Thoracic outlet syndrome in a throwing athlete diagnosed with MRI and MRA

Thoracic outlet syndrome comprises the clinical manifestations in the arm caused by compression of the neurovascular bundle as it leaves the thoracic inlet. The neurovascular bundle is composed of the subclavian artery, the subclavian vein, and the brachial plexus. The symptoms of thoracic outlet or inlet syndrome are most often caused by compression of the nerves of the brachial plexus, which is involved in up to 98% of cases; the remainder are due to vascular compression. MRI with MRA demonstrates well the anatomy of the brachial plexus as well as any vascular compression or occlusion. The relationship of the axillary and subclavian vein to the first rib and subclavius muscle also can be demonstrated. We present a college baseball player who presented with numbness in the fingers of his throwing hand when throwing a baseball. Evaluation with spin-echo and two-dimensional time-of-flight MR angiographic (MRA) imaging of the thoracic outlet region revealed obstruction of the subclavian vein with the arm abducted. To our knowledge, no such cases have been diagnosed previously with MRI.