May 2013 were taken up for the study. A total of 30 cases of symptomatic costoclavicular compression syndrome were reported from May 2011 to May 2013. Mean age of presentation was 26.3 years. The most prevalent age group was 21- 30 years (46.67%,n=14).Majority of patients were females(83.3%,n=25) with male female ratio of 1:5. 66.67%(n=20) had bilateral cervical rib, more in females(72%) than males(40%).96.7%(n=29) had neurogenic thoracic outlet syndrome and 3.3%(n=1) had vascular thoracic outlet syndrome.34.4%(n=10) of cases with neurogenic thoracic outlet syndrome had subclavian artery compression on CT Angio of thoracic outlet. All the patients with subclavian artery compression were subjected to surgery. Costoclavicular compression syndrome affects mainly young females.CT Angio is complementary in finding vascular compression in cases presenting mainly with neurogenic symptoms of thoracic outlet syndrome. Keywords: Costoclavicular compression syndrome, CT Angio, Vascular thoracic outlet syndrome, neurogenic thoracic outlet syndrome.