Pectoralis Minor Syndrome: Case Presentation and Review of the Literature

Abstract

We present a case of a healthy young female with axillary vein compression caused by the pectoralis minor muscle. Diagnosis was made by clinical findings and dynamic venography. After pectoralis minor tenotomy, the patient had total resolution of her symptoms. Compression of the axillary vein by the pectoralis minor is a rare entity that needs a careful exam and imaging to reach its diagnosis and establish the appropriate treatment.

Figure 1

(Neutral position pic.) Resting position with tourniquet: pectoralis muscle stretched by fixing the breast medially: venography was performed by injecting 20 mL of dilute contrast agent through the catheter, showing occlusion of the medial basilic vein and narrowing of the lateral.

Figure 2

Arm pulling. Dynamic venography with the arm pulled inferiorly and then released: venography was performed by injecting 40 mL of dilute contrast agent through the catheter, showing obstruction of the basilic/axillary veins and reflux and filling of the small cephalic vein providing collateral circulation filling the subclavian vein. The occlusion of the axillary vein was completely resolved upon releasing the tension. Findings of both pictures (Figures 1 and 2) in keeping with pectoralis minor syndrome on the right side. No venous compression at the costoclavicular space or the thoracic inlet.