SHM Converge Scientific Abstract ePoster Gallery-Thoracic Outlet With Arterial Block: Rare Presentation of Rare Syndrome

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This case report describes a rare presentation of arterial thoracic outlet syndrome (TOS), which accounts for less than 1% of TOS cases. A 52-year-old woman with hypertension, type 2 diabetes, and a prior history of left upper-extremity deep vein thrombosis presented with sudden pain, numbness, and coldness in her left arm while gardening. On examination, she had absent radial, ulnar, and brachial pulses and decreased sensation in all digits, suggesting acute limb ischemia.<br /><br />Imaging revealed bilateral cervical ribs and a thrombosed subclavian artery aneurysm with acute brachial artery obstruction, consistent with arterial TOS caused by chronic vascular compression. The patient was treated with heparin followed by thrombectomy of the left axillary, brachial, radial, and ulnar arteries. One week later, she underwent a left common carotid-to-axillary artery bypass using a prosthetic graft. The cervical rib was not removed at that time because of dense adhesions. After surgery, her pain resolved, pulses returned, and she was discharged on apixaban with vascular surgery follow-up. She is scheduled for elective cervical rib resection, beginning on the right side.<br /><br />The report emphasizes that arterial TOS is difficult to diagnose and manage, especially when it presents as acute upper-limb ischemia. The authors recommend careful vascular assessment, including color Doppler ultrasound and provocative maneuvers, in young patients with upper-extremity thromboembolic disease. They note that cervical ribs are a common structural cause, leading to chronic subclavian artery injury, aneurysm formation, thrombosis, and distal embolization.

Asset Subtitle

Sourabh Khatri

Meta Tag

Author List Anjana Chandrasekhara Pillai, Sourabh Khatri, Tissa Bijoy George

Category Clinical Vignettes

Concept Thoracic Outlet Syndrome

Concept Acute Upper-Extremity Ischemia

Concept Arterial Thoracic Outlet Syndrome

Concept Upper-Extremity Arterial Occlusion

Concept Absent Pulses

Distinguished Non-Finalist

Presenter Organization UPMC- McKeesport

Presenting Author Sourabh Khatri

Track Adult

Keywords

arterial thoracic outlet syndrome

acute limb ischemia

cervical rib

subclavian artery aneurysm

brachial artery obstruction

upper-extremity thromboembolism

vascular compression

thrombectomy

carotid-to-axillary bypass

color Doppler ultrasound

Thoracic Outlet Syndrome

Acute Upper-Extremity Ischemia

Arterial Thoracic Outlet Syndrome

Upper-Extremity Arterial Occlusion

Absent Pulses