useful tips regarding imaging assessment of patients with suspected thoracic outlet syndrome
- • Obtain cervical spine and chest radiographs first to exclude osseous abnormalities in these locations.
- • Administer intravenous contrast material for CTA or MRA via an upper extremity vein contralateral to the symptomatic side, in order to eliminate artifacts secondary to concentrated contrast material within the veins that may obscure the arterial structures of interest.
- • Perform biphasic image acquisition, first with the arm by the side, and second with the arm elevated. This enables visualization of compression of the subclavian artery, subclavian vein, and/or brachial plexus, which may sometimes only be detected during arm elevation.
- • MRA is generally preferred because the soft tissue structures can be delineated.
- • Sagittal images are very useful to assess for compression of anatomic structures in the thoracic outlet.
