“Double cervical rib with uncommon presentation”

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

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.