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Price A, Fredricks N, Truong N, North RY. Pediatric thoracic outlet syndrome: a systematic review and meta-analysis. J Neurosurg Pediatr 2024; 33:484-495. [PMID: 38428008 DOI: 10.3171/2024.2.peds23511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/01/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Thoracic outlet syndrome (TOS) is a complex disorder affecting the neurovascular structures of the upper extremity as they traverse from the neck and thorax to the upper extremity. This systematic review and meta-analysis focuses on pediatric TOS, offering insights into its clinical presentation, etiology, treatment modalities, and outcomes in contrast to those reported in adult TOS. METHODS A comprehensive search for pediatric TOS in the PubMed database using PRISMA guidelines identified 6 relevant studies published between 2008 and 2022. In total, 227 pediatric TOS cases in 216 patients were analyzed. Data categories explored for TOS in pediatric patients included study design, number of patients included, mean age and sex of patients, TOS type, laterality, bony abnormalities, time to surgery, symptoms, treatment modalities, initial surgical technique, surgical complications, percent lost to follow-up, mean follow-up period, and treatment outcome. RESULTS The results from the 6 studies of 216 patients show a distinct pattern in pediatric TOS, with a 1.84:1 female-to-male ratio, a mean age of 15.49 years, and a lower prevalence of neurogenic TOS (75%, 95% CI 0.41-0.93; I2 = 86%, p < 0.01) compared with the prevailing literature on adults (87.5%-99%). Venous and arterial TOS accounted for a higher proportion of cases in pediatric patients than in adults, challenging the traditional adult-oriented perspective. Right-sided presentations were more common, reflecting right-arm dominance in most individuals. Additionally, bony abnormalities were more common in adults (30%) than in children (10.65%). Treatments involved mixed methods, predominantly using combinations of muscle resection (95.26%), neurolysis (78.02%), and bone resection (72.41%). Patients had high rates of symptom improvement (89%, 95% CI 0.67-0.97; I2 = 85%, p < 0.01) following surgery, with improvement of symptoms ranging from slight to complete relief. Complications were infrequent (5.66%), and most patients reported positive outcomes. The limitations of this analysis include subjective diagnostic and reporting criteria for TOS given its broad range of presentations. CONCLUSIONS This systematic review and meta-analysis brings to light the distinctive characteristics of pediatric TOS and underscores the importance of recognizing these differences to ensure accurate diagnosis and effective treatment in this patient population. Further research is needed to understand the predictive value of conservative treatments, especially in pediatric TOS cases.
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Affiliation(s)
- Anthony Price
- 1John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Texas
- 2Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Texas
| | - Nathan Fredricks
- 1John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Texas
- 2Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Texas
| | - Nina Truong
- 1John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Texas
- 2Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Texas
| | - Robert Y North
- 3Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Bach K, Miller MA, Allgier A, Al Muhtaseb T, Little KJ, Schwentker AR. Thoracic Outlet Syndrome in the Pediatric and Young Adult Population. J Hand Surg Am 2024; 49:337-345. [PMID: 38310509 DOI: 10.1016/j.jhsa.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE This study aimed to assess both nonsurgical and operative treatment outcomes of pediatric and young adult patients with thoracic outlet syndrome (TOS) at a tertiary care pediatric hospital. METHODS A retrospective chart review of patients diagnosed with TOS, who were seen between January 2010 and August 2022 at a tertiary care pediatric hospital, was conducted. Collected pre- and postoperative data included symptoms, provocative testing (ie, Roo's, Wright's, and Adson's tests), participation in sports or upper-extremity activities, additional operations, and surgical complications. Assessment of operative treatment efficacy was based on pre- and post-provocative testing, pain, venogram results, alleviation of symptoms, and return to previous activity level 6 months after surgery. RESULTS Ninety-six patients, (70 females and 26 males) with an average age at onset of 15 ± 4 (4-25) years, met the inclusion criteria for TOS. Among them, 27 had neurogenic TOS, 29 had neurogenic and vasculogenic TOS, 20 had vasculogenic TOS, 19 had Paget-Schroetter Syndrome, and one was asymptomatic. Twenty-six patients were excluded because of less than 6 months of follow-up. Of the remaining 70, 6 (8.6%) patients (4 bilateral and 2 unilateral) underwent nonoperative management with activity modification and physical therapy only, and one was fully discharged because of complete relief of symptoms. Sixty-four (90.1%) patients (45 bilateral and 19 unilateral) underwent surgery. A total of 102 operations were performed. Substantial improvements were observed in provocative maneuvers after surgery. Before surgery, 79.7% were involved in sports or playing musical instruments with repetitive overhead activity, and after surgery, 86.2% of these patients returned to their previous activity level. CONCLUSIONS Few patients were successfully managed with nonoperative activity modification and physical therapy. In those requiring surgical intervention, first or cervical rib resection with scalenectomy using a supraclavicular approach provided resolution of symptoms with 86.2% of patients being able to return to presymptom sport or activity level. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Karen Bach
- University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Melissa A Miller
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Allison Allgier
- Department of Occupational and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Tamara Al Muhtaseb
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Kevin J Little
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Ann R Schwentker
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Vilanilam GK, Gopal N, Middlebrooks EH, Huang JF, Bhatt AA. Compressive lesions of the head and neck: Common and uncommon must-know entities. Neuroradiol J 2024; 37:164-177. [PMID: 37026517 PMCID: PMC10973822 DOI: 10.1177/19714009231166083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
There are many lesions that cause compression of nerves and vessels in the head and neck, and they can often be overlooked in the absence of adequate history or if not suspected by the radiologist. Many of these lesions require a high index of suspicion and optimal positioning for imaging. While a multimodality approach is critical in the evaluation of compressive lesions, an MRI utilizing high-resolution (heavily weighted) T2-weighted sequence is extremely useful as a starting point. In this review, we aim to discuss the radiological features of the common and uncommon compressive lesions of the head and neck which are broadly categorized into vascular, osseous, and miscellaneous etiologies.
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Affiliation(s)
- George K Vilanilam
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Neethu Gopal
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Erik H Middlebrooks
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Alok A Bhatt
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
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Ferris S, Lonie S. Bilateral Thoracic Outlet Syndrome from Anomalous 8th Cervical Vertebrae Ribs. J Brachial Plex Peripher Nerve Inj 2022; 17:e30-e32. [PMID: 35860506 PMCID: PMC9293487 DOI: 10.1055/s-0042-1753541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/09/2022] Open
Abstract
Thoracic outlet syndrome (TOS) is a group of diverse disorders resulting from compression of neurovascular structures as they pass from the lower neck to upper limb. Neurological symptoms, such as pain, weakness, or paraesthesia, are much more common than vascular symptoms such as pallor or venous congestion. Anatomical abnormalities can contribute to this condition. Thirty percent of patients with TOS can have a cervical rib, arising from the transverse process of the 7th cervical vertebra, compared with 1% of the general population. We report the first case in the literature of neurogenic TOS from a cervical rib arising from a supernumerary 8th cervical vertebra. This patient had immediate improvement in TOS symptoms following scalene muscle surgery and resection of cervical and first thoracic ribs.
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Affiliation(s)
- Scott Ferris
- Department of Plastic, Hand and Faciomaxillary Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - Sarah Lonie
- Department of Plastic, Hand and Faciomaxillary Surgery, Alfred Health, Melbourne, Victoria, Australia
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Ansuategui-Vicente M, Tapia-Lopez Y, Cases-Perez C, Ibarra-Sanchez G, Gutierrez AG, Gonzalez-Fajardo JA. Treatment of Thoracic Outlet Syndrome Complications Assisted with a Cerebral Embolism Protection Device. Methodist Debakey Cardiovasc J 2022; 18:108-112. [PMID: 36313530 PMCID: PMC9562785 DOI: 10.14797/mdcvj.1103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023] Open
Abstract
We report a case of a stroke and upper limb ischemia in a 27-year-old female secondary to a right cervical rib and retrograde thromboembolization. Follow-up showed complete patency of the vessels after thrombectomy and internal carotid artery stenting followed by transbrachial embolectomy performed with a cerebral protection device. The cervical rib was surgically removed to prevent additional events.
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Kaderi SAA, Shinde P, Tilloo R, Chetan S, Dalal T, Vaghmare S, Bhesaniya D, Shah S, Rege S. A Never Described Variant of the Cervical Rib Causing Arterial Thoracic Outlet Syndrome: World's First Case. Surg J (N Y) 2021; 7:e179-e183. [PMID: 34307875 PMCID: PMC8298134 DOI: 10.1055/s-0041-1731654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/17/2021] [Indexed: 11/04/2022] Open
Abstract
Cervical ribs, also known as Eve's ribs, are rare and found in 1% of population. They are more common in females and more common on right side. They are asymptomatic in 90% of cases. Cervical rib fused with transverse process of sixth vertebra is rarer. We present a case of dry gangrene of lateral three fingers with right radial and subclavian artery thrombosis with rest pain, due to right cervical rib fused with transverse process of sixth vertebra. After development of line of demarcation of the dry gangrene, patient was operated for excision of cervical rib and sixth cervical vertebral transverse process followed by Ray's amputation of right second finger. Postoperative course was uneventful. Patient was discharged with oral anticoagulation and a healthy wound in right hand.
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Affiliation(s)
| | - Pravin Shinde
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Raviraj Tilloo
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Sonewane Chetan
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Tanvi Dalal
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Sahil Vaghmare
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Dhaval Bhesaniya
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Sulay Shah
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Sameer Rege
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
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Milagres VAMV, Avellar RLDS, Silva APP, Pires PJ, Pinto DM. Treatment of upper limb arterial occlusion caused by a cervical rib. J Vasc Bras 2021; 20:e20200193. [PMID: 34211537 PMCID: PMC8218826 DOI: 10.1590/1677-5449.200193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The cervical rib syndrome occurs when the interscalene triangle is occupied by a cervical rib, displacing the brachial plexus and the subclavian artery forward, which can cause pain and muscle spasms. The objective of this study is to discuss diagnosis of the cervical rib syndrome and treatment possibilities. This therapeutic challenge describes clinical and surgical management of a 37-year-old female patient with upper limb arterial occlusion caused by a cervical rib.
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da Silva ER, Dalio MB, Santarosa MB, Oliveira TF, Ribeiro MS, Joviliano EE. Surgical treatment of cervical rib-associated arterial thoracic outlet syndrome. J Vasc Bras 2021; 20:e20200106. [PMID: 34093679 PMCID: PMC8147708 DOI: 10.1590/1677-5449.200106_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The arterial form of thoracic outlet syndrome is rare and is associated with anatomic anomalies, generally a cervical rib. It has a varied range of manifestations. The aim of this article is to describe two cases with different clinical presentations: microembolization and aneurysm. A cervical rib was present in both cases. Diagnosis was made on the basis of history, physical examination, postural maneuvers, and X-rays. Computed tomography angiography provided the anatomic detail necessary to plan surgery. Surgical treatment was performed via supraclavicular access, successfully, in both cases.
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Affiliation(s)
- Elpidio Ribeiro da Silva
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil
| | - Marcelo Bellini Dalio
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil
| | - Marco Bianco Santarosa
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil
| | - Tércio Ferreira Oliveira
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil
| | - Maurício Serra Ribeiro
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil
| | - Edwaldo Edner Joviliano
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil
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Tung-Chen Y, Marín-Baselga R, Tejada-Sorados R, Enfedaque-Castilla I. The use of ultrasound in the emergency department for the detection of thoracic outlet syndrome: A single case study. Ultrasound 2021; 29:64-66. [PMID: 33552230 DOI: 10.1177/1742271x20941174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/18/2020] [Indexed: 11/15/2022]
Abstract
Introduction Thoracic outlet syndrome (TOS) refers to a spectrum of syndromes related to the compression of the brachial plexus (neurogenic TOS), subclavian vein or artery in the general region of the thoracic outlet, which is the area just above the first rib and behind the clavicle. Case report We report a 27-year-old healthy man who presented to the emergency department with right upper limb pain, tingling and weakness. Point-of-care ultrasonography was performed following a dynamic protocol in the supraclavicular fossa in the right upper limb. A congenital cervical rib, as well as narrowing of the costoclavicular gap, causing vein, artery and spinal roots compression was evidenced. This maneuver reproduced the symptoms, confirming the suspicion of neurogenic TOS. Discussion Early diagnosis is important, because the neurogenic compression associated with neurogenic TOS, if prolonged, can lead to muscle weakness and atrophy, being irreversible. Selected patients with neurogenic TOS who have progressive weakness, disabling pain, or who have failed to improve with conservative measures are considered for first rib resection. Conclusion Using the dynamic approach during point-of-care ultrasonography examination, in combination with physical examination and cervical radiography, could help identify neurogenic TOS.
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Affiliation(s)
- Yale Tung-Chen
- Department of Emergency Medicine, Hospital Universitario La Paz, Madrid, Spain
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10
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Al-Jundi W, Park WM. Digital ischaemia of the upper limbs in middle age: consider arterial thoracic outlet syndrome until proven otherwise! Rheumatol Adv Pract 2020; 5:rkaa045. [PMID: 33615125 PMCID: PMC7884024 DOI: 10.1093/rap/rkaa045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/05/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives Patients presenting with digital upper limb ischaemia are occasionally referred to rheumatology services to rule out vasculitis. We aimed to present two cases of delayed diagnosis of arterial thoracic outlet syndrome (aTOS) in middle-aged patients presenting with digital ischaemia in order to raise awareness of this important pathology that requires timely surgical intervention. Methods Two cases of progressive ischaemia of the right upper extremity caused by primarily undiagnosed compression of the subclavian artery by an accessory cervical rib are presented. The case notes, radiological images, intra-operative and postoperative findings for both patients were reviewed. Patients were followed up after ≥6 months to assess prognosis. Results Both patients had a working diagnosis of Buerger’s disease and had been treated with prostaglandin infusions before establishment of the diagnosis of arterial thoracic outlet syndrome. Both patients were heavy smokers, and one patient had bilateral symptoms and a history of axial SpA and positive HLA-B27. Late presentation in one patient led to the loss of three fingers and the need for plastic reconstructive surgery after cervical rib resection and revascularization. In the other patient, surgical thrombectomy of the upper limb arteries along with resection of a cervical rib and repair of the subclavian artery with an interposition graft were necessitated to heal digital ulcers successfully. Conclusion A high index of suspicion of aTOS should be maintained in middle-aged patients presenting with digital or upper limb ischaemia even in the presence bilateral symptoms or relevant risk factors of other diagnoses, such as smoking or a positive rheumatological history.
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Affiliation(s)
- Wissam Al-Jundi
- Norwich Vascular Unit, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - WooSup Michael Park
- Heart and Vascular Institute, Cleveland Clinic Abu-Dhabi, Abu-Dhabi, United Arab Emirates
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Ramasamy K, Saniasiaya J, Gani NA. A hard left supraclavicular mass in a young boy-is it cancer? Malays Fam Physician 2020; 15:53-55. [PMID: 32843947 PMCID: PMC7430310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- K Ramasamy
- MBBS (Malaya) MRCSI (ENT) Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Tuanku Ja'afar Seremban Malaysia E-mail:
| | - J Saniasiaya
- MMed (ORL-HNS)(USM) Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Tuanku Ja'afar Seremban Malaysia
| | - N A Gani
- MMed (ORL-HNS)(UKM) Department of OtorhinolaryngologyHead & Neck Surgery, Hospital Tuanku Ja'afar Seremban Malaysia
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12
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Schut PC, Ten Broek CMA, Cohen-Overbeek TE, Bugiani M, Steegers EAP, Eggink AJ, Galis F. Increased prevalence of abnormal vertebral patterning in fetuses and neonates with trisomy 21. J Matern Fetal Neonatal Med 2018; 32:2280-2286. [PMID: 29353507 DOI: 10.1080/14767058.2018.1431622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the prevalence of an abnormal number of ribs in a cohort of fetuses and neonates with trisomy 21 and compare this with a subgroup of fetuses without anomalies. MATERIALS AND METHODS Radiographs of 67 deceased fetuses, neonates, and infants that were diagnosed with trisomy 21 were reviewed. Terminations of pregnancy were included. The control group was composed of 107 deceased fetuses, neonates, and infants without known chromosomal abnormalities, structural malformations, infections or placental pathology. Cases in which the number of thoracic ribs or presence of cervical ribs could not be reliably assessed were excluded. The literature concerning vertebral patterning in trisomy 21 cases and healthy subjects was reviewed. RESULTS Absent or rudimentary 12th thoracic ribs were found in 26/54 (48.1%) cases with trisomy 21 and cervical ribs were present in 27/47 (57.4%) cases. This prevalence was significantly higher compared to controls (28/100, 28.0%, Χ2(1) = 6.252, p = .012 and 28/97, 28.9%, Χ2(1) = 10.955, p < .001, respectively). CONCLUSIONS Rudimentary or absent 12th thoracic ribs and cervical ribs are significantly more prevalent in deceased fetuses and infants with trisomy 21.
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Affiliation(s)
- Pauline C Schut
- a Department of Obstetrics and Gynecology , Erasmus MC University Medical Center , Division of Obstetrics and Prenatal Medicine , Rotterdam , The Netherlands
| | | | - Titia E Cohen-Overbeek
- a Department of Obstetrics and Gynecology , Erasmus MC University Medical Center , Division of Obstetrics and Prenatal Medicine , Rotterdam , The Netherlands
| | - Marianna Bugiani
- c Department of Pathology , VU University Medical Centre , Amsterdam , The Netherlands
| | - Eric A P Steegers
- a Department of Obstetrics and Gynecology , Erasmus MC University Medical Center , Division of Obstetrics and Prenatal Medicine , Rotterdam , The Netherlands
| | - Alex J Eggink
- a Department of Obstetrics and Gynecology , Erasmus MC University Medical Center , Division of Obstetrics and Prenatal Medicine , Rotterdam , The Netherlands
| | - Frietson Galis
- b Naturalis Biodiversity Center , Leiden , The Netherlands
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Ferrante MA, Ferrante ND. The thoracic outlet syndromes: Part 2. The arterial, venous, neurovascular, and disputed thoracic outlet syndromes. Muscle Nerve 2017; 56:663-673. [PMID: 28006856 DOI: 10.1002/mus.25535] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 01/08/2023]
Abstract
The thoracic outlet syndromes (TOSs) are a group of etiologically and clinically distinct disorders with 1 feature in common: compression of 1 or more neurovascular elements as they traverse the thoracic outlet. The medical literature reflects 5 TOSs: arterial; venous; traumatic neurovascular; true neurogenic; and disputed. Of these, the first 4 demonstrate all of the features expected of a syndrome, whereas disputed TOS does not, causing many experts to doubt its existence altogether. Thus, some categorize disputed TOSs as cervicoscapular pain syndrome rather than as a type of TOS. To better understand these disorders, their distinctions, and the reasoning underlying the categorical change of disputed TOS from a form of TOS to a cervicoscapular pain syndrome, a thorough understanding of the pertinent anatomy, pathology, pathophysiology, and electrodiagnostic manifestations of these pathophysiologies is required. This review of the TOSs is provided in 2 parts. In part 1 we covered general information pertinent to all 5 TOSs and reviewed true neurogenic TOS in detail. In part 2, we review the arterial, venous, traumatic neurovascular, and disputed forms of TOS. Muscle Nerve 56: 663-673, 2017.
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Affiliation(s)
- Mark A Ferrante
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Neurophysiology Division, Department of Neurology, Veterans Administration Medical Center, Memphis, Tennessee, USA
| | - Nicole D Ferrante
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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14
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Ferrante MA, Ferrante ND. The thoracic outlet syndromes: Part 1. Overview of the thoracic outlet syndromes and review of true neurogenic thoracic outlet syndrome. Muscle Nerve 2017; 55:782-793. [PMID: 28006844 DOI: 10.1002/mus.25536] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 01/15/2023]
Abstract
The thoracic outlet syndromes (TOSs) are a group of etiologically and clinically distinct disorders with 1 feature in common: compression of 1 or more neurovascular elements as they traverse the thoracic outlet. The medical literature reflects 5 TOSs: arterial; venous; traumatic neurovascular; true neurogenic; and disputed. Of these, the first 4 demonstrate all of the features expected of a syndrome, whereas disputed TOS does not, causing many experts to doubt its existence altogether. Thus, some categorize disputed TOS as a cervicoscapular pain syndrome rather than as a type of TOS. To better understand these disorders, their distinctions, and the reasoning underlying the categorical change of disputed TOS from a form of TOS to a cervicoscapular pain syndrome, a thorough understanding of the pertinent anatomy, pathology, pathophysiology, and the electrodiagnostic manifestations of their pathophysiologies is required. This review of the TOSs is provided in 2 parts. In this first part we address information pertinent to all 5 TOSs and reviews true neurogenic TOS. In part 2 we review the other 4 TOSs. Muscle Nerve 55: 782-793, 2017.
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Affiliation(s)
- Mark A Ferrante
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Neurophysiology Division, Department of Neurology, Veterans Administration Medical Center, Memphis, Tennessee, USA
| | - Nicole D Ferrante
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Morjaria JB, Aslam I, Johnson B, Greenstone MA, Kastelik JA. Bilateral chylothorax: an unusual complication of cervical rib resection. Ther Adv Chronic Dis 2015; 6:29-33. [PMID: 25553240 DOI: 10.1177/2040622314552072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bilateral chylothorax is a rare cause of pleural effusions. Here we report an unusual acute presentation of bilateral chylothorax following thoracic outlet surgery. Unique to this case was the disparate characteristics of pleural fluid analyses with an exudate on the left and a transudate on the right. This report describes the recognition and management of bilateral chylothoraces, an uncommon but potentially serious complication of this frequently performed surgical procedure.
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Affiliation(s)
- Jaymin B Morjaria
- Department of Respiratory Medicine, Hull & East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Cottingham, UK
| | - Imran Aslam
- Department of Respiratory Medicine, Hull & East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Cottingham, UK
| | - Brian Johnson
- Department of Vascular Surgery, Hull & East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, Hull, UK
| | - Michael A Greenstone
- Department of Respiratory Medicine, Hull & East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Cottingham, UK
| | - Jack A Kastelik
- Department of Respiratory Medicine, Hull & East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Cottingham, UK
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Ioannou CV, Kafetzakis A, Kounnos C, Koukoumtzis D, Tavlas E, Kostas T. A delayed diagnosis that altered the professional orientation of an athlete with upper limb chronic arterial embolization. Med Sci Monit 2012; 18:CS1-3. [PMID: 22207121 PMCID: PMC3560684 DOI: 10.12659/msm.882184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 08/29/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Vascular disorders of the upper extremity in young and physically active patients present a complex and challenging problem for the treating physician. Initial presentation may often be subtle and the consequences of misdiagnosis, delayed diagnosis or mistreatment can be severe. CASE REPORT In this report, we discuss a case of a young woman with chronic upper limb ischemia due to an arterial thoracic outlet syndrome in whom even though symptoms persisted over a number of years during which she frequently sought medical consultation, remained undiagnosed until finally presenting with limb-threatening ischemia. Furthermore, due to this delay, the patient was forced to withdraw from her professional carrier in athletics. CONCLUSIONS A thoughtful and through approach combining the history, physical findings, and use of appropriate diagnostic aids will provide the physician and patient with the greatest opportunity for a satisfactory outcome. Furthermore, a delay in definitive treatment may not only cause health deterioration, but may also incur social, economic and occupational consequences.
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Affiliation(s)
- Christos V Ioannou
- Department of Vascular Surgery, University of Crete Medical School, Iraklion, Greece.
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