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Helical CT Angiography of Thoracic Outlet Syndrome

Functional Anatomy

¹ Department of Radiology, University Center Hospital Calmette, Blvd. Jules Leclerc, 59037 Lille Cedex, France.
² Medical Research Group "Equipe d'Accueil 2682," Blvd. Jules Leclerc, 59037 Lille Cedex, France.
³ Department of Medical Statistics, University of Lille-1, Place de Verdun, 59045 Lille Cedex, France.

OBJECTIVE. The objective of this study is to determine the anatomic characteristics of the thoracic outlet in symptomatic patients before and after postural maneuver.

SUBJECTS AND METHODS. Seventy-nine symptomatic patients (61 female patients [group 1]; 18 male patients [group 2]; mean age, 38 years) underwent helical CT angiography of the thoracic apexes in the neutral position and after a postural maneuver, enabling the evaluation of the functional anatomy of the musculoskeletal and arterial structures of the ipsilateral thoracic outlet.

RESULTS. A statistically significant difference was found between the distribution of the distances (maximum and costosubclavian) measured in the neutral position and after postural maneuver in groups 1 and 2. The median value of these distances was smaller after postural maneuver in groups 1 and 2. A statistically significant difference was found between the distribution of the distances (maximum and costosubclavian) measured in patients of group 1 with arterial stenosis and in patients of group 1 without arterial stenosis. A slight indentation of the anterior wall of the subclavian artery when it arches around the anterior scalene muscle was observed in 39 patients (64%) in group 1 and in 11 patients (61%) in group 2 in the neutral position, in 19 patients (31%) in group 1 and in six patients (33%) in group 2 after the postural maneuver. The predominant positional changes of the vascular structures were the posteroanterior displacement of the subclavian vessels observed in groups 1 and 2, the arch made by the subclavian artery above the first rib in 40 patients (66%) in group 1 and nine patients (50%) in group 2, and the posterior displacement of the axillary artery observed in 36 patients (59%) in group 1 and in 12 patients (67%) in group 2.

CONCLUSION. Helical CT shows significant narrowing of the costoclavicular space after postural maneuver in symptomatic patients.

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