Thoracic Outlet Syndrome: Unraveling the Anatomy, Reviewing the Computed Tomography Angiography Protocol, and...

The thoracic outlet is an anatomic region that extends from the supraclavicular fossa to the axilla. It passes through an important neurovascular bundle composed of the brachial plexus, artery, and subclavian vein. The relationships between the multiple structures comprising the thoracic outlet are dynamic due to the great mobility of the shoulder joint, which may cause compression of the bundle during movement of the upper limb. However, identification of positional changes in the caliber of the subclavian vessels and the brachial nervous plexus alone in imaging examinations may not have clinical significance and should be interpreted in light of the signs and symptoms of the physical examination. The radiologist must be familiar not only with the different imaging presentations of this pathology but also with its predisposing factors, main maneuvers that sensitize symptoms, possible complications, and expected findings after treatment for decompression. Along with this, it is essential to know the directed protocol of computed tomography angiography (CTA) for acquisition of adequate images, which, together with a directed, specific report, allows proper communication with the attending physician.