Abstract
Thoracic outlet syndrome is caused by compression of the neurovascular bundle as it passes from the upper thorax to the axilla. The neurovascular bundle can be compressed by bony structures such as the first rib, cervical ribs or bone tubercles, or from soft-tissue abnormalities like a fibrous band, muscle hypertrophy or space-occupying lesion. Thoracic outlet syndrome commonly affects young adults but can be seen in the pediatric age group, especially in older children. Diagnosis is based on a holistic approach encompassing clinical features, physical examination findings including those triggered by various maneuvers, electromyography, nerve conduction studies and imaging. Imaging is performed to confirm the diagnosis, exclude mimics and classify thoracic outlet syndrome into neurogenic, arterial, venous or mixed causes. MRI and MR angiography are useful in this process. A complete MRI examination for suspected thoracic outlet syndrome should include the assessment of anatomy and any abnormalities using routine sequences, vessel assessment with the arms in adduction by MR angiography and assessment of dynamic compression of vessels with abduction of the arms. The purpose of this paper is to describe the anatomy of the thoracic outlet, causes of thoracic outlet syndrome, the MR imaging techniques used in its diagnosis and the principles of image interpretation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Moriarty JM, Bandyk DF, Broderick DF et al (2015) ACR appropriateness criteria imaging in the diagnosis of thoracic outlet syndrome. J Am Coll Radiol 12:438–443
Aralasmak A, Cevikol C, Karaali K et al (2012) MRI findings in thoracic outlet syndrome. Skelet Radiol 41:1365–1374
Demondion X, Herbinet P, Van Sint JS (2006) Imaging assessment of thoracic outlet syndrome. Radiographics 26:1735–1750
Likes K, Rochlin DH, Salditch Q et al (2014) Diagnostic accuracy of physician and self-referred patients for thoracic outlet syndrome is excellent. Ann Vasc Surg 28:1100–1105
Desai SS, Toliyat M, Dua A et al (2014) Outcomes of surgical paraclavicular thoracic outlet decompression. Ann Vasc Surg 28:457–464
Rochlin DH, Orlando MS, Likes KC et al (2014) Bilateral first rub resection and scalenectomy is effective for treatment of thoracic outlet syndrome. J Vasc Surg 60:185–190
Chang K, Graf E, Davis K et al (2011) Spectrum of thoracic outlet syndrome presentation in adolescents. Arch Surg 146:1383–1387
Likes K, Rochlin DH, Call D, Freischlag JA (2014) Coexistence of arterial compression in patients with neurogenic thoracic outlet syndrome. JAMA Surg 149:1240–1243
Bains RD, Platt J, MacGregor D, Borschel GH (2014) Atypical thoracic outlet syndrome and reverse flow thromboembolism. Pediatr Neurol 51:453–456
Rehemutula A, Zhang L, Chen L et al (2015) Managing pediatric thoracic outlet syndrome. Ital J Pediatr 41:22
Vu AT, Patel PA, Elhadi H et al (2014) Thoracic outlet syndrome in the pediatric population: case series. J Hand Surg Am 39:484–487
Demondion X, Bacqueville E, Paul C et al (2003) Thoracic outlet: assessment with MR imaging in asymptomatic and symptomatic populations. Radiology 227:461–468
Maru S, Dosluoglu H, Dryiski M et al (2009) Thoracic outlet syndrome in children and young adults. Eur J Vasc Endovasc Surg 38:560–564
Klaassen Z, Sorenson E, Tubbs RS et al (2014) Thoracic outlet syndrome: a neurological and vascular disorder. Clin Anat 27:724–732
Remy-Jardin M, Remy J, Masson P et al (2000) Helical CT angiography of thoracic outlet syndrome: functional anatomy. AJR Am J Roentgenol 174:1667–1674
Hasanadka R, Towne JB, Seabrook GR et al (2007) Computed tomography angiography to evaluate thoracic outlet neurovascular compression. Vasc Endovasc Surg 41:316–321
Chavhan GB, Babyn PS, John P et al (2015) Pediatric body MR angiography: principles, techniques, and current status in body imaging. AJR Am J Roentgenol 205:173–184
Ersoy H, Steigner ML, Coyner KB et al (2012) Vascular thoracic outlet syndrome: protocol design and diagnostic value of contrast-enhanced 3-D MR angiography and equilibrium phase imaging on 1.5- and 3-T MRI scanners. AJR Am J Roentgenol 198:1180–1187
Lim RP, Bruno M, Rosenkrantz AB et al (2014) Comparison of blood pool and extracellular gadolinium chelates for functional MR evaluation of vascular thoracic outlet syndrome. Eur J Radiol 83:1209–1215
Juvonen T, Satta J, Laitala P et al (1995) Anomalies at the thoracic outlet are frequent in the general population. Am J Surg 170:33–37
Baumer P, Kele H, Kretschmer T et al (2014) Thoracic outlet syndrome in 3T MR neurography-fibrous bands causing discernible lesions of the lower brachial plexus. Eur Radiol 24:756–761
Chen H, Doornbos N, Williams K, Criado E (2014) Physiologic variations in venous and arterial hemodynamics in response to postural changes at the thoracic outlet in normal volunteers. Ann Vasc Surg 28:1583–1588
Orlando MS, Likes KC, Mirza S et al (2015) A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome. J Am Coll Surg 220:934–939
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
Dr. A. J. Towbin receives grant support from Guerbet, Siemens Healthcare and the Cystic Fibrosis Foundation.
Additional information
CME activity This article has been selected as the CME activity for the current month. Please visit the SPR Web site at www.pedrad.org on the Education page and follow the instructions to complete this CME activity.
Rights and permissions
About this article
Cite this article
Chavhan, G.B., Batmanabane, V., Muthusami, P. et al. MRI of thoracic outlet syndrome in children. Pediatr Radiol 47, 1222–1234 (2017). https://doi.org/10.1007/s00247-017-3854-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-017-3854-5