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Helical CT Angiography of Thoracic Outlet Syndrome

Functional Anatomy

Martine Remy-Jardin1,2, Jacques Remy1,2, Pascal Masson1, François Bonnel1, Philippe Debatselier1, Ludmilla Vinckier1 and Alain Duhamel3

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.



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  		Fig. 1A. —CT angiograms of left thoracic outlet in 59-year-old woman with paresthesias. Numeral 1 refers to measurement of costoclavicular distance. Sagittal reformations of costoclavicular space in neutral position. Minimal and maximal distances between inferior border of clavicle and superior margin of first rib are 7 mm on A and 11 mm on B, respectively. Note, on B, distance between inferior border of subclavius muscle and superior margin of first rib (numeral 2) is 6 mm. Also note posterior location of subclavian vein (asterisk) and artery (triangle) relative to costoclavicular space, and inferior location of subclavius muscle (circle) relative to clavicular margin.

 


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  		Fig. 1B. —CT angiograms of left thoracic outlet in 59-year-old woman with paresthesias. Numeral 1 refers to measurement of costoclavicular distance. Sagittal reformations of costoclavicular space in neutral position. Minimal and maximal distances between inferior border of clavicle and superior margin of first rib are 7 mm on A and 11 mm on B, respectively. Note, on B, distance between inferior border of subclavius muscle and superior margin of first rib (numeral 2) is 6 mm. Also note posterior location of subclavian vein (asterisk) and artery (triangle) relative to costoclavicular space, and inferior location of subclavius muscle (circle) relative to clavicular margin.

 


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  		Fig. 1C. —CT angiograms of left thoracic outlet in 59-year-old woman with paresthesias. Numeral 1 refers to measurement of costoclavicular distance. Sagittal reformations of costoclavicular space after postural maneuver show narrowing of superoinferior distances measured between bony structures and between subclavian muscle and first rib. Note, on D, stenosis of subclavian artery (triangle). Also note, on D, location of subclavian vein (asterisk, D) below horizontally oriented subclavius muscle (circle, D). Note, on C, precise delineation of lower portion of anterior scalene muscle (arrowhead, C), in close contact with subclavian artery (triangle). Numeral 2 refers to distance between inferior border of subclavius muscle and superior margin of first rib.

 


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  		Fig. 1D. —CT angiograms of left thoracic outlet in 59-year-old woman with paresthesias. Numeral 1 refers to measurement of costoclavicular distance. Sagittal reformations of costoclavicular space after postural maneuver show narrowing of superoinferior distances measured between bony structures and between subclavian muscle and first rib. Note, on D, stenosis of subclavian artery (triangle). Also note, on D, location of subclavian vein (asterisk, D) below horizontally oriented subclavius muscle (circle, D). Note, on C, precise delineation of lower portion of anterior scalene muscle (arrowhead, C), in close contact with subclavian artery (triangle). Numeral 2 refers to distance between inferior border of subclavius muscle and superior margin of first rib.

 


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  		Fig. 2A. —CT angiograms of left thoracic outlet in neutral position in same 59-year-old woman with paresthesias as in Figure 1A,1B,1C,1D. Volume-rendered reconstruction (vertical view) of bony and arterial structures shows reduction of less than 30% in anteroposterior diameter of left subclavian artery at level of interscalene triangle (arrow).

 


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  		Fig. 2B. —CT angiograms of left thoracic outlet in neutral position in same 59-year-old woman with paresthesias as in Figure 1A,1B,1C,1D. Contiguous sagittal reformations shows close contact between anterior wall of subclavian artery (arrow) and posterior border of anterior scalene muscle (arrowhead). Note modification of shape of subclavian artery, rounded in B and oval in C, as it reaches lateral border of anterior scalene muscle.

 


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  		Fig. 2C. —CT angiograms of left thoracic outlet in neutral position in same 59-year-old woman with paresthesias as in Figure 1A,1B,1C,1D. Contiguous sagittal reformations shows close contact between anterior wall of subclavian artery (arrow) and posterior border of anterior scalene muscle (arrowhead). Note modification of shape of subclavian artery, rounded in B and oval in C, as it reaches lateral border of anterior scalene muscle.

 


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  		Fig. 2D. —CT angiograms of left thoracic outlet in neutral position in same 59-year-old woman with paresthesias as in Figure 1A,1B,1C,1D. Contiguous transverse CT scans show course of subclavian artery behind lower portion of anterior scalene muscle (arrowhead).

 


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  		Fig. 2E. —CT angiograms of left thoracic outlet in neutral position in same 59-year-old woman with paresthesias as in Figure 1A,1B,1C,1D. Contiguous transverse CT scans show course of subclavian artery behind lower portion of anterior scalene muscle (arrowhead).

 


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  		Fig. 2F. —CT angiograms of left thoracic outlet in neutral position in same 59-year-old woman with paresthesias as in Figure 1A,1B,1C,1D. Contiguous transverse CT scans show course of subclavian artery behind lower portion of anterior scalene muscle (arrowhead).

 


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  		Fig. 3A. —Volume-rendered reconstructions of left thoracic outlet in 56-year-old woman with exercise-induced complaints. Measurements of angle (arrows) of frontal arch on frontal views before (A) and after (B) postural maneuver.

 


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  		Fig. 3B. —Volume-rendered reconstructions of left thoracic outlet in 56-year-old woman with exercise-induced complaints. Measurements of angle (arrows) of frontal arch on frontal views before (A) and after (B) postural maneuver.

 


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  		Fig. 3C. —Volume-rendered reconstructions of left thoracic outlet in 56-year-old woman with exercise-induced complaints. Measurements of angle (arrows) of transverse arch on vertical views before (C) and after (D) postural maneuver. Note, on C, arch of subclavian artery around anterior scalene muscle (asterisk, C), then concave course of arterial structure toward subcoracoid tunnel. On D, note arch of subclavian artery above first rib and nearly straight course of axillary artery after postural maneuver.

 


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  		Fig. 3D. —Volume-rendered reconstructions of left thoracic outlet in 56-year-old woman with exercise-induced complaints. Measurements of angle (arrows) of transverse arch on vertical views before (C) and after (D) postural maneuver. Note, on C, arch of subclavian artery around anterior scalene muscle (asterisk, C), then concave course of arterial structure toward subcoracoid tunnel. On D, note arch of subclavian artery above first rib and nearly straight course of axillary artery after postural maneuver.

 

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