Dynamic Sonographic Assessment of Vascular Thoracic Outlet Syndrome: A Case Report

Abstract

Thoracic outlet syndrome (TOS) describes the compression of the neurovascular structures within the thoracic outlet. Vascular TOS (vTOS) is uncommon and can be challenging to diagnose due to its non‐specific clinical presentation. We present the case of a 30‐year‐old female with upper limb numbness and heaviness that worsened during overhead activities. Ultrasound assessment with provocative manoeuvres demonstrated significant compression of the right subclavian artery and vein, including a 62% reduction in the right subclavian artery luminal diameter (inner to inner wall), from 5.8 mm in rest position to 2.2 mm during Wright's manoeuvre at 150° of arm abduction. Marked increase in peak systolic velocity on spectral Doppler from 124 to 396 cm/s. This case highlights the value of dynamic ultrasound as a non‐invasive, real‐time imaging modality for identifying vascular compression for vTOS. Assessment during different arm positions and reproducing patient symptoms during provocative manoeuvres are important aspects of a sonographic assessment of vTOS.