Park Dahye, Visoiu Mihaela
Department of Anesthesiology and Perioperative Medicine, UPMC Presbyterian, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Department of Anesthesiology and Perioperative Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA.
Children (Basel). 2025 Jul 2;12(7):873. doi: 10.3390/children12070873.
: Thoracic outlet syndrome (TOS) is a rare and difficult-to-diagnose condition in children, characterized by the compression of neurovascular structures in the thoracic outlet. Neurogenic TOS (nTOS) often presents with nonspecific symptoms such as paresthesia, weakness, and upper extremity discomfort. While anterior scalene muscle block (ASMB) has been used in adults as a diagnostic adjunct, its role in pediatric patients remains underreported. We present two adolescent female patients with suspected neurogenic thoracic outlet syndrome (nTOS) who were referred to the acute pain service for further evaluation. Both patients underwent ultrasound-guided ASMB. : Following the block, both patients experienced rapid and marked relief of symptoms. Subsequently, each underwent first rib resection with brachial plexus neurolysis. At follow-up, both patients reported a complete resolution of symptoms and a return to baseline function. : These cases suggest that ASMB may serve as a functional diagnostic tool and short-term therapeutic test in pediatric nTOS patients. It also helps guide surgical decision-making for invasive treatment. However, as ASMB is not without risk, its role should be considered supportive rather than confirmatory. Further studies are needed to better define its utility and safety in the pediatric population.
胸廓出口综合征（TOS）在儿童中是一种罕见且难以诊断的疾病，其特征是胸廓出口处的神经血管结构受到压迫。神经源性TOS（nTOS）常表现为感觉异常、无力和上肢不适等非特异性症状。虽然前斜角肌阻滞（ASMB）已在成人中用作诊断辅助手段，但其在儿科患者中的作用仍报道较少。我们介绍了两名疑似神经源性胸廓出口综合征（nTOS）的青少年女性患者，她们被转诊至急性疼痛服务部门进行进一步评估。两名患者均接受了超声引导下的ASMB。阻滞术后，两名患者的症状均迅速且显著缓解。随后，她们各自接受了第一肋切除术及臂丛神经松解术。随访时，两名患者均报告症状完全缓解且功能恢复至基线水平。这些病例表明，ASMB可能作为儿科nTOS患者的功能性诊断工具和短期治疗试验。它也有助于指导侵入性治疗的手术决策。然而，由于ASMB并非没有风险，其作用应被视为支持性而非确定性的。需要进一步研究以更好地确定其在儿科人群中的效用和安全性。
