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Have Thoracic Outlet Syndrome. Having Pain In Arm, Breast And Swelling In Back. CT Scan Negative. Suggest

Posted on Thu, 1 Aug 2013

Question: Hello, I was told I may have vascular thoracic outlet syndrome. I lose my pulse in my left wrist when I turn my head to the right. I have pain in my life arm, left breast and back swelling, neck pain, but my CT is negative. How can that be? I am to see vascular surgery in the near future, what will they do? I hope this isn't something that I will just have to live with. I have hit my breaking point of Motrin, Tylenol and lymph drainage.

Answered by Dr. Jorge Brenes-Salazar (1 hour later)

Dear patient

Thanks for your concerns. Most of the cases of thoracic outlet syndrome are caused by compression of the cervical musculature, typically the scalene muscles, of vascular and nervous structures of the neck. Typically, surgery involves partial resection of this muscles to free the structures. Rarely, this syndrome is caused by an accesory cervical rib which does not seem to be your case

Yours truly

Dr Brenes Salazar MD
Cardiology
Mayo Clinic

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Jorge Brenes-Salazar (15 hours later)

What type of surgeon would do this surgery? How do they see the compression that these muscles cause, by physical exam, a scan or some sort?

Answered by Dr. Jorge Brenes-Salazar (1 hour later)

thanks for the follow up

Usually as you mentioned in the first part of your query, it is a clinical diagnosis made on the basis of physical examination maneuvers and the change of pulse when turning the neck; MRI of the chest can be helpful to confirm, but before these imaging techniques it was a physical diagnosis. Vascular and general surgeons should be familiar with the procedure

truly yours

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Jorge Brenes-Salazar (14 hours later)

Thank you. Have you ever heard of breast/chest, back and upper arm edema and arm pain with weakness on the effected side? All the edema is on the left side, sometimes going up to the left side of my face.

Answered by Dr. Jorge Brenes-Salazar (8 hours later)

Hi,

Yes, that could be part of the presentation by virtue of compression of the subclavian vein which receives blood both from those anatomical regions you just mentioned.

Yours truly,

Dr Brenes Salazar MD

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Jorge Brenes-Salazar (5 hours later)

Hmmm, so am I correct in assuming that a CT would not always pick up the compression of the subclavian vein where my CT was normal? My fear is that I will be told that there is nothing that can be done for this issue, and my patience is wearing thin.

Answered by Dr. Jorge Brenes-Salazar (15 minutes later)

Hi,

Consideration could be given to an angiogram to pursue the diagnosis as it could show the dynamic kink; on the angiogram table you are able to turn the neck in the way that reproduces your symptoms. A peripheral vascular cardiologist would be well versed in such a procedure

Yours truly

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Jorge Brenes-Salazar (25 hours later)

Could this issue also cause the feeling of chest heaviness when I lie flat for any length of time, and palpitations? I only notice them during the day very infrequently, and have never been close enough to a monitor to see what it is, but I notice it mostly when I am laying in bed. Self limiting, lasts no more than 10 minutes or so. I usually change position and it stops.

Answered by Dr. Jorge Brenes-Salazar (22 hours later)

It would not be a typical manifestation of thoracic outlet syndrome it being at rest and laying down, not stretching the structures of the outlet. The palpitations might be premature atrial or ventricular contractions. I think overall that if your symptoms are so limiting as you mentioned, and the diagnosis is still in the differential, an axillary/subclavian angiogram could be considered.

Best regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar