Images in vascular medicine:Iatrogenic thoracic inlet syndrome
Abstract
Vascular Medicine 2005; 10: 327328 Images in vascular medicine Iatrogenic thoracic inlet syndrome Mobeen A Sheikh and Riyaz Bashir Panel A Panel B A 44-year-old lady presented to the emergency room at our institution complaining of pain, swelling and discoloration of the digits of the left upper extremity for the preceding 4 weeks. She had undergone a surgical repair of a left clavicular fracture caused by a motor vehicle accident 5 months earlier. The patient was admitted, started on systemic anticoagulation with heparin, and scheduled for diagnostic angiography the next morning. The diagnostic images obtained at that time are shown in Panel A. There was a flow-limiting stenosis of the subclavian vein with no evidence of thrombus. A noninvasive arterial study performed previously had revealed no obstruction to arterial flow, even with provocative maneuvers. Given the proximity of the onset of symptoms and the radiological appearance of the plate and screws, the stenosis of the subclavian vein was deemed to be related to the operative repair of the fractured clavicle. The patient was referred to the surgical service and underwent resection of the first rib and scalenectomy to relieve the external compression on the subclavian vein. Five weeks