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Case Reports
. 2019 Mar;98(11):e14778.
doi: 10.1097/MD.0000000000014778.

Arterial thoracic outlet syndrome caused by cervical ribs-an unusual case report

Shuai Jiang  1 , Hui Shen  1 , Wei Qiang Tan  2 , Hui Lu  1
Affiliations
Case Reports

Arterial thoracic outlet syndrome caused by cervical ribs-an unusual case report

Shuai Jiang et al. Medicine (Baltimore). 2019 Mar.

Abstract

Rationale: Cervical ribs are rare conditions, occurring in 0.05% to 3.0% of the population. This manuscript reports a case of arterial thoracic outlet syndrome (ATOS) associated with this congenital anomaly.

Patient concerns: We report a 32-year-old female worker presenting pain in her left upper-extremity for 7 months. Her left hand became paler and cold when the temperature decreased, and the symptoms could not be eased through rest, physiotherapy and drugs medication.

Diagnoses: Compression of left subclavian artery with axillary and brachial arteries thrombosis was confirmed by duplex ultrasound and computed tomography angiography. ATOS caused by cervical ribs was confirmed by medical history, physical examination, and imaging.

Interventions: The patients underwent acute thrombolysis and balloon angioplasty.

Outcomes: Symptoms of pain and weakness disappeared after surgery. The patient had not experienced any apparent symptom recurrence at 1-year follow-up.

Lessons: Successful treatment of ATOS depends upon urgent assessment, accurate identification of causative factors and compression site and early diagnosis before the event of arterial thrombosis. The surgery combined with anticoagulation treatment can improve the treatment outcome of ATOS.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Duplex ultrasound showed wide artery thrombosis in the left axillary and brachial arteries.
Figure 2
Figure 2
CTA showed the narrow left brachial artery with occlusion of the distal part. CTA = computed tomography angiography.
Figure 3
Figure 3
Lateral neck radiograph: an unusual bony contour anteriorly at C7/T1 suggested a left cervical rib, and it articulated with the bony prominence arising from the mid part of the first rib and forming a pseudarthrosis.
Figure 4
Figure 4
The cervical rib and anomalous bony prominence of the first rib were removed completely.
Figure 5
Figure 5
CTA: the occlusion of subclavian artery with the formation of bypass from subclavian artery to axillary artery 1 year after surgery. CTA = computed tomography angiography.
See this image and copyright information in PMC

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