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Radiographic Imaging in Diagnosis and Assessment of NTOS

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Book cover Thoracic Outlet Syndrome

Abstract

The clinical diagnosis of NTOS remains controversial and challenging. Fortunately, modern medical imaging, particularly MRI, provides excellent evaluation of the brachial plexus, the surrounding soft tissues and bones, and the dynamic changes that occur in the thoracic outlet on movement of the upper extremity. This chapter details the imaging anatomy of the thoracic outlet, including the component anatomic tunnels that comprise the thoracic outlet, the brachial plexus, and the dynamic changes of the thoracic outlet seen on movement of the upper extremity. Imaging findings of NTOS, as defined by pathologic entrapment of the brachial plexus, are demonstrated and defined, including soft tissue anomalies, bony anomalies, and pathologic dynamic changes that cause narrowing of the anatomic tunnels of the thoracic outlet and resultant entrapment of the brachial plexus. A simple and straightforward algorithm for reviewing an imaging study of a patient with TOS is provided. The reader will understand the important anatomic landmarks and tunnels of the thoracic outlet, the soft tissue or bony anomalies and pathologic changes that occur in the thoracic outlet, and the difference between normal and abnormal changes that occur on movement of the upper extremity, along with the resulting entrapment of the brachial plexus.

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  1. Vanguard Specialty Imaging, 1345 Lillian Ave., Sunnyvale, CA, 94087-3523, USA

    Scott Werden MD

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Editors and Affiliations

  1. , Division of Vascular Surgery, University of South Florida, Tampa General Circle, STC 7016 2, Tampa, 33606, Florida, USA

    Karl A. Illig

  2. Barnes-Jewish Hospital, Department of Surgery, Washington University, Queeny Tower Campus Box, St. Louis, 63110, Missouri, USA

    Robert W. Thompson

  3. , Department of Surgery, John Hopkins Medical Institutions, Rutland Avenue - Ross 759 729, Baltimore, 21205, Maryland, USA

    Julie Ann Freischlag

  4. , Department of Thoracic Surgery, Blake 15, Massachusetts General Hospital, Fruit Street 55, Boston, 02114, Massachusetts, USA

    Dean M. Donahue

  5. Neurological Associates of West LA, Wilshire Blvd, Suite 790 2811, Santa Monica, 90403, California, USA

    Sheldon E. Jordan

  6. , Graduate Program in Physical Therapy, UCSF/SFSU, Balmoral Street 2429, Union City, 94587, California, USA

    Peter I. Edgelow

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Werden, S. (2013). Radiographic Imaging in Diagnosis and Assessment of NTOS. In: Illig, K., Thompson, R., Freischlag, J., Donahue, D., Jordan, S., Edgelow, P. (eds) Thoracic Outlet Syndrome. Springer, London. https://doi.org/10.1007/978-1-4471-4366-6_18

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