Thoracic Outlet Syndrome with Undetectable Anomaly of the First Rib from the Point of Plain X Rays Views

Abstract

Thoracic outlet syndrome (TOS) is a complex entrapment syndrome of the neurovascular structures in the thoracic outlet. Cervical rib and anomalous first rib have been well documented as the cause of the TOS. CXR was one of routine studies imagine for our TOS patients. We now report that careful examination of these CXR could detect some pathology like cervical rib and anomalous first rib that could contribute to TOS. This study we reviewed all patients' plain chest X rays. We have found that 1. Five patients present with reactive cortical hyperplasia causing bony protrusion over the inner curvature; of those patients who present with reactive hyperplasia four patients present incomplete calcification of costal cartilage, 2.Six patients present with abnormal widening of the sternal side, 3. Tree patients' first rib run more vertical manner with obtuse inner curvature angle, 4. Five patients present with cervical ribs. Careful examination of the chest X rays of 32 patients of our proven TOS patients, we have detected 19 cases (59%) with detectable anomalies. Thos tinny anomalies frequently are ignored by the physicians or radiologists.