The subclavius muscle may hypertrophy, further narrowing the costoclavicular space, and the repetitive stress leads to thickening and fibrosis, notably in the subclavian vein wall, with restrictive fibrotic tissue surrounding the vein. Eventually, there is damage of the intima, resulting in luminal narrowing and a scarred, thrombogenic surface within the vein. Arterial changes in TOS similarly include intimal damage and thrombosis, with additional concerns of distal embolization and aneurysm formation. Neurological symptoms include chronic arm and hand paresthesia, numbness, or weakness. Although the exact prevalence of TOS is unknown, symptomatic TOS has been estimated to be 10 per 100,000 [4]. The current management of TOS is variable [5-11]. Understanding the various anatomic spaces, causes of narrowing, and resulting neurovascular changes are important in choosing and interpreting radiological imaging, which may be performed to help diagnose TOS and plan for intervention. This document has separated imaging appropriateness based on neurogenic, arterial, or venous symptoms, acknowledging that some patients may present with combined symptoms that may require more than one study to fully resolve. Additionally, in the postoperative setting, a new symptom may indicate a complication. Consultation aResearch Author, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts. bMassachusetts General Hospital, Boston, Massachusetts. cPanel Chair, Massachusetts General Hospital, Boston, Massachusetts. dPanel Chair, University of Chicago, Chicago, Illinois. ePanel Chair, University of Utah, Salt Lake City, Utah. fPanel Vice-Chair, Emory Healthcare, Atlanta, Georgia. gUC San Diego Health, San Diego, California. hThe University of Texas MD Anderson Cancer Center, Houston, Texas. iScripps Green Hospital, La Jolla, California; Society for Vascular Surgery. jMayo Clinic, Rochester, Minnesota. kUniversity of Alabama at Birmingham, Birmingham, Alabama.
Thoracic Outlet Syndrome. The subclavius muscle may hypertrophy, further narrowing the costoclavicular space, and the repetitive stress leads to thickening and fibrosis, notably in the subclavian vein wall, with restrictive fibrotic tissue surrounding the vein. Eventually, there is damage of the intima, resulting in luminal narrowing and a scarred, thrombogenic surface within the vein. Arterial changes in TOS similarly include intimal damage and thrombosis, with additional concerns of distal embolization and aneurysm formation. Neurological symptoms include chronic arm and hand paresthesia, numbness, or weakness. Although the exact prevalence of TOS is unknown, symptomatic TOS has been estimated to be 10 per 100,000 [4]. The current management of TOS is variable [5-11]. Understanding the various anatomic spaces, causes of narrowing, and resulting neurovascular changes are important in choosing and interpreting radiological imaging, which may be performed to help diagnose TOS and plan for intervention. This document has separated imaging appropriateness based on neurogenic, arterial, or venous symptoms, acknowledging that some patients may present with combined symptoms that may require more than one study to fully resolve. Additionally, in the postoperative setting, a new symptom may indicate a complication. Consultation aResearch Author, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts. bMassachusetts General Hospital, Boston, Massachusetts. cPanel Chair, Massachusetts General Hospital, Boston, Massachusetts. dPanel Chair, University of Chicago, Chicago, Illinois. ePanel Chair, University of Utah, Salt Lake City, Utah. fPanel Vice-Chair, Emory Healthcare, Atlanta, Georgia. gUC San Diego Health, San Diego, California. hThe University of Texas MD Anderson Cancer Center, Houston, Texas. iScripps Green Hospital, La Jolla, California; Society for Vascular Surgery. jMayo Clinic, Rochester, Minnesota. kUniversity of Alabama at Birmingham, Birmingham, Alabama.