Unilateral Arm Swelling

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Presentation transcript:

Unilateral Arm Swelling Tim Kubal

Venogram

Provocative Venogram

Thoracic Outlet Syndrome Compression of neurovascular structures as they pass through the thoracic outlet. NTOS, ATOS, VTOS (Paget-Schroetter Syndrome) Whiplash, Repetitive activity, rib anomaly, prior clavicular fx, fibrosis.

Anatomy

NTOS Most common with the majority of these cases being related to trauma and virtually impossible to diagnose objectively Paresthesias, pain Tx conservatively in majority of cases unless demonstrable anatomical abnormality then consider surgery

VTOS Majority of cases related to strenuous or repetitive overhead activity. Acute or subacute swelling, heaviness, pain, venous distention with visible collaterals. Acute: Thrombolytics, stenting/venoplasty, surgical decompression, anticoagulation. Subacute: Conservative vs. Surgery

ATOS Least common Subclavian Artery Compression Typically secondary to demonstrable rib abnormality Pain, Paresthesias, Cyanosis, Embolism, Negative Pulses, Slow capillary refill

How do i work this up? Provocative testing Dopplers (Acutely r/o thrombosis) C-Spine films, shoulder films CT chest

Management VTOS: Usually requires urgent thrombolysis, anticoag, surgical decompressions ATOS: surgical decompression and restoration of arterial blood flow NTOS: PT, surgical decompression.

Surgery Rib, muscle resection Less stuff More space

What else could it be? Brachial plexus injury Carpal Tunnel CRPS Malignancy C-Spine or shoulder MSK Nothing

TOS JR Richard (CVA) David Cone (Arterial aneurysm) Hanson