Nakabayashi Keisuke, Ando Hiroshi
Heart Center, Kasukabe Chuo General Hospital, Kasukabe, JPN.
Cureus. 2021 Nov 2;13(11):e19198. doi: 10.7759/cureus.19198. eCollection 2021 Nov.
A 96-year-old female with severe dementia complained of subacute onset of right arm swelling after sleep using her right arm as a pillow. Computed tomography and ultrasonography could not detect any significant findings. Nevertheless, her unilateral edema was similar to that of a venous disorder; therefore, we performed angiography of the brachial vein with the right arm in a normal position and in an abduction position; significant stenosis was seen in the latter position. We diagnosed her with venous thoracic outlet syndrome. This case was unique from the typical cases of venous thoracic outlet syndrome because of the subacute onset of symptoms, high age at onset, and discrepancies between ultrasonography and angiography findings. Dementia is the key factor explaining these features. The diagnosis of thoracic outlet syndrome is generally difficult. Although provocative physical examination maneuvers and ultrasonography are essential, dynamic testing with provocative maneuvers allows physicians to detect venous compression, even if it is difficult to capture with static imaging tests. Once the diagnosis and its etiology were confirmed, corresponding intervention, including physical therapy, is warranted.
一名96岁的重度痴呆女性患者，主诉在睡眠中将右臂用作枕头后出现右臂亚急性肿胀。计算机断层扫描和超声检查未发现任何明显异常。然而，她的单侧水肿与静脉疾病相似；因此，我们在右臂处于正常位置和外展位置时对肱静脉进行了血管造影；在后一种位置发现了明显的狭窄。我们诊断她患有静脉型胸廓出口综合征。该病例与典型的静脉型胸廓出口综合征病例不同，原因在于症状亚急性起病、发病年龄高以及超声检查和血管造影结果存在差异。痴呆是解释这些特征的关键因素。胸廓出口综合征的诊断通常较为困难。尽管激发性体格检查动作和超声检查至关重要，但激发性动作的动态测试能使医生检测到静脉受压情况，即便静态成像检查难以捕捉到。一旦确诊及其病因得到证实，就有必要进行相应的干预，包括物理治疗。
