Abstract
Background
Clinicians trained in point-of-care ultrasound (POCUS) use the tool to enhance diagnostic
capabilities at the bedside, often excluding or diagnosing conditions that are suspected
based on the history and physical examination. Thoracic outlet syndrome (TOS) involves
compression of arteries and nerves between the clavicle and first rib causing pain
and paresthesia in the affected limbs. To our knowledge, use of POCUS to diagnose
TOS in the literature has not been described.
Case Report
A 46-year-old man presented with left upper extremity (LUE) edema, pain, and paresthesia,
which was progressive over 3 weeks. Examination of the LUE revealed diffuse swelling
without erythema and a left radial pulse present on Doppler only. A subsequent POCUS
examination of the LUE was performed to exclude a deep vein thrombosis, and enlarged
and turbulent veins distal to the internal jugular vein were found, which suggested
venous compression external to the veins. Additional imaging confirmed narrowing of
the subclavian vein and a diagnosis of venous thoracic outlet syndrome (vTOS) was
made.
Why Should an Emergency Physician Be Aware of This?
Failure to promptly diagnose and treat TOS can lead to long-term chronic upper extremity
pain and even permanent disability. Diagnosis of vascular TOS is often made using
computed tomography to identify impinged vessels, although color Doppler sonography
can be an excellent choice for initial imaging in patients with suspected vTOS. Although
POCUS is being used increasingly as a diagnostic tool and for procedural guidance,
our case represents a novel application of POCUS in the diagnosis of vTOS.
Keywords
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References
Jones MR, Prabhakar A, Viswanath O, et al. Thoracic outlet syndrome: a comprehensive review of pathophysiology, diagnosis, and treatment. Pain Ther 2109;8:5–18.
- Thoracic outlet syndrome: evaluation of the subclavian vessels by color duplex sonography.AJR Am J Roentgenol. 1992; 158: 623-630
- Noninvasive Vascular Diagnosis: A Practical Guide to Therapy.Springer, 2012
- Duplex ultrasound in the evaluation of venous and arterial thoracic outlet syndrome.JRSM Open. 2021; 122054270420983101https://doi.org/10.1177/2054270420983101
- The use of ultrasound in the emergency department for the detection of thoracic outlet syndrome: a single case study.Ultrasound. 2021; 29: 64-66
- A comprehensive review of Paget-Schroetter syndrome.J Vasc Surg. 2010; 51: 1538-1547
- Evaluation and management of venous thoracic outlet syndrome.Thorac Surg Clin. 2021; 31: 27-44
Article Info
Publication History
Published online: September 10, 2022
Accepted:
September 4,
2022
Received in revised form:
July 25,
2022
Received:
February 24,
2022
Publication stage
In Press Corrected ProofFootnotes
Streaming video: Seven brief real-time video clips that accompany this article are available in streaming video at www.journals.elsevierhealth.com/periodicals/jem. Click on Video Clips 1–7.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
