scholarly journals A Never Described Variant of the Cervical Rib Causing Arterial Thoracic Outlet Syndrome: World's First Case

2021 ◽  
Vol 07 (03) ◽  
pp. e179-e183
Author(s):  
Saif Abdeali A. Kaderi ◽  
Pravin Shinde ◽  
Raviraj Tilloo ◽  
Sonewane Chetan ◽  
Tanvi Dalal ◽  
...  
Keyword(s):  
Oral Anticoagulation ◽  
Thoracic Outlet Syndrome ◽  
Transverse Process ◽  
Rest Pain ◽  
Postoperative Course ◽  
Cervical Rib ◽  
Artery Thrombosis ◽  
First Case ◽  
Arterial Thoracic Outlet Syndrome ◽  
Cervical Ribs

AbstractCervical ribs, also known as Eve's ribs, are rare and found in 1% of population. They are more common in females and more common on right side. They are asymptomatic in 90% of cases. Cervical rib fused with transverse process of sixth vertebra is rarer. We present a case of dry gangrene of lateral three fingers with right radial and subclavian artery thrombosis with rest pain, due to right cervical rib fused with transverse process of sixth vertebra. After development of line of demarcation of the dry gangrene, patient was operated for excision of cervical rib and sixth cervical vertebral transverse process followed by Ray's amputation of right second finger. Postoperative course was uneventful. Patient was discharged with oral anticoagulation and a healthy wound in right hand.

Undiagnosed bilateral complete cervical rib with subclavian artery aneurysm presenting as acute ischaemic limb following high-altitude expedition

2021 ◽  
Vol 14 (2) ◽  
pp. e241194
Author(s):  
Raja Lahiri ◽  
Udit Chauhan ◽  
Ajay Kumar ◽  
Nisanth Puliyath
Keyword(s):  
High Altitude ◽  
Subclavian Artery ◽  
Thoracic Outlet Syndrome ◽  
Artery Aneurysm ◽  
Limb Ischaemia ◽  
Cervical Rib ◽  
Subclavian Artery Aneurysm ◽  
Acute Limb Ischaemia ◽  
Arterial Thoracic Outlet Syndrome ◽  
Cervical Ribs

Arterial thoracic outlet syndrome is relatively rare and often exclusively seen in the presence of bony anomalies. High-altitude (HA) travel is commonly associated with thrombosis; however, arterial thromboembolism is less frequently described. We describe a case of a young man with undiagnosed bilateral cervical rib, who went for an HA trek, subsequent to which developed acute limb ischaemia of right arm. Diagnostic workup revealed a subclavian artery aneurysm as well along with complete bony bilateral cervical ribs. Thoracic outlet syndrome should be kept as a differential diagnosis in a case of acute limb ischaemia in a healthy adult.

scholarly journals Cervical Rib Surgery: A Study of 20 Cases

1970 ◽  
Vol 17 (1) ◽  
pp. 10-12 ◽  
Author(s):  
M Lutfor Rahman ◽  
G Mohammod ◽  
I Alam ◽  
MS Ali
Keyword(s):  
Upper Limb ◽  
Thoracic Outlet Syndrome ◽  
Small Study ◽  
Fibrous Band ◽  
Private Hospitals ◽  
Cervical Rib ◽  
Orthopedic Surgeon ◽  
Diagnosis And Management ◽  
Initial Surgery ◽  
Cervical Ribs

Cervical ribs give rise to vascular and neurogenic manifestation in the upper limb due to stretching and friction of neurovascular bundle in the base of the neck by numerous mechanisms that includes cervical ribs, anomalous ligament & hypertrophy of the scalenus anticus muscle. Controversy surrounds the diagnosis and management of thoracic outlet syndrome with or without cervical ribs. This is a small study of 20 cases carried out from 1994 to 2003 at RMCH, and some private hospitals. Out of them, 15 patients (75%) were male and 5 patients (25%) were female. The age of the patients was between 15 to 48 years (mean age 33 years) Unilateral cervical ribs were present in 75% cases and the rest 25% had bilateral cervical ribs. Only 3 patients presented with gangrenous upper limb. One of the patient attended to orthopedic surgeon first and amputation was planned. All the patient were treated through supra clavicular approach by excision of cervical ribs together with fibrous band. Only one patient did not respond to this initial surgery as symptoms persist and re-operation done by excision of first-rib and ultimately that patient become symptom free. In this study, authors explained their own experience of various way of presentation of cervical ribs, aetiology, different modalities of the treatment and their out come.     doi: 10.3329/taj.v17i1.3482 TAJ 2004; 17(1) : 10-12  

Thoracic Outlet Syndrome

2016 ◽  
Author(s):  
Mark W Fugate ◽  
Julie A Freischlag
Keyword(s):  
Multimodal Treatment ◽  
Thoracic Outlet Syndrome ◽  
Venous Flow ◽  
Treatment Algorithms ◽  
Effort Thrombosis ◽  
First Rib Resection ◽  
Neurovascular Structures ◽  
Arterial Thoracic Outlet Syndrome ◽  
Cervical Ribs ◽  
Neurogenic Tos

Thoracic outlet syndrome (TOS) is a condition caused by compression of the neurovascular structures leading to the arm passing through the thoracic outlet. The incidence of TOS is reported as 0.3 to 2% in the general population. There are three distinct types of TOS: neurogenic (95%), venous (4%), and arterial (1%). Treatment algorithms depend on the type of TOS. Arterial and venous TOS often present urgently with arterial or venous thrombosis, which is fairly easily identified by thorough history taking and a physical examination. Diagnosis is also aided by duplex ultrasonography. Restoration of arterial or venous flow can often be readily accomplished by thrombolysis. More important, however, is the diagnosis of the underlying structural component involved in the development of symptoms. Although statistically the most common, neurogenic TOS is often the most difficult to diagnose and treat. There are good data indicating that appropriately selected patients benefit from surgical therapy for neurogenic TOS as well. To prevent recurrence of symptoms, patients must undergo first rib resection and anterior scalenectomy, as well as resection of any rudimentary or cervical ribs. Regardless of the type of TOS encountered, proper therapy requires a thorough diagnostic evaluation and multimodal treatment. Keywords: thoracic outlet syndrome, arterial thoracic outlet syndrome, neurogenic thoracic outlet syndrome, venous thoracic outlet syndrome, TOS, effort thrombosis, thoracic outlet decompression

scholarly journals Articulating Cervical Rib - A Culprit Often Overlooked on Imaging! : Review Article

2021 ◽  
Vol 11 (9) ◽  
pp. 230-236
Author(s):  
Pratik S. Itti ◽  
Sharad B. Ghatge ◽  
Shraddha Somani
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Tertiary Care ◽  
Case Series ◽  
Arterial Occlusion ◽  
Radiographic Examination ◽  
Main Body ◽  
Care Hospital ◽  
Cervical Rib ◽  
Arterial Complications ◽  
Cervical Ribs

Background: Cervical rib, though it is seen incidentally in the radiographic examination of chest and cervical spine, a particular subset of it can present with thoracic outlet syndrome. This article mainly focuses on the symptom causation of articulating cervical rib, as compared to non-articulating cervical rib which is often asymptomatic. There are many articles describing a cervical rib, but those highlighting this particular relation between the types of cervical rib and symptom causation are not present in present database. The review of serial radiographs upon correlating clinically, lead us to conclude that articulating variant of cervical rib is majorly symptomatic and caused grave arterial complications. The article consists brief discussions on the types of cervical ribs, thoracic outlet syndrome and role of imaging in diagnosing a cervical rib. Main Body: We have illustrated five such cases from our tertiary care hospital and highlighted the relationship between the magnitude of symptoms and variations of cervical rib. In compliance with PRISMA guidelines, we screened 33 articles dealing with cervical rib and 13 with thoracic outlet syndrome. Overall, 46 articles were filtered on studying the abstract. Further, 15 more had to be excluded as they were case reports and case series, and finally 31 articles were included in our study. We studied and discussed these articles and research papers in relation to variant anatomy of cervical rib, its types and symptom causation. In our study, also routine sequential chest radiographs were reviewed during the period of January 2020 to January 2021 and those with cervical rib and/or elongated C7 transverse process were included. Conclusion: Thus, to conclude we can state that articulating cervical ribs pose a greater threat and cause arterial occlusion. Key words: Cervical rib, thoracic outlet syndrome, subclavian artery.

Posterior Subscapular Approach to the Brachial Plexus

2005 ◽  
Vol 57 (suppl_4) ◽  
pp. ONS-377-ONS-381 ◽  
Author(s):  
Gabriel C. Tender ◽  
David G. Kline
Keyword(s):  
Morbid Obesity ◽  
Brachial Plexus ◽  
Operative Technique ◽  
Thoracic Outlet Syndrome ◽  
Transverse Process ◽  
Senior Author ◽  
Anterior Neck ◽  
Spinal Nerves ◽  
Cervical Rib ◽  
The Past

Abstract THE POSTERIOR SUBSCAPULAR APPROACH to the brachial plexus is commonly indicated in patients with neural entrapment (neurogenic thoracic outlet syndrome, especially when associated with a large C7 transverse process or cervical rib) and paraspinal tumors or lacerating injuries involving the spinal nerves close to the spine. This approach is also preferred in patients with previous anterior neck operations and/or morbid obesity. We describe the anatomy and operative technique of this approach, which has been used by the senior author (DGK) for the past 25 years.

scholarly journals Embolic Stroke and Pulseless Right Arm in a Schoolgirl with Arterial Thoracic Outlet Syndrome: A Case Report

2013 ◽  
Vol 28 (1) ◽  
pp. 63-66
Author(s):  
Aminur Rahman ◽  
Firoz Ahmed Quraishi ◽  
Uttam Kumar Saha ◽  
Maliha Hakim ◽  
Afzal Momin ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Thoracic Outlet Syndrome ◽  
Clinical Presentation ◽  
Embolic Stroke ◽  
School Girl ◽  
Artery Thrombosis ◽  
Retrograde Blood Flow ◽  
The Right ◽  
Distal Disease ◽  
Arterial Thoracic Outlet Syndrome

A rare clinical presentation arterial Thoracic outlet syndrome (TOS) is described in a young school-girl. TOS causing distal; disease is a rare cause of artery to- artery embolic stroke. Brain-stem ischemic stroke is a result of compromise to the posterior circulation. This is often due to antegrade embolism from the heart or proximal vessels. Retrograde blood flow has been described in the subclavian artery, thus making the distal subclavian artery a source of possible retrograde embolism to carotid circulation1. Clinical presentation also included left hemiparesis caused by right subclavian artery thrombosis and retrograde embolizatoin of thrombus via common carotid artery to the right middle cerebral artery (MCA) distribution.Bangladesh Journal of Neuroscience 2012; Vol. 28 (1): 63-66

Histopathological basis for neurogenic thoracic outlet syndrome

2008 ◽  
Vol 8 (4) ◽  
pp. 347-351 ◽  
Author(s):  
R. Shane Tubbs ◽  
Robert G. Louis ◽  
Christopher T. Wartmann ◽  
Robert Lott ◽  
Gina D. Chua ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Immunohistochemical Analysis ◽  
Histopathological Changes ◽  
Histological Findings ◽  
Histological Changes ◽  
Cervical Rib ◽  
Lower Trunk ◽  
Human Cadavers ◽  
Cervical Ribs

Object To the best of the authors' knowledge, no report exists that has demonstrated the histopathological changes of neural elements within the brachial plexus as a result of cervical rib compression. Methods Four hundred seventy-five consecutive human cadavers were evaluated for the presence of cervical ribs. From this cohort, 2 male specimens (0.42%) were identified that harbored cervical ribs. One of the cadavers was found to have bilateral cervical ribs and the other a single right cervical rib. Following gross observations of the brachial plexus and, specifically, the lower trunk and its relationship to these anomalous ribs, the lower trunks were submitted for immunohistochemical analysis. Specimens were compared with two age-matched controls that did not have cervical ribs. Results The compressed plexus trunks were largely unremarkable proximal to the areas of compression by cervical ribs, where they demonstrated epi- and perineurial fibrosis, vascular hyalinization, mucinous degeneration, and frequent intraneural collagenous nodules. These histological findings were not seen in the nerve specimens in control cadavers. The epineurium was thickened with intersecting fibrous bands, and the perineurium appeared fibrotic. Many of the blood vessels were hyalinized. The nerve fascicles contained frequent intraneural collagenous nodules in this area, and focal mucinous degeneration was identified. Conclusions Cervical ribs found incidentally may cause histological changes in the lower trunk of the brachial plexus. The clinician may wish to observe or perform further evaluation in such patients.

scholarly journals Digital ischaemia of the upper limbs in middle age: consider arterial thoracic outlet syndrome until proven otherwise !

2020 ◽  
Author(s):  
Wissam Al-Jundi ◽  
Woo Sup Michael Park
Keyword(s):  
Upper Limb ◽  
Thoracic Outlet Syndrome ◽  
Delayed Diagnosis ◽  
Digital Ulcers ◽  
Limb Ischaemia ◽  
Middle Aged ◽  
Aged Patients ◽  
Cervical Rib ◽  
Digital Ischaemia ◽  
Arterial Thoracic Outlet Syndrome

Abstract Objectives Patients presenting with digital upper limb ischaemia are occasionally referred to rheumatology services to rule out vasculitis. We present two cases of delayed diagnosis of arterial thoracic outlet syndrome (TOS) in middle aged patients presenting with digital ischaemia in order to raise awareness of this important pathology that requires timely surgical intervention. Methods Two cases of progressive ischemia of the right upper extremity caused by primarily undiagnosed compression of the subclavian artery (SCA) by an accessory cervical rib are presented. Both patients case notes, radiological images, intra-operative and postoperative findings were reviewed. Patients were followed up after at least 6 months to assess prognosis. Results Both patients had working diagnosis of Buerger’s disease and treated with prostaglandin infusions prior to establishment of the diagnosis of arterial thoracic outlet syndrome. Both patients were heavy smokers and one patient had bilateral symptoms and history of axial spondyloarthropathy and positive HLA-B27. Surgical thrombectomy of the upper limb arteries along with resection of a cervical rib and repair of the SCA with interposition graft were necessitated to successfully heal digital ulcers in one patient. However, late presentation in the second patient led to the loss of three fingers and the need of plastic reconstructive surgery following cervical rib resection and revascularisation. Conclusion High index of suspicion of arterial TOS should be maintained in middle aged patients presenting with digital or upper limb ischaemia even in presence bilateral symptoms or relevant risk factors of other diagnoses such as smoking or positive rheumatological history.

scholarly journals Successful treatment of Subclavian artery thrombosis with gangrene of fingers- a case report

2009 ◽  
Vol 5 (1) ◽  
pp. 44-46
Author(s):  
Md Rezwanul Hoque ◽  
Sabrina Husain ◽  
Md Alauddin ◽  
Zerzina Rahman
Keyword(s):  
Case Report ◽  
Physical Examination ◽  
Male Patient ◽  
Subclavian Artery ◽  
Severe Pain ◽  
Thoracic Outlet Syndrome ◽  
Index Finger ◽  
Doctor Who ◽  
Cervical Rib ◽  
Artery Thrombosis

Mr. X, a smoker, normotensive, nondiabetic male patient of 24 years of age, presented with acute severe pain of the left upper extremity for 2 days. He had discoloration of the thumb and index finger for which he consulted a quack doctor who made an incision over the blackened area to drain subcutaneous collection and gave antibiotic and analgesics. There was no bleeding from the site of incision and regular dressing could not improve his condition. After waiting for 15 days without any improvement, he reported to a private clinic in Dhaka. Thorough physical examination and investigation revealed subclavian artery thrombosis due to cervical rib. The thoracic outlet syndrome was relieved by sclaneous muscle division and excision of the cervical rib, subclavian artery thrombectomy was possible through transbrachial route even after more than 2 weeks.   doi: 10.3329/uhj.v5i1.3443 University Heart Journal Vol. 5, No. 1, January 2009 44-46

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