A case series of first rib resection patients assessed with a novel MRI protocol for neurogenic thoracic outlet syndrome

Phillip J Whiley; Rohit Tamhane; David T A Hardman

doi:10.1093/jscr/rjad672

A case series of first rib resection patients assessed with a novel MRI protocol for neurogenic thoracic outlet syndrome

J Surg Case Rep. 2023 Dec 16;2023(12):rjad672. doi: 10.1093/jscr/rjad672. eCollection 2023 Dec.

Authors

Phillip J Whiley^{1

2}, Rohit Tamhane³, David T A Hardman^{4

5}

Affiliations

¹ Department of General Surgery, The Canberra Hospital, Yamba Drive, Garran, Canberra, ACT 2605, Australia.
² The Australian National University Medical School, Yamba Drive, Garran ACT 2605, Australia.
³ Canberra Imaging Group, 173 Strickland Crescent Deakin West, ACT 2600, Australia.
⁴ Calvary John James Hospital, 173 Strickland Crescent, Deakin West, ACT 2600, Australia.
⁵ University of Canberra, Centre for Research in Therapeutic Solutions 11 Kirinari St, Bruce ACT 2617, Australia.

Abstract

Selecting patients who will benefit from first rib resection for neurogenic thoracic outlet syndrome (nTOS) is made difficult by the variety of overlap symptoms with other musculoskeletal, neurogenic and psychological disease. A single diagnostic test is not available, and the diagnosis is typically made based on clinical findings and history. This case series assessed the utility of magnetic resonance imaging (MRI), with the patient's arm placed in a symptom provoking position above the head, as a component of diagnosis nTOS and selection of patients to offer surgery. Outcomes from first rib resection were assessed using the guidelines of The Society for Vascular Surgery for Thoracic Outlet Syndrome. The cases demonstrate that the loss of perineural fat signal on MRI of the brachial plexus with the arm in the provocative position is a useful tool for assessing patients who would benefit from first rib resection for nTOS.

Keywords: MRI; first rib resection; outcomes; thoracic outlet.

Publication types

Case Reports