Clinical application of Doppler ultrasonography in the thoracic outlet syndrome.

Difficulties in diagnosing the thoracic outlet syndrome prompted a pilot study of noninvasive Doppler ultrasonography in 160 thoracic outlets of healthy volunteers. Encouraged by the results we applied the technique to the clinical evaluation of flow disturbances during various provocative maneuvers. Ninety-four thoracic outlets were examined; of these, 32 were operated upon. Severe flow occlusion which was detected by Doppler ultrasonography reproduced symptoms of which the patients had originally complained. All patients were relieved of their symptoms, and only five had minor flow disturbances after resection of the first rib and scalenotomy. Resection of cervical ribs was carried out in seven of nine patients with this anomaly. Doppler ultrasonography was found to be a most valuable diagnostic modality and its wider application in this field is recommended.