A Case of Traumatic Thoracic Outlet Syndrome
A 74-year-old woman who had no health problems other than diabetes mellitus was admitted due to right chest wall pain and right shoulder pain after a traffic accident. Upon arrival at the emergency room, fractures of the right clavicle and first rib were observed by chest computed tomography (CT) (). Edema and a tingling sensation of the right upper extremity were progressively worsening. Subclavian vein compression by the fractured clavicle and rib were identified by three-dimensional CT angiography leading us to suspect thoracic outlet syndrome (TOS) (). Preoperative electromyography (EMG) was not performed since the patient did not complain of motor weakness, and the main problem of the patient was venous compression. With these symptoms and results, traumatic TOS was diagnosed and surgical treatment was planned. An operation was performed under general anesthesia. The first rib was partially removed, leaving the posterior stump through the axillary incision. The fractured clavicle and other ribs were aligned manually and fixed with plates and screws through the supraclavicular and thoracotomy incision, respectively. Venous engorgement had disappeared on postoperative three-dimensional CT angiography (). The patient was discharged without complications and had no complaint of edema or a tingling sensation of the right upper extremity as of the last follow-up.