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Kakamad FH, Asaad SK, Tahir SH, Sabr NS, Ghafour AK, Omer CS, Rashid RJ, Hama Amin BJ, Kareem PM, Mohammed MS. Thoracic outlet syndrome caused by superior mediastinal mass: A case report. Asian Cardiovasc Thorac Ann 2024:2184923241230706. [PMID: 38327076 DOI: 10.1177/02184923241230706] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Thoracic outlet syndrome (TOS) caused by superior mediastinal soft tissue mass has never been reported in the literature, the aim of this study is to discuss a case of TOS caused by a superior mediastinal mass in which the histopathological examinations of the mass showed vascular malformation. CASE REPORT A 45-year-old female presented with left upper limb pain and numbness for three months, associated with swelling and attacks of shortness of breath. Imaging studies showed soft tissue mass involving the superior mediastinum. The condition of the patient deteriorated and the signs and symptoms of TOS became clearer, all provocative tests and nerve conduction studies were positive. The patient underwent thoracic outlet decompression. The patient did not respond and the symptoms deteriorated further. After a multidisciplinary board discussion, the patient was prepared for median sternotomy under general anesthesia. A total resection of the mass was done. The patient was totally relieved a few hours after the operation. DISCUSSION The etiology of TOS can be multifaceted. Several factors contribute to its onset, and these can be categorized as congenital or acquired. Congenital causes include anatomical anomalies such as a cervical rib, or an elongated transverse process of the cervical vertebrae. These anatomical deviations can reduce the size of the thoracic outlet and make it prone to compression. CONCLUSION Although it is rare, TOS could be due to superior mediastinal mass and the treatment of choice is total resection either through median sternotomy or thoracoscopic procedure.
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Affiliation(s)
- Fahmi H Kakamad
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
- Kscien Organization for Scientific Research (Middle East office), Kurdstan, Iraq
- Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan, Iraq
| | - Saywan Kakarash Asaad
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
- Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan, Iraq
| | - Soran H Tahir
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
- Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan, Iraq
| | - Nasren Sharef Sabr
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
| | - Adullah K Ghafour
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
- Department of Orthopaedics, Shahid Peshraw Hospital, Kurdistan, Iraq
| | - Choman Sabah Omer
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
| | - Rezheen J Rashid
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
- Department of Radiology, Hiwa Cancer Hospital, Kurdistan, Iraq
| | | | - Pavel Mustafa Kareem
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
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Sakamoto A, Okudaira S, Onishi Y, Noguchi T, Matsuda S. Stress Fractures of the First Rib Related to Soft Tennis, Associated with the Tennis Ground Stroke. Open Access J Sports Med 2023; 14:99-102. [PMID: 38162145 PMCID: PMC10757769 DOI: 10.2147/oajsm.s447674] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024] Open
Abstract
Stress fractures of the first rib are uncommon and thought to be associated with overhead-throwing athletes. Soft tennis is similar to regular tennis but uses a much softer rubber ball. In the current report, a 14-year-old girl suffered from shoulder girdle pain, especially at the end of her tennis ground stroke. Plain radiographs showed overgrowth of bone with a fracture line on the first rib, and a diagnosis of stress fracture was made. She was advised to amend her stroke form to reduce force to the shoulder and was able to continue sports activity without pain 10 months after the appearance of her symptoms and before confirmation of bone healing. The current case is not associated with overhead-throwing, but possibly with repetitive exercises of her tennis ground strokes. Conservative medical follow-up with proper sport-specific professional advice allows continuation of the sport.
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Affiliation(s)
- Akio Sakamoto
- The Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuzo Okudaira
- The Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuta Onishi
- The Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Noguchi
- The Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- The Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Akaslan I, Ertas A, Uzel M, Ozdol C, Aghayev K. Surgical Anatomy of the Posterior Intermuscular Approach to the Brachial Plexus. Hand (N Y) 2021; 16:759-764. [PMID: 31948270 PMCID: PMC8647327 DOI: 10.1177/1558944719895619] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: First rib resection and scalenectomy is a well-established treatment option for thoracic outlet syndrome. The posterior approach is rarely used due to extensive muscle sacrifice resulting in significant procedural morbidity. In this paper, we report the surgical anatomy of modified and less-invasive muscle-sparing posterior approach. Methods: Eleven human cadavers were used in this study. With specific care to preserve muscles' integrity, the brachial plexus was exposed by dissecting through the posterior neck musculature. A muscular triangle was found under the trapezius muscle, which provided direct access to deeper structures. Four anatomical reference points were identified to denote a 3-dimensional space enclosing proximal brachial plexus. Results: A muscular triangle was found under the trapezius muscle in all cadavers. It was bordered infero-medially by rhomboid minor, supero-medially by splenius capitis, and laterally by levator scapula muscles. The inferomedial border (rhomboid) was 55 mm (48-80), superomedial border (splenius capitis) was 60.5 mm (42-89), and the lateral border (levator scapulae) was 99 mm (60-130). A consistent vein was present inside the triangle and could be used as an anatomical landmark. The 4 reference points were C5, T1 intervertebral foramina, transverse tubercle, and scalene tubercle of the first rib. Removal of the first rib could be performed without brachial plexus retraction. The latter was exposed from neural foramina to lateral border of the first rib. Conclusions: The posterior approach provides ample space to for exposure and manipulation with the first rib and proximal brachial plexus.
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Affiliation(s)
| | | | | | | | - Kamran Aghayev
- Biruni University, Istanbul, Turkey,Kamran Aghayev, Department of Neurosurgery, Biruni University, Eski Londra Asfalti No 10, Küçükçekmece, Istanbul 34010, Turkey.
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Artico M, Santarelli MT, Stevanato G, Cirocchi R, D'Andrea V, Nicolai A, Cialone G, Monteleone G, Pindinello I, Taurone S. The role of congenital malformations of the thoracic egress in the development of the syndrome. Folia Morphol (Warsz) 2021; 81:117-123. [PMID: 33438186 DOI: 10.5603/fm.a2020.0152] [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: 09/24/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022]
Abstract
Thoracic Outlet Syndrome (TOS) represents a clinical condition caused by compression of the neurovascular structures that cross the thoracic outlet. TOS can be classified in: 1) NTOS (neurogenic TOS), 2) VTOS (venous TOS), 3) ATOS (arterial TOS). Many different causes can determine the Syndrome: Congenital Malformations, Traumas, and Functional Impairments. This manuscript reviews how the congenital malformations play an important role in adult age; however, TOS also affects patients of all ages. Radiological imaging like RX (radiography), MR (Magnetic Resonance) and CT (Computed Tomography) can provide useful information to assess TOS causes and decide a potential surgery.79% of the patientsincluded in the first two stages of NAV staging experienced excellent results with FKT; whereas patients included in the third and fourth stage of NAV staging were subject to surgery.The treatment of acute forms of TOS involves thrombolysis and anticoagulant therapy; surgery is appropriate for true neurogenic TOS, vascular TOS and in some cases when conservative treatment fails.
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Affiliation(s)
- M Artico
- Department of Sensory Organs, "Sapienza" University of Rome, Italy
| | - M T Santarelli
- Department of Sensory Organs, "Sapienza" University of Rome, Italy
| | - G Stevanato
- Neurosurgery Unit, Dell'Angelo Hospital, Mestre, Venice, Italy
| | - R Cirocchi
- Department of Surgical Sciences, University of Perugia, Italy
| | - V D'Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Italy
| | - A Nicolai
- Department of Sensory Organs, "Sapienza" University of Rome, Italy
| | - G Cialone
- Unit of Radiology Regina Coeli, Rome, Italy
| | - G Monteleone
- Department of Biomedicine and Preventive Medicine, Tor Vergata University of Rome, Italy
| | - I Pindinello
- Department of Drug Chemistry and Technology, "Sapienza" University of Rome, Italy
| | - S Taurone
- Department of Sensory Organs, "Sapienza" University of Rome, Italy.
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Lynch JJ, Cross P, Heaton V. Sexual Dimorphism of the First Rib: A Comparative Approach Using Metric and Geometric Morphometric Analyses. J Forensic Sci 2017; 62:1251-1258. [PMID: 28168691 DOI: 10.1111/1556-4029.13421] [Citation(s) in RCA: 5] [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] [Received: 08/15/2016] [Revised: 11/11/2016] [Accepted: 12/06/2016] [Indexed: 11/30/2022]
Abstract
This research investigated the sexual dimorphism of the first human rib using geometric morphometric and metric approaches on a sample of 285 specimens containing European Americans and African Americans from the Hamann-Todd collection. Metric measurements were investigated for sexual dimorphism and ancestral differences using univariate statistics. Four type II landmarks and 40 sliding semi-landmarks were placed outlining the dorsal and ventral curvatures of the ribs. Landmark data were processed using Generalized Procrustes Analyses with Procrustes distance sliding, and the subsequent coordinates were investigated for sexual dimorphism and ancestral differences using Procrustes ANOVAs. Both geometric morphometric and metric data were analyzed using cross-validated discriminant function analyses to test the hypothesis that variables from both approaches can be combined to increase sex classification rate. European Americans had sex correctly classified as high as 88.05% and African Americans as high as 70.86% using a combination of metric and geometric morphometric variables.
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Affiliation(s)
| | - Peter Cross
- School of Forensic and Applied Sciences, University of Central Lancashire, Maudland Building, Room 137, Preston, PR1 2HR, UK
| | - Vivienne Heaton
- School of Physical and Geographical Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
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Rehemutula A, Zhang LI, Yu C, Chen L, Gu Y. Thoracoscopy-assisted first rib resection for the treatment of thoracic outlet syndrome caused by fibrous dysplasia: A report of two cases. Exp Ther Med 2015; 9:2241-4. [PMID: 26136967 DOI: 10.3892/etm.2015.2371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 01/16/2015] [Indexed: 11/05/2022] Open
Abstract
This study reports two rare cases of thoracic outlet syndrome (TOS) caused by fibrous dysplasia of the first rib. Two patients, aged 19 and 29 years old, were admitted with TOS in the lower trunk of the brachial plexus caused by an inflated first rib. In these two cases symptoms included hypoesthesia of the anterior medial aspect of the forearm and two fingers in the ulnar side, and progressive weakness of the upper limbs. Surgery was required to resect the first rib. Transaxillary and supraclavicular excisions were challenging to perform due to the involvement of the subclavian vasculature and brachial plexus. Thoracoscopy was used in these cases in order to peel the pleura off the first rib and facilitate resection by the supraclavicular approach. None of the patients exhibited nerve or vascular complications following the surgery.
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Abstract
A case of a first rib fracture and Horner's syndrome due to a motor vehicle collision is reported. Initial evaluation in a hospital emergency department and follow-up by a medical primary care physician failed to provide identification of the Horner's syndrome. Careful assessment and review of the patient's symptoms, signs and images revealed this uncommon and important neurologic case presentation. A brief discussion related to traumatic first rib fracture, Horner's syndrome and arterial dissections of the neck is provided.
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Affiliation(s)
- James Demetrious
- Private Practice, Demetrious Chiropractic Orthopedics, 4837 Carolina Beach Road, Suite 205, Wilmington, NC 28412, USA.
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Abstract
Subclavian vein (SCV) effort thrombosis, also known as the Paget-Schroetter syndrome, is a relatively uncommon condition that affects young, active, otherwise healthy individuals. It is considered a form of thoracic outlet syndrome, arising as a consequence of compression and repetitive injury of the SCV between the first rib and the overlying clavicle, as well as the anterior scalene muscle, subclavius muscle, and costoclavicular ligament. Effort thrombosis is distinct from other forms of deep vein thrombosis with respect to pathophysiology, clinical presentation, and functional consequences, and it requires treatment considerations unique to effective management of thoracic outlet compression as well as the obstructed SCV. In this review the comprehensive management of SCV effort thrombosis is addressed, with an emphasis on current interventional radiology techniques used in conjunction with definitive surgical treatment, based on early catheter-based venography, thrombolytic therapy, and prompt paraclavicular thoracic outlet decompression with direct SCV reconstruction.
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Affiliation(s)
- Robert W Thompson
- The Center for Thoracic Outlet Syndrome and the Department of Surgery, Section of Vascular Surgery ; Radiology, Washington University School of Medicine, St. Louis, Missouri
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Fujioka H, Kokubu T, Makino T, Nagura I, Toyokawa N, Inui A, Sakata R, Kurosaka M. Stress fracture of the first rib in a high school weight lifter. J Sports Sci Med 2009; 8:308-310. [PMID: 24149543 PMCID: PMC3761492] [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: 03/18/2009] [Accepted: 05/04/2009] [Indexed: 06/02/2023]
Abstract
A 17-year-old boy, who played a weight lifting in high school, sustained stress fracture of the first rib without any causes. We successfully treated first rib stress fracture with limitation of using the upper extremity and with using low-intensity pulsed ultrasound. Key pointsStress fracture of the first rib in a weight lifter was successfully treated with limitation of sports activity and with LIPUS treatment.
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Affiliation(s)
- Hiroyuki Fujioka
- Department of Orthopaedic Surgery, Hyogo College of Medicine , Nishinomiya, Japan ; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine , Kobe, Japan
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