Endara Santiago A, Dávalos Gerardo A, Fierro Christian H, Montero R Alejandra, Molina Gabriel A
Hospital Metropolitano, Department of Surgery, Division of Cardiothoracic Surgery, Quito, Ecuador.
Hospital Metropolitano, Department of Surgery, Division of Cardiothoracic Surgery, Quito, Ecuador.
Int J Surg Case Rep. 2022 Feb;91:106788. doi: 10.1016/j.ijscr.2022.106788. Epub 2022 Jan 25.
Thoracic outlet syndrome (TOS) is a rare syndrome caused by compression of one of the three neurovascular structures in their passage from the cervical area toward the axilla and proximal arm either at the interscalene triangle, the costoclavicular triangle, or the sub coracoid space. The mainstay of management is nonsurgical; however, surgery may be needed when patients persist with symptoms despite conservative management and when vascular structures are involved. Symptoms are non-specific and require high clinical awareness since this pathology tends to affect otherwise healthy young patients.
We present the case of a 45-year-old female without any past medical history. She was active and did plenty of exercises. After a high-intensity routine without any guidance, she presented with acute upper limb swelling with pain. After further examination, a venous thoracic outlet syndrome was identified and treated without complications.
CLINICAL DISCUSSION & CONCLUSION: Venous TOS is a rare pathology associated with high long-term morbidity and disability if left untreated; heightened clinical awareness of the possibility of acute thrombosis obstructing venous return and producing these rare symptoms should lead the medical team to assess the patient further and lead to the appropriate medical and surgical intervention.
胸廓出口综合征(TOS)是一种罕见的综合征,由三种神经血管结构之一在从颈部向腋窝和上臂近端走行过程中,于斜角肌间隙、肋锁三角或喙突下间隙受到压迫所致。治疗的主要方法是非手术治疗;然而,当患者尽管接受了保守治疗仍持续出现症状,以及血管结构受累时,可能需要进行手术。症状不具有特异性,需要高度的临床警惕性,因为这种病症往往会影响原本健康的年轻患者。
我们报告一例45岁女性,既往无任何病史。她活动活跃,经常进行大量运动。在没有任何指导的高强度日常锻炼后,她出现了急性上肢肿胀伴疼痛。经过进一步检查,确诊为静脉型胸廓出口综合征,并进行了治疗,未出现并发症。
静脉型TOS是一种罕见的病症,如果不治疗,长期发病率和致残率较高;提高对急性血栓形成阻碍静脉回流并产生这些罕见症状可能性的临床认识,应促使医疗团队对患者进行进一步评估,并采取适当的药物和手术干预措施。