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Thoracic outlet syndrome: evaluation with CT.

J H Bilbey1, N L Müller, D G Connell

  • 1Department of Radiology, University of British Columbia, Vancouver, Canada.

Radiology
|May 1, 1989
PubMed
Summary
This summary is machine-generated.

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Diagnosing thoracic outlet syndrome (TOS) can be challenging, especially without bone abnormalities. Computed tomography (CT) scans reveal C-7 transverse process impingement in 66% of TOS patients with normal X-rays, aiding diagnosis.

Area of Science:

  • Radiology
  • Orthopedics
  • Anatomy

Background:

  • Thoracic outlet syndrome (TOS) diagnosis is challenging, particularly when plain radiographs lack osseous abnormalities.
  • Conventional imaging often fails to identify the cause of TOS in a subset of patients.

Purpose of the Study:

  • To evaluate the utility of computed tomography (CT) in diagnosing thoracic outlet syndrome (TOS) in patients with normal plain radiographs.
  • To identify specific CT findings indicative of TOS when initial radiographic assessment is inconclusive.

Main Methods:

  • Retrospective review of radiographic and CT findings in 27 patients diagnosed with TOS and 21 healthy controls.
  • Independent assessment of plain radiographs and CT scans by two observers unaware of clinical history.
  • Analysis of osseous abnormalities and soft tissue impingement, specifically C-7 transverse process interactions.

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Main Results:

  • Fifteen TOS patients had identifiable osseous abnormalities on plain radiographs (e.g., cervical ribs, elongated C-7 transverse processes).
  • CT provided no additional diagnostic value in patients with abnormal radiographs.
  • Eight of 12 TOS patients (66%) with normal radiographs showed C-7 transverse process impingement on CT, compared to only 2 of 21 controls (P < .01).
  • CT identified impingement of the C-7 transverse process on the scalene triangle or middle scalene muscle.

Conclusions:

  • Computed tomography (CT) is a valuable tool for diagnosing thoracic outlet syndrome (TOS) in patients presenting with symptoms but lacking radiographic evidence of osseous abnormalities.
  • CT can reveal C-7 transverse process impingement, a key finding in TOS cases not apparent on standard X-rays.
  • This imaging modality enhances diagnostic accuracy for TOS when conventional radiography is negative.