Thoracic Outlet Syndrome

I clock out of work for the day and go straight to get my CTA. My heart is racing, I’m as nervous as can be! Prior to going to get the CTA I had researched and all I could come up with is that if there really wasn’t an aneurysm, and at the time there was no reason to believe there was, then there has to be something pushing on the artery causing it to protrude. I finish up my test and go back to my office to gather my things to leave for the day. Typically, test results are posted and you are notified within an hour or so that the results are on the patient portal for viewing. I have roughly a 40 minute drive home, so I assume my results will be waiting on me when I get home. But I get home and check my email notifications to find nothing! I am really worried at this point because the only other time I had a delay in results being posted, my results were abnormal. I wait, what seems like an eternity, and finally get a notification that my results have been posted. I get on the patient portal to view my results and find the following CTA result: Accessory right sided cervical rib. Distal tip abuts the right subclavian artery. Correlate for underlying thoracic outlet syndrome.

What in the world is thoracic outlet syndrome? Being a utilization review case manager in a hospital I get to see all sorts of different diagnoses, but I can say with certainty that I have never seen CRPS or thoracic outlet syndrome listed on any of my patients or their medical history. I immediately start researching to find that this is rare. Mayo Clinic’s website states that thoracic outlet syndrome occurs when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. They go on to discuss the different types of thoracic outlet syndrome. The one that fits my CTA results is Vascular thoracic outlet syndrome which occurs when one or more of the veins (venous thoracic outlet syndrome) or arteries (arterial thoracic outlet syndrome) under the collarbone (clavicle) are compressed. The website lists several causes and the one that fits my results is Anatomical defects which are defects that are present at birth (congenital) may include an extra rib located above the first rib (cervical rib). In other words, I have an extra rib coming off my neck. I start reading through the list of symptoms and see listed: Discoloration of your hand (bluish color), cold fingers, hands or arms, and lastly a throbbing lump near your collarbone. WOW! I am in shock and instantly call my Mom to tell her the results. She asks, “so what now?” Well, I go on to research and it looks like the only option for vascular thoracic outlet syndrome is surgery. Now I get to go to bed with this news fresh in my mind, wait some more and wonder, yet again, what’s next?

Resources:

Thoracic outlet syndrome. (2016, August 27). Retrieved February 20, 2019, from https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988

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